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 S ELIGIBILITY APPLICATION This Application must be accompanied by a copy of a letter from HUD approving the contract renewal, a copy of the executed renewal contract, and an application fee of $500. Applicant Information Name: __________________________________ Telephone: (_____)___________________________ Address: ____________________________________________________________________________ City: _______________________________ State: __________ *Note: Zip Code: ______________________ 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: ______________________ 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: __________ Township: _________________________ Split Codes: ______________________ Zip Code: ______________________ Existing Class: _______________________________ 1 of 2 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com DESCRIPTION OF PROPOSED BUILDING Mark Up to Market contract date: _______________ [ ] Check here if this property is eligible for Mark Up To Market option and explain: _______________________________________________________________________ [ ] Check here if this property is eligible for Mark Up To Market under the “discretionary provision” and explain: _______________________________________________________________________ [ ] Check here if this property is eligible as a not-for-profit and explain: _______________________________________________________________________ Number of dwelling units: ________________ Number of Section 8 units: ________________ Approximate square footage of building: ___________________________ If building will have uses other than residential, describe such uses and approximate square footage for each use: ___________________________________________________________________ Senior Housing: Yes / No (Please Circle) Number of Senior Housing Units: ____________ STIPULATION PURSUANT TO SECTION 2 OF THE REAL PROPERTY ASSESSMENT CLASSIFICATION ORDINANCE In return for receiving the Class S incentive classification for the subject property, the undersigned owner(s) hereby stipulates and agrees that in the event the undersigned, or any successor in interest in the subject property, fails to comply with the requirement that during the five-year incentive period, at least 20% of the dwelling units of the subject property be maintained as Section 8 units in accordance with the U.S. Housing and Urban Development (HUD) contract, the Class S classification shall be deemed null and void from its inception as to the subject property, and that the undersigned shall be personally liable for and shall reimburse to the County Collector an amount equal to the difference, if any, in the amount of taxes that would have been collected had the subject property been assessed without the Class S classification and the amount of taxes actually billed and collected upon the subject property for the period during which it was being assessed with the Class S classification. Failure of the undersigned to make such a reimbursement to the County Collector shall not constitute a lien upon the subject property but shall constitute an in personam liability that may be enforced against the owners. Further, the undersigned certifies that he/she has read this Application and that the statements set forth in this Application and in the attachments hereto are true and correct, except as to 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 of Owner(s)* _________________________________ Title _________________________________ Print Name _________________________________ Date *Note: If title to the property is held in trust or by a corporation or a partnership, this Class S Eligibility Application must be signed by the beneficiary, officer and/or general partner. **Note: Applicants must file three copies of an Incentive Appeal Form with the Assessor’s Office requesting a reclassification to Class S. Information listed in the Class S bulletin must accompany the Appeal (see bulletin for details). The Assessor’s acknowledgement of the application will inform the applicant of the time for filing an appeal. If the appeal dates are not yet available, the acknowledgement will suggest a time to contact the Specific Properties Department at (312) 603-5331 for an appeal date. FOR ASSISTANCE IN PREPARING THIS APPLICATION, PLEASE CONTACT THE ASSESSOR’S OFFICE, SPECIFIC PROPERTIES DEPARTMENT AT (312) 603-7529. 2 of 2 12/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com