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This record contains private information, which has been redacted from public viewing.
Record #: O2011-1624   
Type: Ordinance Status: Passed
Intro date: 3/9/2011 Current Controlling Legislative Body: Committee on Traffic Control and Safety
Final action: 4/13/2011
Title: Handicapped Parking Permit No. 77758
Sponsors: Zalewski, Michael R.
Topic: PARKING - Handicapped
Attachments: 1. O2011-1624.pdf
Related files: SO2011-3566

APPLICATION FOR DISABLED PARKING SIGNS 77756 PLEASEIREAD 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 payment of the application fee; Please note: The application fee shall be waived for ahy person holding a valid, current disabled veterans plate.
• : Disabilityrhust be1 permanent as evidenced by "a copy'of your valid disabled placard and/dr current vehicle registration
submitted at the time of application;
• Proof of residency, in the'form of a copy of yourdrivers license, state identification, or utility bills are subrriitted at the time of application.
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
SMO- _/_ DAY
YEAR/,
2. State Identification Number
3. Drivers License Number
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4. Applicant Last Name
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First Name
5. Home Address (primary residence)
STREET NUMBER DIR. STREET NAME _
| ZIP CODE
6. Address where signs will be posted
STREET NUMBER I DIR. I STREET NAME
STREET NUMBER I DIR. I STREET NAME
, WARD NUMBER
7. Phone Numbers
Home
VP 9 ~Q> ft (g-T/i f
3k
Business
8. Current Permanent Disabled Placard Number (b& 30 3#5" Registered to Relationship to Applicant

9. Current License Plate Number Registered to City Sticker No. Relationship to Applicant

10. Description of Medical Condition and Disability s-j
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options.
11. Is there off-street parking availa...

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