2011 3:45 F
Jo. 9317 P. 17
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea R«yM-Hickey Director
City Hall, Room 107 121 North LaSalle Sir eel Chicago, Illinois 60602 (312) 744-0512 (312) 744-2303 (FAX) (312) 744-2975 (TTY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER. 35'3if^_
(Please print or type.)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) io bloolO ( PHONE NUMBER)fn^f?^>^^^
REASON FOR REMOVAL: j)065 flflf (lg(/£ QA \j6\idk. CMtjMO^L
ILLINOIS VEHICLE LICENSE NUMBER: ^-737^0_
(W or V plate)
ILLINOIS DISABLED PLACARD NUMBER:
UILDINC CHIcACO TOCBTHCR
(Secretary of State) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE
SL
(Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TOyYOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINJ
_ _ /
ALDERMANIC CERTIFICATION.
(Ward)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TOJCOUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGNS REMOVAL ORDINANCE IS INTRODUCED