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Application For Certificate Of Payment Form

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Application for Certificate of Payment

Village of Lincolnwood

6900 N. Lincoln Ave.

Lincolnwood, Illinois 60712

Phone: 847-673-1540

Fax: 847-673-4403

Ordinance # 06-2711 of the Village of Lincolnwood Municipal Code establishing a Certificate of Payment

requires anyone who sells property or transfers real estate to pay any water, local ordinance fines, citations

and penalties related thereto in full before a Certficate of Payment Certificate is issued. This also requires

the Seller to give the Village a five (5) day notice before the scheduled closing to allow sufficent time to

obtain a final meter reading and issue a certificate once all debts to the Village of Lincolnwood have been

paid. This procedure is also required for Quit Claim deeds. Please complete this form not more than ten

(10) days prior to closing and either fax or deliver this form to the Finance Department located at 6900 N.

Lincoln Ave.

Once this application is received the Village will take the appropriate action to obtain a meter reading and

notify the Seller of any monies due the Village. The final amount due may be paid in cash, credit card

(Mastercard /Visa), cashier’s check, certified check or money order. PERSONAL CHECKS NOT

ACCEPTED. Once payment is made the Village will issue a Certificate of Payment certifying that all

amounts owed by the Seller have been paid in full.

SELLER’S NAME ______________________________________________________

SERVICE ADDRESS ____________________________________________________

PROPERTY INDEX NUMBER (PIN) _______________________________________

WATER ACCOUNT NUMBER ____________________________________________

BUYER’S NAME________________________________________________________

SCHEDULED CLOSING DATE AND TIME _________________________________

Phone number for seller ______________________

If you wish to be faxed the final water bill please provide a fax number and the name to which the

the bill should be sent:

Fax # ____________________________ Attention of: __________________________

I REQUEST A FINAL READING AT MY SERVICE ADDRESS. PLEASE NOTIFY ME OF ANY

AND ALL AMOUNTS DUE.

SIGNED __________________________________ DATE: _______________________

( May be signed by the seller or an authorized agent)

THE FOLLOWING IS FOR OFFICE USE ONLY:

Final Water Bill:$ _______________ Judgment: $ ________________

Administrative Citations: $___________________ Parking Ticket:$ _______________

Other:$___________

TOTAL AMOUNT DUE: $ _________________________

Application For Certificate Of Payment Form

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