City of Chicago Richard M. Daley, Mayor
Department orRevenue
B53 Reyna-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312) 747-4747 (IR]S) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER
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( Please print or type.)
NAME OF DISABLED INDIVIDUAL; Q <^>r N g I >j\ ryV\V e
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address.) CHICAGO, ILLINOIS (ZIP GODE)taQfetfSPHONE NUMBER)
REASON FOR REMOVAL: rPlfMSg A rmvV OfC 5>4r-w-\-^
ILLINOIS VEHICLE LICENSE NUMBER: _
(\V or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
(Secretary of State Disabled. Placard ) CERTIFICATION: THE ABOVE INFORMATION IS QORRECT TO THE
(Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR AlKerImaS ^ ~
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APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION:
(Aldermanic Signatsffe) (Date )
( Ward)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED