Kane County Chief County Assessment Office 719 Batavia Ave., Building C Geneva, IL 60134 (630) 208-3818 Application for Model Home Assessment In accordance with Illinois Tax Code 35 ILCS 200/10-25, the person liable for taxes on property eligible for assessment as provided in this Section shall file a verified application form to request Model Home Assessment. The property must be a single-family residence, townhome or condominium, used solely as a model home for prospective buyers, and not occupied as a dwelling. The model home may contain home furnishings, appliances, office equipment and offices to further sales activities. No more than 3 model homes can be located within a 3-mile radius, the center of which is the model home that has been used for the longest period of time. No model home can be used for model home purposes longer than 10 years. You must file this form with the Chief County Assessment Officer (CCAO) at the address shown above by December 31 of each assessment year for which that assessment is desired. Failure to make a timely filing in any assessment year constitutes a waiver of the right to benefit for that assessment year. Note: When any portion of this property no longer qualifies as a model home, you must notify the CCAO of Ineligibility for Model Home Assessment, within 60 days. Step 1: Complete the following information Please type or print 5 This model home is a 1 ___________________________________________ Single-family residence Townhome Property owner’s name ___________________________________________ Street address Condominium 6 Have you applied for other model home assessments in this county? Yes ___________________________________________ City State No ZIP (______)____________________________________________________ ______ Phone 7 Write the property index number (PIN) of the property for which you are requesting this model home assessment. Your PIN is listed on your property tax bill or you may obtain it from the CCAO. If you are unable to obtain your PIN, write the legal description on Line b. Send notice to (if different than above) 2 ___________________________________________ Name ___________________________________________ a PIN____ ____-____ ____-____ ____ ___-___ ___ ____ b Write the legal description only if you are unable to obtain your PIN. Mailing address ___________________________________________ City State _________________________________________________ __________________________________________ ZIP (______)____________________________________________________ ______ Phone 8 Write the street address of the property, if different than the address in Item 1. ___________________________________________ 3 Write the assessment year for which you are requesting this model home assessment. 3 ______ ______ ______ ______ Street address ___________________________________________ City State ZIP 4 Write the date the property began to be used for model home purposes. 4 ___ ___ / ___ ___ / ___ ___ ___ ___ Month Day Year Step 2: Sign below Under penalties of perjury, I state that, to the best of my knowledge, the information contained in this affidavit is true, correct, and complete. ___________________________________________________________/_____/_______ Property’s owner’s or authorized representative’s signature Date Subscribed and sworn to before me this _______day of_________________________,____ ____ ____ ____. ______________________________________/_____/________ Notary public Date Mail your completed Form to the above address: For use by the CCAO Date received ___ ___/___ ___/___ ___ ___ ___ Do not write in this space. American LegalNet, Inc. www.USCourtForms.com Month Yes Approved Date approved Day Year No ___ ___/___ ___/___ ___ ___ ___ Month Day Year Denied Date denied Yes No ___ ___/___ ___/___ ___ ___ ___ Month Day Year Reason for denial______________________________ PTAX-762(R-12/97) IL-492-3076 American LegalNet, Inc. www.USCourtForms.com