DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER //^g^7
(Please print or7Wpe.)
NAME OF DISABLED INDIVIDUAL: Ch&dl^S ^4ubl)fHxi
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address.) CHICAGO, ILLINOIS (ZIP CODE \(n7)/n <M (PHONENUMBER). REASON FOR REMOVAL:.
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: >^ J^^^fr^
(AJdermanic Signature)
(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.