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Certificate of Error Application for Exempt ... - …

Appeal YearCertificate of Error Applicationfor Exempt PropertyAppeal NumberDO NOT file this form if the property does not qualify as Exempt from property Index Number(s) property ClassFor Office Use Only Grant Deny Date(attach separate sheet for additional PINs)Reason for C/E (be specific)Signature of Owner/LesseeDateZipStateCityApplicant's Street AddressApplicant's NameDaytime Phone NumberSignature of RepresentativeDateZipStateCityRepresenta tive's Street AddressRepresentative's Name/Firm NameDaytime Phone NumberFOR REPRESENTATIVE ONLY (IF APPLICABLE)TownshipC/E YearPage 1 of 3 COOK COUNTY ASSESSORJOSEPHBERRIOSCOOK COUNTY ASSESSOR'S OFFICE118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: FAX: Other:Appeal YearCertificate of Error Applicationfor Exempt PropertyAppeal NumberTownshipDocument SchedulePINs:Check box if document is Year1. Affidavit(must submit an original and a copy of one of the following items:):Department of Revenue Letter or Department of Revenue Hearing DispositionNotice of Road TakingDepartment of Local Government Affairs LetterCourt OrderMemorandum from the Cook County Assessor's Office Legal DepartmentRecorded Deed (if property transferred to a trust, then the assignment of the beneficial interest must also be submitted)Installment Agreement, Articles of Agreement or Contract of SaleComplaint to Condemn, Order Vesting Title and Final Judgement Order (include "Exhibit A" which contains the legalPlat of DedicationO)

5. Other: Appeal Year Certificate of Error Application for Exempt Property Appeal Number Document Schedule Township PINs: Check …

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