Pbc-M-2000 M:2Bam From-CITY OP CHICAGO DEPT OF REVENUE
T-005 P.002/002 F-
Ciiy of Clileii|;o Mchiuil M. Haley. Mayor
Department fiI J(«ttfiK(n I In ill P. Murpli)
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DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER ^ 7 6
(Please print or type.)
NAME OF DISABLED INDIVIDUAL: cTpy^np f^oQ-vZ-A
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
5^-3*4- W Otrrrys &(/tzc~ j--r _.__
(Please print or type cuireut sign location ndrlrcss.) CHICAGO, ILLINOIS (ZIP CODE )CO G 3o (PHON£ NUMBER),
REASON FOR REMOVAL: f (Lofton**/ 3p*-Q Z~}%-\1
NAME AND ADDRESS OF PERSON CURRENTLY DEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE:
(Please provide iiiformrifion only il billing information diflhin.)
ILLINOIS VEHICLE LICENSE NUMBER: A///1
(W or V plales)
ILLINOIS DISABLED PLACARD NUMBER; AC / 3 7 £>3
(Secretory of Slate Disabled Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY
KNOWLEDGr/^^^.^-^,
(Signaling iff Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION:
^6
(Aldermamc Signature)
(Ward)
(Date)
AFTER APPRO VAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED.