2009 TAXPAYER EXEMPTION APPLICATION Subject Property Permanent Index Number - - - Property Owner(s) Name(s) Property Address ( ) City Daytime Phone Number State Zip 2009 HOMEOWNER EXEMPTION As owner of the above property, I hereby apply for the Homeowner Exemption. I affirm by signature that this property was occupied by its current or previous owner as a principal residence as of January 1, 2009. I understand that it is against the law to provide false information on this Homeowner Exemption application. Applicant’s Signature Date / / 2009 SENIOR CITIZEN EXEMPTION IF YOU ARE APPLYING FOR THIS EXEMPTION FOR THE FIRST TIME AT THIS ADDRESS: you must include a copy of a recent property tax bill and a copy of one of the following valid forms of proof of age and residency with this application: - Illinois Driver’s License (both sides) - Illinois Identification (ID) Card NOTE: Individuals using forms indicating a different name must demonstrate a connection to the current name by including a copy of a marriage certificate or other supporting documents. Owners of Cooperative Apartments must also submit a copy of their Stock Certificate, Occupancy or Trust Agreement. I affirm that I was born in 1944 or earlier, or my spouse was born in 1944 or earlier and myself or my spouse is liable for payment of the taxes and that this property was occupied by its current or previous owner as a principal residence. Date of Occupancy / / Applicant’s Signature Cook County Assessor’s Office Date of Birth / / Date / / 118 N. Clark, 3rd Floor Chicago, IL 60602 American LegalNet, Inc. www.FormsWorkFlow.com