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 6b ELIGIBILITY APPLICATION Carefully review the Class 6b Eligibility Bulletin before completing this Application. For assistance, please contact the Assessor's Office, Development Incentives Department, (312) 603-7529. This application, a filing fee of $500.00, and supporting documentation (except drawings and surveys) must be filed as follows: This application must be filed PRIOR TO the commencement of New Construction or PRIOR TO the commencement of Substantial Rehabilitation Activities or PRIOR TO the commencement of Reoccupation of Abandoned Property. Applicant Information Name: _____________________________ Telephone: (_____)_______________________ Address: ___________________________________________________________________ City: ______________________ State: __________ Zip Code: ______________________ Contact Person (if different than the Applicant) Name: _____________________________________________________________________ Company: __________________________ Telephone: (_____)______________________ Address: ___________________________________________________________________ City: ______________________ State: __________ Zip Code: ______________________ Email Address: ______________________________________________________________ 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: __________________________ Attach legal description, site dimensions and square footage, and building dimensions and square footage. 1 of 5 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Identification of Persons Having an Interest in the Property Attach a complete list of all owners, developers, occupants and other interested parties (including all beneficial owners of a land trust) identified by names and addresses, and the nature and extent of their interest. Industrial Use Attach a detailed description of the precise nature and extent of the intended use of the subject property, specifying in the case of multiple uses the relative percentages of each use. Include copies of materials, which explain each occupant's business, including corporate letterhead, brochures, advertising material, leases, photographs, etc. Nature of Development Indicate nature of the proposed development by checking the appropriate space: [ ] New Construction (Read and Complete Section A) [ ] Substantial Rehabilitation (Read and complete Section A) Incentive only applied to market value attributable to the rehabilitation [ ] Occupation of Abandoned Property – No Special Circumstances (Read and complete Section B) [ ] Occupation of Abandoned Property – With Special Circumstances (Read and complete Section C) A. If the proposed development consists of new construction or substantial rehabilitation, provide the following information: Estimated date of construction commencement (excluding demolition, if any): ______________________________ Estimated date of construction completion: ______________________________ Attach copies of the following: 1. 2. 3. 4. 5. Specific description of the proposed new construction or substantial rehabilitation. Current plat of survey for subject property. 1st floor plan or schematic drawings. Building permits, wrecking permits and occupancy permits (including date of issuance). Complete description of the cost and extent of substantial rehabilitation or new construction (including such items as contracts, itemized statements of all direct and indirect costs, contractor's affidavits, etc.) 2 of 5 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com B. If the proposed development consists of the reoccupation of abandoned property, purchased for value, complete (1) and (2) below: 1. Was the subject property vacant and unused for at least 24 continuous months prior to the purchase for value? [ ] YES [ ] NO When and by whom was the subject property last occupied prior to the purchase for value? _________________________________________________________________________ _________________________________________________________________________ Attach copies of the following documents: (a) Sworn statements from persons having personal knowledge attesting to the fact and duration of vacancy and abandonment. (b) Records (such as statements of utility companies) which demonstrate that the property was vacant and unused and indicate duration of such vacancy. 2. Application must be made to Assessor prior to reoccupation: Estimated date of reoccupation: ____________________ Date of purchase: ____________________ Name of purchaser: ____________________ Name of seller: ____________________ Relationship of purchaser to seller: ____________________ Attach copies of the following documents: (a) (b) (c) (d) (e) Sale contract Closing statement Recorded deed Assignment of beneficial interest Real estate transfer declaration C. If the applicant is seeking special circumstances to establish that the property was abandoned for purposes of the incentive where there was a purchase for value, but the period of abandonment prior to purchase was less than 24 continuous months, please complete section (1) below. If the applicant is seeking special circumstances to establish that the property was abandoned for purposes of the incentive where there was no purchase for value, but the period of abandonment prior to application was 24 continuous months or greater, please complete section (2) below. 