Ptax-766 Form - Application And Affidavit For Irc 501(C)(2), (C)(8), Or (C)(10) Fraternal Organization Assessment Freeze
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PTAX-766
Application and Affidavit for IRC 501(c)(2), (c)(8), or (c)(10)
Fraternal Organization Assessment Freeze
Step 1: Complete the following information
Please type or print.
3
1
Write the assessment year for which you are applying.
___________________________________________________
Name of fraternal organization
Assessment year: ___ ___ ___ ___
___________________________________________________
Street address of fraternal organization’s property
4
Is this the first time you are applying for this
assessment freeze?
Yes
No
___________________________________________________
Mailing address, if different than above
Note: If “Yes,” please see the instructions for what attachments
you must send along with this form.
___________________________________________________
City
State
ZIP
(
)
—
5
Are you renewing this assessment freeze and
___________________________________________________
Name of contact person
Phone
have no changes to report for this
assessment year?
Yes
No
2
Note: If “Yes,” the chief presiding officer only needs to complete
Write the property index number (PIN) of the property for which
Step 1, sign this form, and have it notarized before filing
you are requesting this assessment freeze. Your PIN is listed on
with the CCAO.
your property tax bill or you may obtain it from the chief county
assessment officer.
6
Are you renewing this assessment freeze and
a
have changes to report for this assessment
PIN _____________________________________________
b
year?
Yes
No
Write the legal description only if you are unable to obtain
Note: If “Yes,” the chief presiding officer needs to complete
your PIN. _________________________________________
Step 1, any lines in Step 2 that have changed, sign this
_________________________________________________
form, and have it notarized before filing with the CCAO.
_________________________________________________
See “How do I renew the assessment freeze?” for what
_________________________________________________
you may need to attach.
_________________________________________________
Step 2: Complete this affidavit
7
10
Did your organization own or have a legal or
Describe your organization’s activities that take place on this
property. ___________________________________________
equitable interest in the property on January 1
___________________________________________________
of this assessment year?
Yes
No
11
Do your members provide direct or indirect
If “Yes,” check and complete the appropriate line below.
financial support for charitable works, such as
a Deed or contract for deed executed __ __/__ __/__ __ __ __
Month
Day
Year
medical care, drug rehabilitation, or education?
Yes
No
b Other (specify)
__ __/__ __/__ __ __ __
Month
Day
Year
12
Is the principal building for your organization
located on this property?
Yes
No
_______________________________________________
13
8
Is your organization liable for the property
Write the dimensions or acreage of the
taxes on the property for this assessment
property. ___________________________________________
year?
Yes
No
14
Write for each building on the property, the square feet of
9
Does your organization lease any of the
ground area (SFGA), number of stories, and indicate if there is a
property to another person or entity not
basement.
qualified to receive this assessment freeze?
Yes
No
No. of
Basement
SFGA
stories
Y or N
If “Yes,” you must attach a copy of the lease.
a Bldg. 1
________________ __________ _______
b Bldg. 2
________________ __________ _______
c Bldg. 3
________________ __________ _______
Under penalties of perjury, I state that, to the best of my knowledge, the information contained in this application and affidavit is true, correct,
and complete.
______________________________________________/____/____
Subscribed and sworn to before me this
Signature of chief presiding officer
Date
________ day of _________________________, 20____.
____________________________________________________
Notary public
PTAX-766 (N-1/03)
IL-492-4341
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