APPLKJAMUN hUH DISABLED KAttMNU OIValNO PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
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An application will not be considered complete unless:
• All lines of the application have been completed in full;
A check or money order fc S70.00 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).
Date of Birth
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2. Stale Ideniilicahon Number
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3. Drivers License Number
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4. Applicant Last Name
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First Name
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5. Home Address (primary residence)
STREET NUMBER I CMR | STREET NAME
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6 Address where signs will be posted
STREET NUMBER I DIH J STREET pJAME
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WARD NUMBER
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7. Phone Numbers Home
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8. Current Permanent Disabled Placard Number
Registered to
Relationship to Applicant
9. Current License Plate Number
Registered to
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City Slicker No.
Relationship to Applicant
10 Description of Medical Condition and Disability
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ay be denied if you have alternative accessible off-street patting options. /
Alternative Parki...
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