Lake County Board of Review Thomas D. Cooprider, C.I.A.O. Chairman Linda M. Barbera-Stein, C.I.A.O. 3HWH )OHPLQJ Members Martin P. Paulson, M.B.A., M.S. Clerk 18 North County Street – 7th Floor Waukegan, IL 60085-4335 Telephone: (847) 377-2100 REQUEST TO INTERVENE IN APPEAL PROCEEDING Form Must be Filed in Quadruplicate Board of Review Appeal Number: __________________ Permanent Index Number: _______________________________ Date of Hearing: ___________________ Time of Hearing: ______________________ Name of Appellant: ____________________________________________________________ Now comes ___________________________________________________________________________ and applies to the Lake County Board of Review for leave to intervene in an appeal proceeding before the Board. The Intervenor’s interest in this appeal is as: _______ The taxpayer or owner of the subject property _______ A taxing district which has a revenue interest in the subject property. _________________________________________ Intervenor Name _________________________________________ Attorney Name _________________________________________ Intervenor Street Address _________________________________________ Attorney Firm Name _________________________________________ Intervenor City State Zip _________________________________________ Attorney Street Address _________________________________________ Intervenor Phone Number _________________________________________ Attorney City State Zip ______________________________________________ _____________________________________________ Signature of Intervenor or Attorney Attorney Phone Number Dated this _____ day of __________________, 20_____. Note: Must be submitted to the Board of Review at least five days in advance of the scheduled hearing. American LegalNet, Inc. www.FormsWorkFlow.com