03-03-1 1; 01 :29PM;
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APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An appficallon not be cor^lderad. ,,. !'¦;;
• All lines of the application have been completed in full;
¦ •: A check or, ;mohey order forS7p.00 ;mad9 pa>^We; to the Gity ot Chicago issuomitted a> payment pt. the; application lee;
"' .PleasehotaiTho applied ;• .- Disability must be permanent as evidenced by -a copy of yoocyaiiiddisabled, ptaea^anc^rcu'rrenl Vehicle;registration
¦; submitted at the lima or application; - . ' ¦'¦ '.¦!;: '
> Proof of residency, in the lorm of a cop/ of your drivers license, stale jdentificatiph; ;cir: iuiitUy:.b|ll5 are submitted atthe
.' time of application. ' \ ' i'-j":' i!,!"!'' '• | '. . '
' Completed application forms may be returned to: the'office of your'aldoirnan, any City of'Chicago Dec*rtmo!nr of; Revenue faalily.br Wama^
fee will be billed to you annually.1 Should ybu have question's or concerns, pfoase call our permit processing division at 312-744-PARK (7275).
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1: Oato 61 Btrth
2. Siato Identification Number -
H\*\o\\uwti\Jm\m
3. Drivers License Number
1 0
I Ml
11
4. Applicant Last Namo
Bie.lU.ll
I Ml
....M I
first Namo
5 Home Address (primary residence)
6T«EEtM<*MA , |»B. '
BTTCeriwiMe
zipccwc. ¦.
6. Addrasa whore signs will bopostod
STREET NUWB5K,
¦«rl;9l.all;(:. Is/I^ldla.
SmttTHUME
.WW1DKUMHH
AL
7. Phono Numbers.
Home
'Business1
2 \Q
8. Currant Pbrmanont Disabled Placard Number
Registered to
Relationship ic-Applicant
8. Currant L'eorise Plate Number
Rogrstered to
. ijCijr- Stlclibr -Moi. ¦: •:
Relationship; to Applicant
I fti.
nn In*
1 ,¦!¦
lO.DMCffrton oTMadienl Conc^^'pl«rtillliif!; z. 'k&JL ¦ sm«£ *** i^ife^ ^jAiiar>c'L*J ':i'.::
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Altomauvo Parking: PJeaBenot»ypur,a'ppJtato^ .". (i.o.i oaragB.cnrpori, drr...
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