TAX ASSESSMENT COMPLAINT Sub Case 241 Page 1 96-263 (Rev. 12/04) UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT Plaintiff(s) Case Number —VS— DU PAGE COUNTY COLLECTOR Defendant(s) File Stamp Here TAX ASSESSMENT OBJECTION COMPLAINT For Tax Year If you have any questions regarding this Rate Complaint form, please call 630/682-7056 OWNER (If more than one taxpayer joins, each must file a separate Page 1) YOU ARE REQUIRED TO APPEAR FOR A PRE-TRIAL CONFERENCE AT: Room Date INDICATE THE NAME OF EACH TAXING BODY WHICH IS AFFECTED BY THIS COMPLAINT DuPage County Judicial Center 505 N County Farm Road Wheaton, Illinois Time FAILURE TO ATTEND THE STATUS DATE WILL RESULT IN YOUR COMPLAINT BEING DISMISSED PURSUANT TO LOCAL COURT RULE REASONS FOR COMPLAINT ARE SHOWN ON PAGE TWO OF FORM ATTORNEY DuPage Number TAX CODE(S) If there is more than one parcel, indicate code which applies to each parcel ADDRESS CITY ZIP CODE BILLING VALUATION(S) If there is more than one parcel, indicate the valuation which applies to each parcel PHONE White — Circuit Clerk Green — County Clerk Canary — Treasurer Pink — State's Attorney Goldenrod — Plaintiff CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT WHEATON, ILLINOIS 60189-0707 © American LegalNet, Inc. www.FormsWorkflow.com TAX ASSESSMENT OBJECTION COMPLAINT PAGE 2 96-263 (New 12/04) Case No. x 1. I protest the valuation placed upon said premises for the said year before the DuPage County Board of Review. PLEASE NOTE: Failure to protest before the Board of Review can result in this objection being dismissed by the court. x 2. Amount of Assessed Value Sought: $ Factual reasons for seeking such amount: WHEREFORE, the Plaintiff(s) pray(s) that this Court enter an order granting the relief requested and any other relief the Court deems necessary. SUBSCRIBED & SWORN BEFORE ME DATE NOTARY PUBLIC White — Circuit Clerk CIRCUIT COURT CLERK Green — State's Attorney SIGNATURE OF PLAINTIFF OR ATTORNEY Canary — Objector Pink — Treasurer Goldenrod — County Clerk CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT WHEATON, ILLINOIS 60189-0707 © American LegalNet, Inc. www.FormsWorkflow.com