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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 (312)7.14-6146 (312)7-14-0471 (FAX) (312)744-2975 (TTY)
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BU1UUNG CHICAGO TOGETHER
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER.
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NAME'
( Please print or type.)
! OF DISABLED INDIVIDUAL: REMOVAL LOCATION OF DISABLED^ ARKJNG SPACE REQUESTED:
(Please print or type current sign location address,)
.(PHONE NUMBER).
CHICAGO, ILLINOIS (ZIP CODE) .
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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:
(AWermanic Signature)
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(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.