Handicapped Parking Permit No. 77479

Sponsors

Sponsor Ward
Harris, Michelle A.
Harris, Michelle A.Primary Sponsor Ward 8

History

Legislation Text

MEMORANDUM FOR TRAFFIC REGULATIONS OVERRIDE PROHIBITION AGAINST PARKING (Except for the Handicapped): Street, etc:. South Clyde Avenue Location, etc: No. 8008 (Permit No. 77479) Distance or extent: Hours: at all times Days: no exceptions MAMIE G. GIBSON MICHELLE A. HARRIS Alderman, 8th Ward APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM 77479 An application will not be considered complete unless: Ail lines oi iho. application have been completed in full: A check or money order for S70.00 made payable to the City of Chicago is submitted es payment of the appt«a«ion fee: Please note: The application fee shall be waived for any parson holding a valid, current disabled veieians piue. Disability muii im permansril ;i.'_; evidenced by a copy of your valid diuflbleo placard Wi6io< currem v-?'».'.-ie •■^istratior-submitted at the time of application; » Proof ot residency, in ihe form ct a copy oi your d;;vers license. sUue identification, cr utility sills are <.v>brn;Us.-.1 ■:>.: trie t-:ne o' :i!ipln:;i'!on. Completed application forms may be returned to: the office oi your alderrnan, any City ol Chicago Deparrm«ni of Revenue iaciiity. or v,a mail at P.O. Box 303100. Chicago, IL 60680-3100. ATTN: Disabled Pr>rmitima Socman. A $25.00 >na<;*ier>ancc> lee will b»jr b:!led la vou awitiailv. Should yuu have questions or concerns, please call o..;r permii mocessinq dwsior- at 3'i-744-PARK (7275). 1 Date oi Birth J..J3.I/......I2^...i G:ijBLSia..y........! 2. SiaW laonlilicn:iO-i Muml:':; 3 Drivers L:: ' Nu.Ti::.- i ....U.J........:......I.........L......!...... !0 ! |_ \ ; t,t! ]i l-i:«! N;;;h.: • i.•!'•>.• Ati'.irass lj:;i,"-"3ry io:;ic:onr;c! froJftlKl ISlaUViQif^.! 1^1 i 1 i I 1 i : 1 I M ItjQ^ posted Stfif-Er NijWjf n "i r.iil I SWCF.r NAMK ,j......j.......i. Phone Numbers Home 2iiX_7iiJ^lLQLOii E Curront Permanent Disabled Placard Numbet BlKtlWSS Registered to 9 Current L Plate Nunibec L^Q^ie.......£......(ld.Jb&x± Hagistorix; to Cily Sticfccr No. K-?Litionf.!m Attpiicant ,-",">i.'i!!or,Ki''!p to A;);')! ;:;■)■■'! 6 .....j | 10 Description of Mectcai Condition and Disability . - ; Alternative Parking: Please nolo your application may'be denied :•' yc. U -lavd W'W! r.., /,-; /V' alternative nccesstbio o if vou .■;"---;-.v«rtui v~; to <).jert on ii. ;::«jii.«j ;!K:j:;^:ie- '■J •O'-sJi-".--.---.;--.-: J •••• .-/.<,•; J L'..i.- i'5ort: J Otf ■ ■ Ii-/by J t>r : tj.fs your oil-strtjet parting accessible'-' , , ; ,■ \ _ JQTNo Ptoasc-explain^ _Cj3Jv£_ ^J/C\h^± . T'GLsf... 14 Afiiimauon: I hereby affirm that ihe above inlormation is ime and correct If the City of Chicago Ooparimfrfit y. P.cs-n.- txi.-r"«u.n that the applicant has falsely represented one or more ol Ihe above conditions, the applicant shall bo subject :o a 'me -.if not I'J-ss than $100 but no more than $500. and ihe application shall bo dented. I also understand that it is my responsibility lo noiify ;nr? Dt;pi' ...... Datv; / / L FOR OFFICE USE ONLY ^FEE CARD/PLATE SIDENCY .-' 1iV,ri'> « C-r;-'-i.i. ■J COMPLETE u

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