JOSEPH BERRIOS WWW.COOKCOUNTYASSESSOR.COM Vacancy Affidavit Appeal Year Property Index Number(s) Owner's Mailing Address Property Street Address City Appeal Number Owner / Taxpayer Property Index Number(s) Town City State Zip Zip State Daytime Phone Number Email Address Township I, being first duly sworn on oath state that (owner or lessee), and that in said I am capacity I have sufficient knowledge of the above property to state that for the year the following information is accurate. Further affiant sayeth not. Signature of Owner/Lessee Print Name Date Subscribed and sworn before me this day of , Notary Stamp Signature of Notary Public Page 1 of 2 5401122210 COOK COUNTY ASSESSOR'S OFFICE 118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: 312.443.7550 FAX: 312.603.3352 COOK COUNTY ASSESSOR American LegalNet, Inc. www.FormsWorkFlow.com JOSEPH BERRIOS WWW.COOKCOUNTYASSESSOR.COM Vacancy Affidavit Total number physically vacant and for which no rent was collected: Total number of: Square Feet Square Feet Units January January February February March March April April May May June June July July August August September September October October November November December December Total Units Total Vacant Percent Vacant Page 2 of 2 % American LegalNet, Inc. www.FormsWorkFlow.com 5402122210 COOK COUNTY ASSESSOR'S OFFICE 118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: 312.443.7550 FAX: 312.603.3352 COOK COUNTY ASSESSOR