COOK COUNTY ASSESSOR’S OFFICE 118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: 312.443.7550 FAX: 312.603.3352 WWW .COOKCOUNTYASSESSOR.COM COOK COUNTY ASSESSOR JOSEPH BERRIOS CLASS 2 SRO ELIGIBILITY APPLICATION Applicant Information Name: _____________________________ Telephone: (_____)_______________________ Address: ___________________________________________________________________ City: ______________________ State: __________ Zip Code: ______________________ *Note: If title to the property is held or will be held in trust or by a corporation or a partnership, attach additional pages with the names, addresses and telephone numbers of the beneficiary, officers and/or general partners. Contact Person (if different than the Applicant) Name: _____________________________________________________________________ Company: __________________________ Telephone: (_____)_______________________ Address: ___________________________________________________________________ City: ______________________ State: __________ Zip Code: ______________________ Property Description (per PIN) If you are applying for more than three different PINs, please submit the additional PIN information in an attachment. Street address: (1) _________________________________________________________ Permanent Real Estate Index Number: ____________________________ (2) _________________________________________________________ Permanent Real Estate Index Number: ____________________________ (3) _________________________________________________________ Permanent Real Estate Index Number: ____________________________ City: ______________________ State: __________ Zip Code: ______________________ Township: _______________________ Existing Class: __________________________ Split Codes: _______________________ 1 of 8 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com SRO Checklist Supply the following information and documents. Check each item that is supplied with this application. Names and addresses of owner(s), including any beneficial owner(s) if title to the property is held in trust. Identification of the subject property, including address, Permanent Real Estate Index Number(s) and township. Complete the Class 2 SRO Occupancy and Rent Information Form for each month of the twelve months immediately prior to the date of application (see attached instructions and forms). If rents for the building have been reduced to comply with the Ordinance, supply copies of written notice to tenants in all units that have had a rent reduction, stating the new rent level and the beginning date of the rent change. Provide a drawing of the layout of each floor. If a general architectural plan is not available, your own drawings are acceptable. (Note: Newly constructed, rehabilitated or converted buildings require architect's drawings.) For the subject building, supply income and expense statements for the past three years, accompanied by the Assessor's form affidavit stating that the information provided is true and correct (Note: Statements certified by an independent Certified Public Accountant or copies of the Federal Income Tax return relating to the property are preferred. However, income and expense statements prepared in the ordinary course of business are acceptable.) Provide documentation that the property is in substantial compliance with all local building, safety and health codes and requirements. Provide a description and approximate square footage for all building areas that are not residential units, such as lobbies, meeting rooms, street-level stores and offices. Provide a sworn statement attesting that rents for the next year will not exceed the rent level requirements set forth above. Provide a copy of your current business license. 2 of 8 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Occupancy and Rent Data Summary Please complete the following from the data supplied on the attached Occupancy and Rent Information Form: Number of dwelling units ______ Number of single room occupancy units ______ Number of rooms occupied by management employees ______ Fair Market rent amount for existing housing for single room occupancy units $______ Number of SRO units occupied annually for monthly terms ______ Senior housing Yes / No If yes, please list the number of rooms ______ Number occupied ______ New Construction or ______ Substantial Rehabilitation ______ 3 of 8 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Certification The undersigned owner(s) certifies that he/she has read this Application and that the statements set forth in this Application, the Occupancy and Rent Information Forms, and all other documents provided in support of this application are true and correct. The undersigned further certifies that he/she understands the Class 2 SRO requirements of the Ordinance and Eligibility Bulletin including, specifically, the requirements for filing an annual affidavit prior to the filing deadline, maintenance of SRO units in the building at ninety percent of the total units, compliance with the occupancy and rent level requirements, and compliance with all local building, safety and health codes, and that failure of compliance with any of these requirements may result in termination of the incentive by the Assessor's Office. __________________________ ______________________________ __________________________ Signature of Owner(s)* ______________________________ Title __________________________ Date *Note: If title to the property is held in trust or by a corporation or a partnership, this Class 2 SRO Eligibility Application must be signed by the beneficiary, officer and/or general partner. Subscribed and sworn to before me this day of , 20 . __________________________ NOTARY PUBLIC FOR ASSISTANCE IN PREPARING THIS APPLICATION, PLEASE CONTACT THE ASSESSOR’S OFFICE, SPECIFIC PROPERTIES AT (312) 603-7529. 4 of 8 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com CLASS 2 SRO OCCUPANCY AND RENT INFORMATION FORM APPLICANT Unit # MONTH No. of Rooms Use (LT,ST, E,O,V) Monthly Rent 5 of 8 No. of Days Occupied YEAR_________ Name of Occupant (if Long-Term) 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING THE CLASS 2 SRO OCCUPANCY AND RENT INFORMATION FORM You must complete the attached Occupancy and Rent Information Form for all units and all months for the twelve-month period preceding application, up to and including the most recent month for which data is available. We suggest that you first complete the form, for all units, with data that is the same throughout the twelve-month period. Then copy the partially completed forms in sufficient quantity to cover the twelve months, completing each month's form with data that has changed from month to month, if any. If the building has been recently converted, rehabbed or newly constructed and does not have a twelve-month occupancy and rent history, supply the requested data for as many months as are available. Thereafter, monthly data must be submitted to the Assessor's Office each month until a twelve-month history is completed. EXPLANATION OF TERMS Column 3, "Use": for each residential unit, list the use for each month. "Use" categories are: Long-term (LT) unit: occupancy by the same tenant for the entire month. The rent term may be -week-to-week so long as occupancy was by the same tenant for entire month. Short-term (ST) unit: occupancy, consecutively, by more than one tenant for the current month. Employee (E) unit: residence for building staff. Office (O) unit: residential unit used for building offices Vacant (V) unit: no occupancy for the current month. Column 6, "Name of occupant, if Long-Term": if the unit's use for the current month is "Long-Term", that is, occupancy was by the same tenant for the entire month, supply the tenant's name in this space. Otherwise, leave this space blank. As a guide, see the attached Sample Form. 6 of 8 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com SAMPLE FORM CLASS 2 SRO OCCUPANCY AND RENT INFORMATION APPLICANT: Claridge Arms MONTH: January YEAR: 2001 No. of Rooms Use (LT,ST, E,O,V) Monthly Rent No. of Days Occupied Name of Occupant 101 1 LT 305 31 John Evans 102 1 LT 275 31 Ron Smith 103 1 ST 290 18 104 1 E 0 31 105 2 LT 310 31 106 1 ST 300 26 107 1 V 0 0 Unit # 7 of 8 (if Long-Term) 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com 2010 SRO FAIR MARKET RENTS (FMR) SRO Rent level requirements are: - At least one-third of the SRO units are leased at no more than 80% of the current Fair Market Rent Schedule for Existing Housing for single room occupancy units as set by the United States Department of Housing and Urban Development. - The overall maximum average rent per unit for all SRO units in the building does not exceed 90% of the current HUD Rent Schedule for SROs. - No SRO unit rent exceeds 100% of the current HUD Rent Schedule for SROs. The allowable rents for Class 2 SRO for 2009 and 2010 follow: % of FMR 2010 2009 100% $593 $586 90% $534 $527 80% $474 $469 8 of 8 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com