1. How long was the period of abandonment prior to the purchase for value? ____________ When and by whom was the subject property last occupied prior to the purchase for value? _________________________________________________________________________ _________________________________________________________________________ 3 of 5 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Attach copies of the following documents: (a) Sworn statements from person having personal knowledge attesting to the fact and duration of vacancy and abandonment. (b) Records (such as statements of utility companies) which demonstrate that the property was vacant and unused and indicated duration of such vacancy. (c) Include the finding of special circumstances supporting “abandonment” as determined by the municipality, or the County Board, if located in an unincorporated area. Also include the ordinance or resolution for the Board of Commissioners of Cook County stating its approval for the less than 24-month abandonment period. Application must be made to Assessor prior to commencement of reoccupation of the abandoned property. Estimated date of reoccupation: ____________________ Date of purchase: ____________________ Name of purchaser: ____________________ Name of seller: ____________________ Relationship of purchaser to seller: ____________________ Attach copies of the following documents: (a) (b) (c) (d) (e) Sale contract Closing statement Recorded deed Assignment of beneficial interest Real estate transfer declaration 2. Was the subject property vacant and unused for at least 24 continuous months prior to the filing of this application? [ ] YES [ ] NO When and by whom was the subject property last occupied prior to filing this application? _________________________________________________________________________ _________________________________________________________________________ Attach copies of the following documents: (a) Sworn statements from persons having personal knowledge attesting to the fact and duration of vacancy and abandonment. (b) Records (such as statements of utility companies) which demonstrate that the property was vacant and unused and indicate duration of such vacancy. (c) Include the finding of special circumstances supporting “abandonment” as determined by the municipality, or the County Board, if located in an unincorporated area. Also include the ordinance or resolution for the Board of Commissioners of Cook County stating its approval for lack of a purchase for value. Application must be made to Assessor prior to commencement of reoccupation of the abandoned property. Estimated date of reoccupation: ___________________ 4 of 5 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Employment Opportunities How many construction jobs will be created as a result of this development? ________ How many permanent full-time and part-time employees do you now employ in Cook County? Full-time: __________ Part-time: _________ How many new permanent full-time jobs will be created as a result of this proposed development? ______ How many new permanent part-time jobs will be created as a result of this proposed development? _____ Cook County Living Wage Ordinance Applicant confirms that it has reviewed a copy of Chapter 34, Article IV, Division 1, of the COOK COUNTY LIVING WAGE ORDINANCE, Sec. 34-123, as amended. Please mark the appropriate blank below to indicate which statement applies to the applicant: _____ Applicant acknowledges that during the appeal process it must provide an affidavit to the Cook County Assessor’s Office stipulating it is in compliance with the above referenced Living Wage Ordinance because applicant is currently paying a living wage to its employees. OR _____ Applicant acknowledges that during the appeal process it must provide an affidavit to the Cook County Assessor’s Office stipulating it is in compliance with the above referenced Living Wage Ordinance because applicant is not required to pay a living wage. Local Approval A certified copy of a resolution or ordinance from the municipality in which the real estate is located (or the County Board, if the real estate is located in an unincorporated area) should accompany this Application. The ordinance or resolution must expressly state that the municipality supports and consents to this Class 6b Application and that it finds Class 6b necessary for development to occur on the subject property. If a resolution is unavailable at the time the application is filed, a letter from the municipality or the County Board, as the case may be, stating that a resolution or ordinance supporting the incentive has been requested may be filed with this application instead. If the applicant is seeking to apply based on the reoccupation of abandoned property and will be seeking a finding of “special circumstances” from the municipality, in addition to obtaining a letter from the municipality confirming that a resolution or ordinance supporting the incentive has been requested, the applicant must file a letter from the County Board confirming that a resolution validating a municipal finding of special circumstances has been requested. If, at a later date, the municipality or the County Board denies the applicant’s request for a resolution or ordinance, the applicant will be deemed ineligible for the Class 6b incentive, whether or not construction has begun. In all circumstances, the resolution must be submitted by the time the applicant files an “Incentive Appeal”. I, the undersigned, certify that I have read this Application and that the statements set forth in this Application and in the attachments hereto are true and correct, except as those matters stated to be on information and belief and as to such matters the undersigned certifies that he/she believes the same to be true. _________________________________ Signature _________________________________ Date _________________________________ Print Name _________________________________ Title 5 of 5 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com