Lake County Board of Review Thomas D. Cooprider, C.I.A.O. Chairman Linda M. Barbera-Stein, C.I.A.O. Pete G. Fleming Members Martin P. Paulson, M.B.A., M.S. Clerk 18 North County Street – 7th Floor Waukegan, IL 60085-4335 Telephone: (847) 377-2100 To Whom It May Concern: In reply to your request, enclosed please find an Application for Property Tax Exemption. Please be sure to answer all questions completely. This office will complete the Recommendation Section of the application. The Lake County Board of Review requires that you complete the application and submit it, along with any documentation, in duplicate. If you file in person, you may wish to bring it in triplicate. We can then stamp the extra copy of your filing for your records. Once your completed filing has been processed, you will be notified by mail of your hearing date and time before the Board of Review. If you have any questions, please feel free to contact Cheryl Jenkins in my office. Very truly yours, Martin P. Paulson, M.B.A., M.S. Clerk, Board of Review MPP/cj encs. American LegalNet, Inc. www.FormsWorkFlow.com  Illinois Department of Revenue PTAX-300 Application for Non-homestead Property Tax Exemption — County Board of Review Statement of Facts Complaint no.: _______________ Volume no.: _______________ IDOR docket number: County use only _______________ IDOR use only Step 1: Identify the property 1 __________________________________________________ County in which property is located 2 __________________________________________________ Property owner ______________________________________IL __________ Is the applicant on Line 4 the lessee of Yes the property? If “Yes”, write the dates the lease is in effect. ZIP 4 __________________________________________________ Name of organization applying for the exemption (i.e., “applicant”) No From __ __/__ __/__ __ __ __ to __ __/__ __/__ __ __ __ 3 __________________________________________________ Street address of property City 5 6 __________________________________________________ Property index number (PIN) Attach a copy of the property’s legal description if the county has not assigned a number or if the property is a division. 7 Dimensions or acreage of this property___________________ 8 __ __/__ __/__ __ __ __ Date of ownership A ttach a copy of proof of ownership (deed, contract for deed, title insurance policy, condemnation order and proof of payment, etc.) Step 2: Identify any previous exemptions or applications (Providing this information will expedite processing.) Yes No 9 Does the applicant have an Illinois sales tax exemption number? If “Yes”, write the exemption number. E— ___ ___ ___ ___ — ___ ___ ___ ___ 10 Has a previous application been filed for this property or by this applicant? Yes No If “Yes”, write the Illinois Department of Revenue docket number, if known. __ __ - __ __ __ - __ __ __ __ Step 3: Identify the property’s use 11 Identify the Illinois Compiled Statutes citation for this application. 35 ILCS 200/_____________ Or __ ILCS ___/_____________ _ 12 Is any income derived from this property? Yes No If “Yes”, explain in detail.__________________________________________________________________________________________ If applicable, attach __________________________________________________________________________________________ a copy of any contracts or leases. 13 Does a unit of local government own this property? Yes No If “Yes”, is the property located within its corporate boundaries? Yes No 14 If granting this application will reduce the property’s assessed aluation by $100,000 or more, has the municipality, v school district, community college district, and fire protection district in which the roperty is located been notified p that this application has been filed? Yes Attach a copy of the notices and postal return receipts. No 15 Describe the specific activities that take place on this property. Write the exact date each activity began and how frequently it takes place. _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ 16 Did the activities described on Line 15 begin on the same date as the effective date of the lease on Line 5 or the date of ownership on Line 8, whichever is applicable? Yes No If “No”, explain in detail how the property was used between the lease or ownership date and the date these activities began.____________ _____________________________________________________________________________________________________________ 17 Identify each building’s use, square feet of ground area (SFGA), number of stories, and whether or not there is a basement. Use SFGA No. of stories Basement? (Y/N) Building 1 ___________________________________________ _________________ _________________ Yes No Building 2 ___________________________________________ _________________ _________________ Yes No Building 3 ___________________________________________ _________________ _________________ Yes No PTAX-300 front (R-12/09) Attach a copy of the contract or lease. American LegalNet, Inc. www.FormsWorkFlow.com Step 4: Attach documentation T he following documents must be attached: • Proof of ownership (copy of the deed, contract for deed, title insurance policy, condemnation order and proof of payment, etc.) • Picture of the property • Notarized affidavit of use • Copies of any contracts or leases on the property The documents listed on Lines 18 through 23 may be attached to expedite processing. Mark an “X” next to any documents that are attached. 