City 6f Chicago Richard M. Daley, Mayor
Department of Rtreant
Bea R«yiu-Hickej Director
City Hall.Roon 107 121 North USaD« Street OAaia, niinoij 60602 (312) 747-4747 (IMS) (312) 744-W1 (FAX) (312) 744-2975 (TT10
iivnoixc Chicago TocmitR
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER
(Please print or type.)
NAME OF DISABLED INDAODUAL: £1 ^/~M ^°^SA
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or tyjle current sign location address. ) '.
CHICAGO, ILLINOIS (ZD? CODE).
(PHONE NUMBER)
77J
REASON FOR REMOVAL: ^JfJ^//^
ILLINOIS VEHICLE LICENSE NUMBER: /?f -(? J - 5^ £ 3
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER: t Q~?
< Secretary of State Disabled Placard )
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE___
( Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTTFICATION:
(Ward)
{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
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