201 Taxpayer Exemption Application Cook County Assessor
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O
OOK
OUNTY
SSESSOR'S
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OOK
OUNTY
SSESSOR
118 N
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, C
, IL 60602
ORTH
LARK
TREET
HICAGO
J
B
O S E P H
E R R I O S
P
: 312.443.7550
HONE
201 TAXPAYER EXEMPTION APPLICATION
Property Index Number(s)
Owner / Taxpayer
Property Index Number(s)
Property Address
Zip
Daytime Phone Number
City
State
201 HOMEOWNER EXEMPTION
As owner of the above property, I hereby apply for the Homeowner Exemption. I affirm by signature that this property was
occupied by its current or previous owner as a principal residence as of January 1, 201 . I understand that it is against
the law to provide false information on this Homeowner Exemption application.
Applicant's Signature
Date
201 SENIOR CITIZEN EXEMPTION
IF YOU ARE APPLYING FOR THIS EXEMPTION FOR THE FIRST TIME AT THIS ADDRESS, you must include a
copy of a recent property tax bill and a copy of one of the following valid forms of proof of age and residency with
this application: an Illinois Driver's License (both sides) OR an Illinois Identification (ID) Card.
NOTE: Individuals using forms indicating a different name must demonstrate a connection to the current name by
including a copy of a marriage certificate or other supporting documents. Owners of Cooperative Apartments must also
submit a copy of their Stock Certificate, Occupancy or Trust Agreement.
I affirm that I was born in 194 or earlier, or my spouse was born in 194 or earlier and myself or my spouse is liable for
payment of the taxes and that this property was occupied by its current or previous owner as a principal residence.
Date of Occupancy
Date of Birth
Applicant's Signature
Date
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