18 ___ Audited financial statements for the most recent year 21 ___ Plot plan of each building’s location on the property with each 19 ___ Copy of the applicant’s bylaws and complete certified building and land area labeled with property index numbers recorded copy of Articles of Incorporation, including purpose and specific uses clause and all amendments 22 ___ Copy of any Illinois Department of Revenue Exemption 20 ___ Copy of the notices to the municipality, school district, Certificate community college district, and fire protection district in which 23 ___ Other (list) ________________________________________ the property is located and postal return receipts if granting _________________________________________________ this application will reduce the property’s assessed valuation _________________________________________________ by $100,000 or more Step 5: Identify the person to contact regarding this application 24 ____________________________________________________ 25 ____________________________________________________ _ Name of applicant’s representative Owner’s name (if the applicant is not the owner) ____________________________________________________ _____________________________________________________ Mailing address Mailing address ____________________________________________________ _____________________________________________________ City State ZIP City State ZIP ( ) — ) — ____________________________________________________ ( _____________________________________________________ Phone number Phone number Step 6: Signature and notarization State of Illinois ) SS. County of ________________________________________ ) I, ______________________________________, _____________________________, being duly sworn upon oath, say that I have read Name Position the foregoing application and that all of the information is true and correct to the best of my knowledge and belief. _______________________________________________________ Affiant’s signature Subscribed and sworn to before me this _____ day of _____________________________, 2______. _______________________________________________________ Notary Public County official use only. Do not write in this space Step 7: County board of review statement of facts 1 Current assessment $__________________________________ For assessment year 2_______ 2 Is this exemption application for a leasehold interest assessed to the applicant? Yes No If “Yes”, write the Illinois Department of evenue docket number for the exempt fee interest to the owner, R if known. ___ ___ — ___ ___ ___ — ___ ___ ___ ___ 3 tate all of the facts considered by the county board of review in recommending approval or denial of this exemption application. S _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ 4 County board of review recommendation ___ Full year exemption ___ Partial year exemption from ___ ___ / ___ ___ / ___ ___ ___ ___ to ___ ___ / ___ ___ / ___ ___ ___ ___ ___ Partial exemption for the following described portion of the property: ___________________________________________________ __________________________________________________________________________________________________________ ___ Deny exemption 5 Date of board’s action ___ ___ / ___ ___ / ___ ___ ___ ___ Step 8: County board of review certification I certify this to be a correct statement of all facts arising in connection with proceedings on this exemption application. Mail to: OFFICE OF LOCAL GOVERNMENT SERVICES MC 3-520 ILLINOIS DEPARTMENT OF REVENUE 101 WEST JEFFERSON STREET PTAX-300 back (R-12/09) SPRINGFIELD IL 62702 _______________________________________________________ Signature of clerk of county board of review American LegalNet, Inc. www.FormsWorkFlow.com General Instructions for Form PTAX-300 When must Form PTAX-300 be completed? Complete Form PTAX-300 to apply for any non-homestead exemption except for a federal/state agency or a religious exemption. • For a federal/state agency exemption, complete Form PTAX-300-FS to apply for a non-homestead exemption under 35 ILCS 200/15-50 or 15-55. • For a religious exemption, complete Form PTAX-300-R to apply for a non-homestead exemption under 35 ILCS 200/15-40. Which steps must the applicant complete? The applicant must complete Steps 1 through 6. The county board of review must complete Steps 7 and 8. Complete all lines and attach all required documents or the county board of review will not accept the incomplete exemption application. If there is not enough space on this form to answer a question fully, attach additional sheets. On the top of each additional sheet, identify the number of each question to which a response is being made. Note: The Cook County Board of Review requires that their complaint form be filed in addition to Form PTAX-300. What must be attached to Form PTAX-300? The following documents must be attached to Form PTAX-300: • Proof of ownership (deed, contract for deed, title insurance policy, copy of the condemnation order and proof of payment, etc.) • Picture of the property • Notarized affidavit of use • Copies of any contracts or leases on the property To expedite processing, attach additional documents as specified in Step 4. Must any taxing bodies be notified that an exemption application has been filed? If granting this application will reduce the property’s assessed valuation by $100,000 or more, the municipality, school district, community college district, and fire protection district in which the property is located must be notified that this application has been filed. How many forms must be filed if an exemption for multiple parcels is being