DISABLED PERMIT PARKING
REMOVAL APPLICATION
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Hugh P. Murphy Directo;
Ciiy Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312) 744-6146 (312)7/(4.0471 (FAX) (312)7-14-2975 (TTY)
luip^/www,ci.chi,il.us
aUt^UlNe CHICAGO TOCfTHLK
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBEF
NAME OF DISABLED INDIVIDUAL:
(Please print or/
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
( Please print or type currenfsign location address,) CHICAGO, ILLINOIS (ZIP code ). (PHONE NUMBER).
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:_
1 (Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION:
(AldermanicTsfignature)
(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.