PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless:
• All lines of the application have been completed in full;
• A check or money order for $70.00 made payable to the City of Chicago is submitted as paym*? Please note: The application fee shall be waived for any person holding a valid, current disables
Disability must be permanent as evidenced by a copy of your valid disabled placard and/or cu^'^^s^^^i*1^^ submitted at the time of application; ^SEll^^
• Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at the time of application.
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Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Date of Birth
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2. State Identification Number
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3. Drivers License Number
4. Applicant Last Name
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First Name
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5. Home Address (primary residence)
STREET NUMBER DIR. STREET NAME
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ZIP CODE
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6. Address where signs will be posted
STREET NUMBER DIR. STREET NAME
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. WARD NUMBER
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7._ Phone Numbers
Home
Business
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8. Current Permanent Disabled Placard Number Registered to Relationship to Applicant
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9. Current License Plate Number Registered to City Sticker No. Relationship to Applicant
10. Description of Medical Condition and Disability
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options.
11. Is there off-street parking available at your primary residence (i....
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