sought? File one application in both of the following situations: • Multiple parcels acquired by the same deed — Form PTAX-300 must identify any variation of use or other qualifying information or characteristic (e.g., leases, photos, affidavits of use) by property index number. • A single parcel that was acquired by multiple deeds. File a separate application for each parcel if multiple parcels were acquired by separate deeds, unless all four of the following conditions are met: • The parcels are contiguous. • All deeds were acquired before the year for which the exemption is now being sought. • Form PTAX-300 identifies which property index numbers are associated with each deed. • Form PTAX-300 identifies any variation of use, other qualifying information, or characteristic (e.g., leases, photos, affidavits of use) by parcel identifying number and deed. Where is Form PTAX­ 300 to be filed? - File the completed and notarized Form PTAX-300 with the county board of review. Contact the county board of review where the property is located to determine the filing deadline and session dates. How is a property’s exempt status determined? The following text is a brief outline of the procedures used to determine exempt status. For more information, see 35 ILCS 200/15-5 through 15-160, 16-70, 16-130, and the Illinois Administrative Code, Title 86, Chapter 1, Section 110.115, Non-homestead Exemption Proceedings, and Sections 200.101 through 200.225, Practice and Procedure for Hearings Before the Illinois Department of Revenue. Links to these references are available on the department’s web site at tax.illinois.gov. Step 1 Obtain Form PTAX-300 from the county board of review where the property is located. Complete the form, have it notarized, attach all required documents, and file the form with the county board of review. Step 2 The county board of review may hold a hearing to evaluate the application and supporting documents. Step 3 The county board of review completes Steps 7 and 8 and recommends whether or not the exemption should be granted before forwarding Form PTAX-300 and all supporting documents to the department. Step 4 The department assigns a docket number, reviews the facts regarding the application, and determines whether or not the exemption should be granted. Note: In some instances, the department will request more information from the applicant, who has 30 days from the date of the department’s request to provide that information. The department mails its decision to • the applicant, • any intervenors, • the county clerk, and • the clerk of the county board of review. The department’s decision is final unless the applicant (or another party to the matter) requests a formal hearing. How is a formal hearing requested if the applicant disagrees with the department’s decision? Formal hearing requests must be made within 60 days after the date of the department’s decision. Mail requests for a formal hearing to the address provided on the exemption decision. The request will be forwarded to the Administrative Hearings Division. The county board of review considers exemption applications for the assessment year for which the board is in session only. It cannot consider an exemption for a previous or subsequent assessment year. PTAX-300 Instructions front (R-12/09) American LegalNet, Inc. www.FormsWorkFlow.com Specific Instructions for Form PTAX-300 Step 1: Identify the property Line 1 — Write the name of the county in which this property is located. Line 2 — Write the property owner as shown on the deed or other proof of ownership. Line 3 — Write the property’s street address. Line 4 — Write the name of the organization applying for the exemption (i.e., “applicant”). Line 5 — Check the box to indicate whether or not the applicant on Line 4 is the lessee of the property. If “Yes”, write the dates the lease is in effect. Attach a copy of the contract or lease. Line 6 — Write the property index number. The chief county assessment officer or the county board of review can provide this number. Attach a copy of the property’s legal description if the county has not assigned a number or if the property is a division. Line 7 — Write the dimensions (square footage) or acreage of this property. Line 8 — Write the date on which ownership began. Attach a copy of proof of ownership (deed, contract for deed, or title insurance policy, etc.). If the property was obtained through condemnation, write the date the condemnation proceedings were filed and attach a copy of the condemnation order and proof of payment. Step 2: Identify any previous exemptions or applications Line 9 — Check the box to indicate whether or not the applicant has an Illinois sales tax exemption number. If “Yes”, write the exemption number. Line 10 — Check the box to indicate whether or not a previous property tax exemption application has been filed for this property or applicant. If “Yes”, write the Illinois Department of Revenue docket number, if known. Step 3: Identify the property’s use Line 11 — Write the Illinois Compiled Statutes (ILCS) citation for this application. Most of the provisions may be found in 35 ILCS 200/15-35 through 15-160. Line 12 — Check the box to indicate whether or not any income is derived from the property. If “Yes”, explain in detail. If applicable, attach a copy of any written contracts, leases, or terms of oral agreement. Line 13 — Check the box to indicate whether or not a unit of local government owns this property. If “Yes”, indicate whether or not the property is located within