APPLICATION FOR D ISABLED F AF KING SIGNS PLEASE READ THE f=OLLOWING CAREFULLY BEFORE COMP LETING THE FORM
7361.
An application will not be considered complete unless;
• All lines of the application have been completed >n ful,
• A check or money order for $70.00 made payabh? to I .e City of Chicago s submitted as payment of the application fee-Please note. The application fee shall be waived foraiy person hoidng < valid, current disabled veterans plate.
• Disability must be permanent as evidenced by a :opy of your valid di ^ab, »d placard and/or currant vehicle registration submitted at the time of application;
• Proof of residency, in the form of a copy of your cnve; license, state idei tificat on. or utility bills are submitted at the time of application.
Completed application forms may be returned to: the off id- of your alderman, iny City of Chicago Department of Revenue ¦ facility, Or via mail at P.O. Box 803100. Chicago. IL 6O580- 1100, ATTN: Di.;abl >d Pemitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have qusstio is or concerns, pie isecall our permil processing division at 312-744-PARK (7275).
1. Date of Birth
MO __DAY
0 I 4 I 2J
YEAH
4. Applicant Last Name
$£\D\Ti7
2 Stare Identification Nui nb«r
J T i 1-LLl-U
5. Home Address (primary residence)
. , STREET NUMBER DIR. I SWEET NAME I /-> /
Viomn MF\o\homa\c\ v-pprn1
.jLJ_L
I. I irivers License Number
Ml
M
OA 1\0\0\t\$\s>\lftl\7\!\4
Fir ;t Name
J £|S|SV(5l
6. Address where signs will be posted
STREET NUMBER | OIR I STREET NAME
ZIP CODE ^
(j>\Q\UP\STREET NUMBER I OIR I STREET NAME
H\o\2ai\ \M KO\-t]or>tac\ u--:
7. Phone Numbers Home
„ WARD NUMBER
|3T3|4 |2T7|^?
8. Current Permanent Disabled Placard Numbe
9. Current License Plate Number
2.2|1010|Business
Registered t<
Ragisti red to
City Stic ;er No
aw
Relationship to Applicant
Relationship to Applicant
10. Description of MeJical Condition and Disability
SSI bfKQbc/f-fzl
Alternative Parking: Please note your appt...
Click here for full text