Transcription of Disabled Parking Permit Application - Chicago
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Disabled Parking Permit Application - Chicago
Application FOR Disabled Parking SIGNSNOTE: All sections must be Date of Birth2. Drivers License or State ID Number3. Applicant Last NameMI First Name4. Home Address (primary residence)6. Phone NumbersHome / CelltnacilppA ot pihsnoitaleR Registered toPermanent Disabled Placard Number ot pihsnoitaleR Registered toLicense Plate If alternative Parking is available, why are you unable to access the space?13. Is this a permanent disability?Note: Permit is only available for permanent disability10. Is there off-street Parking available at your primary residence?YESNOMODAYSTREET NAMEZIP CODEWARD NUMBER you rent or own?RENTOWN9. Does the registered owner of the vehicle reside at the address of the applicant?YESNO14. Do you use assisted devices?YESNOIf yes, what type do you use?OTHER15. Are you able to walk 200ft?YESNOYESNOT ypesGarageDrivewayOtherYEARD isabled Parking Application Payment StubPlease make check or money order payable to the City of AMOUNT DUES ignature _____ Date _____FOR OFFICE USE ONLYFEEPLACARD/PLATERESIDENCYCOMPLETE$ ENSURE PROPER CREDIT PLEASE RETURN THIS STUB WITH YOUR 07/19 PLEASE: DO NOT DO NOT fold the payment stub(s) DO NOT staple the check or money order to thepayment stub(s) DO NOTsend credit card informationsend cashBe sure to submit the following: A complete Application for Disabled Parki
• A complete application for Disabled Parking Signs. All sections must be completed. • A copy of a valid permanent disabled plate or placard issued by the Secretary of State to the applicant at the address where the signs are to be posted. • Proof of residency for the address where the signs are to be posted (i.e., Driver’s License or
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