Office of the City Clerk - Record #: O2011-1658

• Record #: O2011-1658
• Type: Ordinance
• Status: Passed
• Intro date: 3/9/2011
• Current Controlling Legislative Body: Committee on Traffic Control and Safety
• Final action: 5/4/2011
• Title: Handicapped Parking Permit No. 74580
• Sponsors: Levar, Patrick
• Topic: PARKING - Handicapped
• Related files: SO2011-4258

Date	Journal Page Number	Action By	Action	Result
5/4/2011	117754	City Council	Passed	Pass
5/3/2011		Committee on Traffic Control and Safety	Recommended to Pass	Pass
3/9/2011	114177	City Council	Referred

APPLICATION FOR DISABLED PARKING SIGNS 74580 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 payment of the application fee; Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate.

• Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;

• 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.

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                             2. State Identification Number MO _                    DAY _                    YEAR n _ o IS\ JI / I HI 4  I I I I I I I I I I I				3.  Drivers License Number -fl4l<3|oT515161^1/1^/14'
4. Applicant Last Name H\u\t\k\ i i i i i i i i i i i i			Ml	First Name til i\CL\U\fl\£\L\   M M
5. Home Address (primary residence) STREET NUMBER            DIR.     STREET NAME                                                                                                                                                         II ZIP CODE £\^\(d\   IV.    IMM/VIr I 0\A\   l4lKM   1   1   1   1   1   1 \U0\Cn\3\0
6. Address where signs will be posted STREET NUMBER            DIR.     STREET NAME ^IHWI 61          \M.\o 1 til f ITI a\ (?\		WARD NUMBER 4.11/IS.........1 I^A"
7. Phone Numbers Home .7 17 \3T7\&. I3T /l<P	n\ 1	Business
8. Current Permanent Disabled Placard Number	Registered to				Relationship to Applicant
9. Current License Plate Number	Registered to		City Sticker No. 30103GI4		Relationship to Applicant S£JLF '
			i ■■
10. Description of Medical Condition and DisabilityH*V£  M^lrjfLE S&£KOSi S * UE£* WE-          °f *
Alternative Parking: Please note your application may be denied it you have alternative accessible off-street parking options, y'
11. Is there off-street parking available at your primary residence         ^YES    □ NO -/ (i.e., garage, car port, driveway, etc.)? /
12. If you answered Yes to question 11, please describe: '"" (^"Garage;    □ Driveway;      □ Car Port;       □ Other: ^
13.1s your oft-street parking accessible? (£^fVi^G   * &  £/W £/C j^G^M^   Hory[£         k,AYJL A □ Yes;       ^[No. Please explain: pf^     ^.                ^tf, ^   r//sf rt-//(!/TS

14. Affirmation: I hereby affirm that the above information is true and correct. If the City of Chicago Department of Revenue determines that the applicant has falsely represented one or more of the above conditions, the applicant shall be subject to a fine of not less than $100 but no more than $500, and the application shall be denied. I also understand that it is my responsibility to notify the Department of Revenue of any changes in the information provided.

Date

Signature jL/

 

FOR OFFICE USE ONLY

□ FEE □ PLACARD/PLATE      □ RESIDENCY        □ COMPLETE

^: MICHAEL R. HUCK -owe MARGARET A. HUCK

5446 N. MONITOR AVE. ... - CHICAGO, IL 60630-1236 v -.

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MAROON SHEFFIELD'

 

Jesse White-Secretary of State

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MICHAEL R HUCK 5446 N MONITOR-CHICAGO IL 60630

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