Handicapped Parking Permit No. 73523


Sponsor Ward
Stone, Bernard
Stone, BernardPrimary Sponsor Ward 50


Legislation Text

JANUARY 13, 2011 CITY COUNCIL BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CHICAGO: SECTION 1. PROHIBITION AGAINST PARKING (EXCEPT FOR DISABLED) NAME OF APPLICANT: SAMUEL L. MCFEE PRIMARY STREET ADDRESS: 6639 N. ROCKWELL LOCATIONS OF SIGNS TO BE POSTED: 6639 N. ROCKWELL PERMIT NUMBER: 73523 HOURS: AT ALL TIMES DAYS: NO EXCEPTIONS SECTION 2. This ordinance shall take effect upon its passage and publication. BERNARD L Alderman, 50 ONE th Ward APPLICATION FOR DISABLED PARKING SIGNS 7352' PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM An application will not be considered complete unless: • All lines of the application have been completed in full; • A check or money order for $70.00 made payable to the City of Chicago is submitted as payment of the application fee; Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate. • Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application; • Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at the time of application. Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275). 1. Date of Birth MO _ DAY Ol I I j I>i4l U 2. State Identification Number 3. Drivers License Number Mi2i/ iOT^li4-TfciQilff 4. Applicant Last Name IMici'F|£iei Ml L First Name S|fliMim£|Li 5. Home Address (primary residence) STREET NUMBER | DIR. I STREET NAME ZIP CODE (d\(d\3\1\ ImI g|OlC|£lLo|£lLiLl |S| I i<2 |£|€/|T| \f\2.\ |fc|0|fc|4|5 6. Address where signs will be posted , STREET NUMBER DIB. I STREET NAME (pikiaiqi \m\o\c\Kmt\L\u iQTieieisn , WARD NUMBER iSiO 7. Phone Numbers Home !•=?• I3T2-I Ul2.T6> |3> I I i(b Business Ri^rr ft |£TD 8. Current Permanent Disabled Placard Number fir. aaA-i ^ Registered to Relationship to Applicant Se.\f 9. Current License Plate Number Registered to City Sticker No. Relationship to Applicant 10.Description of Medical Condition and Disability JjoJUfi-fo b(>{h -(rk/tA Glcff^^A Oc^Vl^ (X\Q. Alternative "Parking: Please note your application may Tie denied if you have alternative accessible off-street parking options. 11. Is there off-street parking available at your primary residence (i.e., garage, car port, driveway, etc.)? □ YES □ NO 12. If you answered Yes to question 11, please describe: □ Garage; □ Driveway; □ Car Port; □ Other: 13. Is your off-street parking accessible? □ Yes; □ No. Please explain: 14. Affirmation: I hereby affirm that the above information is true and correct. If the City of Chicago Department of Revenue determines that the applicant has falsely represented one or more of the above conditions, the applicant shall be subject to a fine of not less than $100 but no more than $500, and the application shall be denied. I also understand that it is my responsibility to notify the Department of Revenue of any changes^in the information provided. Signature Date FOR OFFICE USE ONLY □ FEE □ PLACARD/PLATE □ RESIDENCY □ COMPLETE 'twmmsss!) am easy fiEans? od