City of Chicago Richard M. Daley, Mayor
Department of Revenue
Hugh P. Murphy Directo;
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602 1312)744-6146 (312) 7-14.0471 (FAX) (312)744-2975 (TTY)
OUI -AUNG CHICAGO ToChTHtK
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER 10&2-<^
(Please print or type.)
NAME OF DISABLED INDIVIDUAL:/^ nflPtoJg' /TlcJYr/ S
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
( Please print or type current sign location address.) CHICAGO, ILLINOIS (ZIP CODE ) OX* I *7 (PHONE NUMBER)__^ZZ REASON FOR REMOVAI/ f\£ C &
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: fa
(Aldennanic Signature)
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.