DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER.
(Please print'or type.) NAME OF DISABLED INDIVIDUAL: /1A\W\ S ^- Gf- 6)1/W/V REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
S'dOK vS- Clycl& flvfnue_
( Please print or type current sign location address.) CHICAGO, ILLINOIS (ZIP CODE). (PHONE NUMBER),
REASON FOR BKMOVAL: f)eC&(X^J_
NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE:__;_:_
(Please provide information only if billing information differs.) 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:_
(Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION:
(AJdermanic Signature)
g$ 3/3|//
(Ward) (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.