^Ma|t_08 201 1 5:01PM HP LRSERJET FAX
312 758 5323 JUN 11 2007 11:17 FR COPY ROOM
312 768 5823 TO 917733488480
p.2
P. B1/-02
3fy of Cliira»o
t'Jharti M. Datcy, Mayor
teparroerir of Revenue
:ea Reyru-Hiclicy >irt«lor
ii> Hall. Room 107 2) North USalkSlrcti hicajn. Illinois 60602 H2) 747-4747 (IRIS) 112) 744-0471 (KAX) 112) 744-2975 (TTY)
sILDIKC CHICAGO TOCCTXCT
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER
NAME OF DISABLED INDIVIDUAL:
( Please print or type.)
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED: 5 Hi M-flfl-jgA,
nintcrltype eu
( Please print crkype euirem sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) 6^23 (PHONE NUMBER)_
REASON FOR REMOVAL: Pi ^<VoUd ?rCen P&Qf,fl£gflL
ILLINOIS VEHICLE LICENSE NUMBER: f^OTlO_
( Wor V plates)
ILLINOIS DISABLED PLACARD NUMBER: (J/V$^6X-T)^
( 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: DQ NOT WRITE BELOW THIS LINI AI^T^MANIcTE^riFICATIoS
( Aldermanic Signature j
4i_ MmOl sf got{
( 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