City of Chicago Richard M. Daley, Mayor
Department of Revenue
Hugh P. Murphy Director
City Hall. Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312)744-6146 (312)744-0471 (FAX) (312)744-2975 (TTY)
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DISABLED PERMIT PARKING
REMOVAL APPLICATION FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER
( Please print or type. )
NAME OF DISABLED INDIVIDUAL:
Sl ILI'iSC iHIi ia roVETHEX
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
_2.6 Z°i ki'lrji^ _
( Please print or type current sign location address. )
CHICAGO, ILLINOIS ( ZIP CODE y 60GZZ (PHONE NUMBER)_
REASON FOR REMOVAL: Mo^tTfl______
NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE:_;_1
(Please provide information only if billing information differs.)
ILLINOIS VEHICLE LICENSE NUMBER-_
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER
(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 CERTIFICATION:
(Aldcrmanic Signature
(Ward)
)atc)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES . BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED.