APPLICATION FOR: DISABLED PARKING SIGNS PLEASE rIeAD THE FOLLOW
BEFORE COMPLETING THE FORM S~
72136-
An application will not be considered complete! unless: AH lines ol the applicatiort'have been-c6mpk?1ed in lull; -A^chcck uvriiortey order for $70.00 rnsde,payabie to-'tne pity .of Chicago.is. submitted as payment pf thu .^pfcc^icm ;oe /Please note: The application lee.sr:;.tl.l be,waived for any person holding a valid.-current-disabled .veterans yia'a .
' Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current v$Kc~ rejjistfalion''
submitied'ai the time oi application; ■W- Proof of residency, in the form of a copy of your drivers license, date identification, or utility biils are submitted at the time cf application.
Completed application forms may be returned to- the.officeo? your 'aide.! man. any City of Chicago Department est Revenue * facility, or via mairat P.O. Box 803100. Chicago. IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 ma-mnmoet fee will bri billed to you annually. Should you have questions or concerns, pieoise call our'permit proc'.ssVv';; diyifiC'i s\ 312-
_ F^^Ij fcr-o' ....>~c~C\_:.-:
Dnv^is tacsiise Number
Ml 2U ^~V:2 1.........L1.lTJ.......■ iTi 1 1, f< '2 i3 II T/ ^itf'"
■*i Appiicant Last K'amo . . Il Ml |
744-PARK (7275).
L. Oa'O Oi Biflf: ' i
i'j<%£ Ki;:'iu!>i;a::Or) dumber
ft li/.ISJ j \U
\/j\0\'r\J
e in
First Nrimt?
Vi-I ii
(5. Horn?. Address {primary residence)
6i Oj 3 0 Is ' Ik je jfr K P* 1" j
.■'S-:' Address where sts«s will be posted Phone Nu-T:ticfi'
Fr-' l:;
■Hoine
7i7 ;3 .7 r6- iV"T* '6 if" tl
Business
8. Current Petrnanent Disabled-Placard Number Registered to
6 A 2 1353_________Posij Ku^dork.
■9. Current License Plate Number
Registered to
Ci:y Silckor No.
GUN S
Retationshit: to Applicant
Retat:ohstvp to Applicant
£10.Description of Medical Condition and Disability i
Kn e c_Pa> <7 -f<-s?m_____^^r.£.rZ^^J2i^;.',^
Alternative Parking: Please note your application may be denied if you have alternative accessible:off-street parking option*.
.1.1. Is thoro off-street parking available at your primary residence (I.e garage, car port, driveway; etc.)?
□ yes UTno
.12 If you answfe-'sd Yes to question 11. please describe:
J Garage: □ Driveway: □ Car Port: □ Other
.13 Is your ofl-street parking accessible?
J Yes; □ No Please explain:
14. Affirmation, i hereby affirm (hot the'above information is true and correct. H the Ciiy ol Chicago Deportment ol Revenue dote-wines' that the applicant nas lalseiy represented one or more of Ihe above conditions, ihe applicent shall be subject 10 a fine oi m\ less than SiOO but no more than $500, and the application shall be denied. I also understand that il is my responsibility to notify If-* Department of Revenue of any changes in the information provided.
^PLACARD/PLATE 0>ftESIDENCY □COMPLETE A-
for office use only
Ufee
. . A
FRANK OLIVO
Alderman, 13th Ward 6500 S. Pulaski Road - 60629 Telephone: (773) 581-8000
CITY COUNCIL
CITY OF CHICAGO
COUNCIL CHAMBER
SECOND FLOOR, CITY HALL 121 NORTH LASALLE STREET
TELEPHONE: (312) 744-3076
COMMITTEE MEMBERSHIPS
AVIATION - COMMITTEES RULES and ETHICS FINANCE
LICENSE and CONSUMER PROTECTION BUDGET TRAFFIC CONTROL and SAFETY ZONING
February 24, 2011
Honorable Patrick O'Connor Chairman
Committee on Traffic Control and Safety 121 N. LaSalle Street, Room 300 Chicago, IL 60602
Dear Chairman O'Connor:
I wish to override the following application for handicapped parking signs:
6030 S. Kenneth-#72136
Your assistance with this matter will be greatly appreciated. If you have any questions, please call Shari Knight at (773) 581-8000.
With kindest personal regards, I remain
Sincerely,
Frank J. Olivo Alderman, 13th Ward