Board of Review DuPage County Jack T. Knuepfer Administration Building 421 North County Farm Road Wheaton, IL 60187-3985 (630) 407-5888 REQUEST TO INTERVENE IN ASSESSMENT APPEAL PROCEEDING Name of Intervening Taxing Body: __________________________________________________________ This Taxing Body Hereby Applies to Intervene in the Following Pending Assessment Appeal: Permanent Parcel Number: ___________________________ (One Parcel Per Form) Board of Review Appeal Number: ______________________ Taxpayer/Appellant of Record: ____________________________________________________________ Property Street Address: _________________________________________________________________ (or brief legal description) City, State ZIP: ____________________________ ______________________________________________ Signature of Intervenor or Authorized Representative Date _______________________________________________ Date of Hearing:_______________ Location: ____________________ Name _______________________________________________ Room Number:________________ Title _______________________________________________ Time: ____________________ Mailing Address _______________________________________________ _______________________________________________ _______________________________________________ Telephone Number File in Duplicate BOR Copy TWP Assessor Copy BOR Form 101 (Rev. 12/2004) American LegalNet, Inc. www.USCourtForms.com