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2. 
4. Program Incentives and Requirements:

   A.	The objective of the Light Up Our Neighborhood Program is to increase the nighttime visibility in the neighborhood in order to discourage crime in areas where lighting would be beneficial.
   B.	Reimbursement of half or up to $100 for restoration, replacement or new installation of light post.
   C.	Building permit fee waived.
   D.	Select an electric light post with a photocell sensor.
   E.	Attach light post picture and details.
   F.	Attach invoice with proof of payment.

5. Date:*
   Date:
7. Owner First Name:*
8. Owner Last Name:
10. Address 1:*
11. Address 2:
13. City:*
14. State:
15. Zip:
17. Lot
18. Block
19. Subdivision
21. Cook County P.I.N. # (Property Index Number):
23. Phone Number #1:*
24. Phone Number #2:
26. E-Mail:
27. Total Cost:*
29. Upload Invoice, Proof of Payment or Photo:

    Include Light Specifications.

30. Do you have additional files to upload?

    1. Yes
    2. No

    Invoice(s), Photo(s) or Payment Proof

32. Upload Invoice, Proof of Payment or Photo 2:
33. Do you have additional files to upload?

    1. Yes
    2. No

    Invoice(s), Photo(s) or Payment Proof

35. Upload Invoice, Proof of Payment or Photo 3:
36. Do you have additional files to upload?

    1. Yes
    2. No

    Invoice(s), Photo(s) or Payment Proof

38. Upload Invoice, proof of Payment or Photo 4:
40. Description of Work Done:*

42. AGREEMENT:  By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

    Electronic Signature:

44. I hereby certify that I am the owner or duly authorized agent of the owner for the purposes of this application. I further certify that I have read and examined this application and know the same to be true and correct. If any of the information provided on this application is incorrect, the permit or approval may be revoked. I also understand that all work shall be completed in compliance with the City of Oak Forest Codes and Ordinances and the statues of the State of Illinois.

46. Please type your First and Last Name:*
47. Date:*
    Date:
49. Legal Signature:*

    1. I Understand

    I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field