RECEIVED AND CHECKED BY: Name of Taxpayer / Owner 201 201 201 Address of Taxpayer Email 1 City State Zip Code Phone 2 3 Owner Former Owner Liable for Tax Tenant Liable for Tax Executor Beneficiary of Trust 4 Other (Explain) 5 6 7 8 9 Current Year Appeal only Current Year & C of E C of E Only Taxable Exempt 10 11 Street Address 12 City Township DATA SUBMITTED WITH APPEAL DATA TO BE SUBMITTED Affordable Housing Class 7A Farm Land Residential Landmark Class L (Landmark) Class 7B Fraternal SER Class C (Brownfields) Class 7C Omitted SRO Class S Class 8 Open Space TEERM Class 6B Class 9 Railroad Veterans Current Property Class? Class Change Requested If purchased on or after January 1, 201, indicate year purchased and purchase price. If purchased prior to January 1, 201 insert "prior". Year Purchase Price FIELD CHECK REQUEST If yes, attach explanation Signature of Taxpayer or Attorney / Representative ATTORNEY/REPRESENTATIVE CERTIFICATION: I ATTORNEY / REPRESENTATIVE NAME (PRINT OR TYPE) FIRM / COMPANY NAME certify that I have obtained from FIRM / COMPANY ADDRESS CITY ZIP PHONE (1) explicit authorization to file this 201 assessment appeal and/or Certificate of Error and (2) the Taxpayers assurance that I am the only attorney /Representative so authorized. Attorney / Representative Fax Number Attorney / Representative Signature and Code Number e-mail Address The undersigned states that he/she has read this appeal, has personal knowledge of the contents thereof, and the same is true in substance and in fact and further so certifies under the penalties as provided by law pursuant to section 1-109 of the Illinois Code of Civil Procedure. NOTE: FALIURE TO FILE OWNER / LESEE AFFIDAVIT MAY RESULT IN DENIAL OF THIS APPEAL. YES NO LIST ADDITIONAL INDEX NUMBERS ON ANOTHER APPEAL FORM How is the Subject Property used? Check all that apply. The assessment on the property described is inaccurate based on the following facts: THIS FORM MUST BE FILED IN DUPLICATE. FILE BOTH COPIES WITH COOK COUNTY ASSESSOR'S OFFICE - RETAIN TIME STAMPED COPY FOR YOUR RECORDS 3 ATTORNEY / REPRESENTATIVE ONLY TAXPAYER NAME TAXPAYER TITLE OR POSITION NOTICE TO FILERS: YOU WILL BE NOTIFIED BY MAIL OF THE APPEAL NUMBER. YOU CAN FIND YOUR APPEAL NUMBER AND CHECK APPEAL STATUS ONLINE @ www.cookcountyassessor.com DO NOT LIST COMPARABLES BELOW IDENTIFICATION AND STATUS OF OWNER / TAXPAYER List in ascending order all Permanent Index Numbers associated with the subject property. 1 SUBJECT PROPERTY PERMANENT INDEX NUMBER(S) CERTIFICATE OF ERROR YEAR(S) Select one: NATURE OF APPEAL - LOCATION AND IDENTIFICATION OF REAL ESTATE 2 Location of Subject Property: Office Hours: 8:30 A.M.- 5:00 P.M. 201 Real Estate Assessed Valuation Appeal PLEASE COMPLETE ALL PARTS OF THE APPEAL FORM. TYPE OR PRINT ALL INFORMATION. COMPLY WITH ASSESSORS OFFICE RULES AND REGULATIONS IN FILLING OUT AND FILING THIS FORM. IF AIR RIGHTS PROPERTY, SUBMIT PLAT OF SURVEY. Appeal Type: Cook County Assessor's Office Cook County Assessor 118 N. Clark Street - 3rd Floor Chicago, Illinois 60602 Incentive I COOK COUNTY ASSESSOR APPEAL NUMBER Control Number American LegalNet, Inc. www.FormsWorkFlow.com