2 0 1 8 Certificate of Error Application for Taxable ...

1 17 Certificate of Error Applicationfor Taxable PropertiesAppeal NumberTownDO NOT USE this form if you are requesting a Certificate of Error (C/E) for a Homeowner Exemption, Senior Exemption, Senior Freeze Exemption or exempt Index Number(s) (use PIN in effect during C/E year) Certificate of Error Year(s) (identify each year requesting C/E)For Office Use Only Grant Deny Date(use back of this page for additional PINs)Property ClassReason 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)16 5 COOK COUNTY ASSESSORJOSEPHBERRIOSCOOK COUNTY ASSESSOR'S OFFICE118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: FAX: : By accepting this Application , there is no guarantee that the C of E will be approved.

2 This is especially true if, for the same year(s), there is also an appeal pending before the Illinois Property Tax Appeal Board which has either been adjudicated or has not been Year2 0 1 8 Certificate of Error Applicationfor Taxable PropertiesAppeal NumberTownTownshipAdditional Property Index NumbersProperty Index Number(s) (use PIN in effect during C/E year) Certificate of Error Year(s) (identify each year requesting C/E)For Office Use Only Grant Deny Date 51617 COOK COUNTY ASSESSORJOSEPHBERRIOSCOOK COUNTY ASSESSOR'S OFFICE118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: FAX: 0 1 8 Appeal Year