PTAX-762 Application for Model Home Assessment Who should complete this form? When and where must I file? You should complete this form to request an alternative assessment if your property is used for model home purposes. The property must be a single-family residence, town home, or condominium, used solely as a model home for prospective buyers, and not occupied as a dwelling. The model home may contain home furnishings, appliances, offices, and office equipment to further sales activities. No more than three model homes can be located at the same time within a three mile radius, the center of each radius is the model home that has been used for the longest period of time. No model home can be used for model home purposes longer than ten years. You must annually file this form with the Chief County Assessment Officer (CCAO), at the address shown below, on or before April 30 in Cook County and December 31 in all other counties. Failure to file in a timely manner will result in waiver of the model home assessment for that year. Note: When any portion of this property no longer qualifies as a model home, you must notify the CCAO within 60 days by completing Form PTAX-762-C, Certificate of Ineligibility for Model Home Assessment. Step 1: Complete the following information 1. 4. Write the date the property began to be used for model home purposes. Property owner’s name / 5. This model home is a: Street address of model home property Single-family residence Town home Condominium IL City / Zip 6. Have you applied for other ( ) model home assessments in this county? Daytime phone Send notice to: (if different than above) Yes No 7. Write the parcel # of the property for which you are 2. requesting this model home assessment. Your parcel # is listed on your property tax bill or you may obtain it from the CCAO. If you are unable to obtain your parcel, write the legal description on line b. Name Mailing address a. Parcel # City ( State b. Legal description Zip ) Daytime phone 3 Write the assessment year for which you are requesting this model home assessment: Step 2: Sign below Under penalties of perjury, I state that, to the best of my knowledge, the information on this form is true, correct, and complete. / Subscribed and sworn to before me this of day , . / / Property owner’s or authorized representative’s signature & date Notary Public If you have any questions, please call: (309) 558-3660 Mail your completed form PTAX-762 to: Rock Island County Chief County Assessment Officer 1504 3rd Avenue / Date Notary stamp: Rock Island, Illinois 61201 For use by the CCAO Date received Yes Date complete Date sold Full year value Approved: Do not write in this space / Instant / No Pro-rated L Date approved / / TAX-762 (R-09/03) IL-492-3076 I T American LegalNet, Inc. www.USCourtForms.com