Transcription of Certificate of Error Application for Exempt ... - …
1 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 DedicationOther:Affidavit of UseContinuing Use Affidavit (if this is submitted, then a copy of the applicable division must also be included.))
2 2. Proof of Ownership(must submit two copies of one of the following items:):description of the property in question), and the receipt for the Condemnation Deposit (from the Treasurer's Office).3. Administrative Decisions(must submit two copies of one of the following items:):4. MiscellaneousDivision(if the property Index Number is different on any of the documents submitted)Block cover (if there is an older division, multiple divisions, or if copy of division is not available)Lease agreement (or Court Order for Eviction)Amendment to the Articles of Incorporation changing the name (if organization's current name is different than what is listedon the other documents submitted)Page 2 of 3 COOK COUNTY ASSESSORJOSEPHBERRIOSCOOK COUNTY ASSESSOR'S OFFICE118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: FAX: ScheduleCertificate of Error Applicationfor Exempt PropertyPage 3 of 3 Notary StampSignature of Affiant* property Street AddressCityStateZipDaytime Phone Number*This Affidavit must be signed by someone who has personal knowledge of the property at the time in further this affiant sayeth not.
3 (Affiant's Name)(Title in Organization)ofbeing first duly sworn deposes and says that:(Name of Organization)(list below property Index Numbers as listed on the Department of Revenue Letter)(Address, City, State, Zipcommonly known aswas acquired on by(Date)(Type of Document (attached))(Date)and further states that said property was used fromto(Date)as(state use of property )Signature of Notary*Subscribed and sworn before me this day of,COOK COUNTY ASSESSORJOSEPHBERRIOSCOOK COUNTY ASSESSOR'S OFFICE118 NORTH CLARK STREET, CHICAGO, IL 60602 PHONE: FAX.)