its corporate boundaries. Line 14 — If granting this application will reduce the property’s assessed valuation by $100,000 or more, the municipality, school district, community college district, and fire protection district in which the property is located must be notified that this application has been filed. Check the box to indicate whether or not notice has been given to these taxing districts. Attach a copy of the notices and postal return receipts. PTAX-300 Instructions back (R-12/09) Line 15 — Describe the specific activities that take place on this property. Write the exact date each activity began and how frequently it takes place. Do not state conclusions about the type of activity such as “charitable” or “educational”. If the property contains more than one building or a building contains more than one floor, separately describe the activities that take place in each building and on each floor. Include the square footage of each building and floor used for each activity. Line 16 — Check the box to indicate whether or not the activities described on Line 15 began on the same date as the effective date of the lease on Line 5 or the date of ownership on Line 8, whichever is applicable. If “No”, explain in detail how the property was used between the lease or ownership date and the date these activities began. Line 17 — Identify the use of each building on the property (e.g., classrooms, fire station). Write the square feet of ground area (SFGA) covered by each building, the number of stories, and indicate whether or not there is a basement. Step 4: Attach documentation The following documents must be attached: • Proof of ownership (copy of the deed, contract for deed, title insurance policy, condemnation order and proof of payment, etc.) • Picture of the property • Notarized affidavit of use • Copies of any contracts or leases on the property Lines 18 through 22 — Mark an “X” next to any documents that are attached. Attaching the documents listed on Lines 18 through 22 may expedite processing. Line 23 — If this property is used as a parking area, playground, lawn, or other ancillary use to an already exempt parcel, attach a copy of the Illinois Department of Revenue Exemption Certificate for the exempt parcel. Make a clear distinction between the parcel that is already exempt and the property for which exemption is now being sought. Describe how each parcel is used and indicate the proximity of the parcels to each other. Step 5: Identify the person to contact regarding this application Line 24 — Write the name, address, and phone number of the person the county board of review and the department should contact regarding this application. Line 25 — If the applicant is not the owner, write the owner’s name, address, and phone number. Step 6: Signature and notarization The application must be signed under oath, verifying that all of the information is true and correct to the best of the applicant’s knowledge and belief. This application must be notarized before sending to the county board of review. American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT FOR TAX EXEMPT USE I, , being duly sworn under oath, understand that the penalty of perjury can be imposed for falsified statements, and do hereby testify as follows: 1) I am the _____________________________________________________________ (Title) for _________________________________________________________________. (Organization) 2) The real property(ies) identified as Permanent Index Number(s) _______________________________ ______________________________ _______________________________ ______________________________ is/are being used solely by the _____________________________________________________________________ (Organization) for tax exempt purposes. 3) That the activity/usage of the property(ies) is as follows: ______________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (attach additional page if needed) Signed: ________________________________________ Subscribed and sworn to before me this day of 20 . _______________________________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com Lake County Board of Review Thomas D. Cooprider, C.I.A.O. Chairman Linda M. Barbera-Stein, C.I.A.O. Robert S. Glueckert, C.I.A.O. Members Martin P. Paulson, M.B.A., M.S. Clerk 18 North County Street – 7th Floor Waukegan, IL 60085-4335 Telephone: (847) 377-2100 CERTIFICATION I, _______________________________________________, do hereby certify that copies Owner, Agent, Attorney of this Application for Tax Exemption to the Lake County Board of Review by _____________________________________________________________________ Applicant have been mailed to the municipality, school district and community college district in which the property is situated on____________________________. Date SIGNED: ____________________________________ DATED: ___________________________ THIS FORM IS TO BE SUBMITTED IN DUPLICATE TO: LAKE COUNTY BOARD OF REVIEW 18 NORTH COUNTY ST WAUKEGAN IL 60085-4335 This form is authorized by the Lake County Board of Review pursuant to Chapter 35 (ILCS) 200/16-70. Any Application for Tax Exemption filed with the Board requesting the removal of $100,000 or more in assessed valuation will not be processed until receipt of this completed form. The Board reserves the right to deny a hearing to any person(s) not in compliance with the aforementioned statute, as provided in the Rules Governing Hearings Before the Board of Review of Lake County, Rule VII. American LegalNet, Inc. www.FormsWorkFlow.com