COOK COUNTY ASSESSOR'S OFFICE 118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: 312.443.7550 FAX: 312.603.5221 JOSEPH BERRIOS WWW.COOKCOUNTYASSESSOR.COM 2010 TAXPAYER EXEMPTION APPLICATION Property Index Number(s) Owner / Taxpayer Property Index Number(s) Property Address Daytime Phone Number City State Zip 2010 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, 2010. I understand that it is against the law to provide false information on this Homeowner Exemption application. Applicant's Signature Date 2010 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: an Illinois Driver's License (both sides) OR an 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 1945 or earlier, or my spouse was born in 1945 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 Date of Birth Applicant's Signature Date American LegalNet, Inc. www.FormsWorkFlow.com 3501012011 COOK COUNTY ASSESSOR