TYPE OR PRINT ALL INFORMATION. COMPLY WITH BOARD RULES AND REGULATIONS IN FILLING OUT THIS FORM. Name of Appellant Address of Appellant City State Zip STATUS OF APPELLANT Owner Former Owner Liable for Tax Tenant Liable for Tax Taxing Body or Taxpayer Alleging Underassessment Bene ciary of Trust Executor Other (Explain) LOCATION AND IDENTIFICATION OF REAL ESTATE Address City pihsnwoTSingle Family 6 Apartments or Less Over 6 Apartments Co-op Description of Property: Commercial Industrial Other Mixed Use Vacant Land Condo If purchased on January 1, 201.Year Purchased Purchase Price $ The undersigned Appellant states that the above described real estate is OVERASSESSED by the Assessoro f Cook County for the year Signature of Appellant or Attorney ATTORNEYS ONLY ATTORNEY222S CERTIFICATION: I, ATTORNEY222S NAME (PRINTED OR TYPED) CITY ZIP PHONE , certify that I have obtained from APPELLANT TITLE OR POSITION (1)explicit authorization to file this 201 assessment complaint and (2) the Appellant222s assurance that I am the only attorney so authorized. Attorney fax number Attorney signature Board Atty Code COMISSIOER COMMISSIONER LARRY R. ROGERS, JR. COMMISSIONERDO NOT LIST COMPARABLES BELOW COMPLAINT NO. Received & Checked by: List in ascending order all Permanent Index Numbers of related parcels of the property owned by Appellant. PROPERTY INDEX NUMBR E 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 12. 11. 13. 14. 15. Phone: Fax: The undersigned states that he/she has read the above complaint, has personal knowledge of the contents thereof, and the same is true in substance and in fact , and Email Address MICHAEL M. CABONARGICOMMISSIONER DAN PATLAKCOMMISSIONERLARRY R. ROGERS, JR. COMMISSIONER REAL ESTATE ASSESSED VALUATION COMPLAINT THE BOARD OF REVIEW OF COOK COUNTY I REQUEST A HEARING BEFORE THE COOK COUNTY BOARD OF REVIEW, 118 N. CLARK ST., CHICAGONOTICE TO APPELLANT: If you requested a hearing, you will be notified by mail of the time and place of your hearing. You must be prepared at thattime to present any evidence in support of your claim. Please see the rules of the Board which govern all appeals. If you do not request a hearing, your complaint will be adjudicated based on the written evidence submitted on your behalf and information available to the Board of Review.Is this an appeal of an omitted assessment?YesNo If yes, check box. LAW FIRM ADDRESSLAW FIRMBOARD OF REVIEW ORIGINAL emohnwoT :sserdda liamE yenrottA www.cookcountyboardofreview.comThe Cook County Board of Review is a quasi-judicial agency. Only licensed attorneys and individual taxpayers representing themselves may practice before the Board. Board Rule 1.Non-attorneys may not complete complaint forms or present an appeal on a taxpayer222s behalf before the Board because it is considered the unauthorized practice of law. In Re Yamaguchi, 118 Ill.2d 417 (1987). Any complaint completed or presented by a non-attorney in the course of representaiton of a taxpayer may be denied or voided for lack of jurisdicion. SAME AS ABOVE IMPORTANT NOTICE Do you plan to submit additional evidence?YesNo American LegalNet, Inc. www.FormsWorkFlow.com Page of VOLUME VOLUME VOLUME164166174267184368194469204570214671224772234873244974255075265176275277285378295479305580315681325782335883345984356085366186376287386388396489406590PERMANENT INDEX NUMBER PERMANENT INDEX NUMBER ListinascendingorderallPermanentIndexNumbersofrelatedparcels of the property owned by the appelant.DO NOT LIST COMPARABLES BELOWCOMPLAINT NO.Received & Checked by:PERMANENT INDEX NUMBER American LegalNet, Inc. www.FormsWorkFlow.com Page of VOLUME VOLUME VOLUME PERMANENT INDEX NUMBER PERMANENT INDEX NUMBER ListinascendingorderallPermanentIndexNumbersofrelatedparcels of the property owned by the appelant.DO NOT LIST COMPARABLES BELOWCOMPLAINT NO.Received & Checked by: PERMANENT INDEX NUMBER American LegalNet, Inc. www.FormsWorkFlow.com PLEASE MAIL FORM(S) TO: COOK COUNTY BOARD OF REVIEW 118 N. CLARK STREET ROOM 601 CHICAGO, IL 60602 PLEASE WRITE 223COMPLAINT FORM224 ON THE ENVELOPE American LegalNet, Inc. www.FormsWorkFlow.com