City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hal], Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
BUILDING CHICAGO TOGETHER
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER /& &
( Please print or type.)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
SO/<T S - Ckfasfr*^ ■ " _.
(Please print or^type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) \$j/h%* (PHONE NUMBER) -7/3 °?<f' 0
REASON FOR REMOVAL: \^ Lufly/ &VHL>U£ [ndulidufit
ILLINOIS VEHICLE LICENSE NUMBER: \l^\Clf\QM '
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
■ ( Secretary of State Disabled Placard )
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
i
BEST OF MY KNOWLEDGE .-X' \fLoQ^ 7?J-4p^ _
( Signature of Applicant)
FORWARD THIS COMPLETED APPLICATIONS YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW TgflS LINE ALDERMAMC CERTIFICATION:
(Aldermanic Signature )
S/O2J1)
(Wa/d)
(Date )
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED