Mar 08 2011 2:13PM
uiard40
773-769-3804
p.2
City of Chicago
Richard M. Daley, Mayor
Department of Revenue Bea Reyna-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312)744-2975 (TTY) http://www.ci.chi.il.us
NEIGHBORHOODS
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER_4
NAME REMOV.
CP lease print of type) SPACE REQUESTED:
W. VWd
(Please print or type current sign location address.) ^ CHICAGO, ILLINOIS (ZIP code) \ao (phone NUMBER) 773-/H P? \&
REASON FOR REMOVAL: 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: \A^dJ^ <S^fJy^^ lO^C^.
(Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE.
ALDERMANIC CERTIFICATION:
(Ward 40)
2>-g-ll
(Date]
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED.
BUILDING CHICAGO TOGETHER.