Application For Senior Citizen'S Homestead Exemption - Lake County, Illinois Form
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1Application for Senior Citizen’s Homestead Exemption
Lake County, Illinois
Parcel Index Number:_____________________________ Township:__________________________________
Applicant Name:__________________________________________ Date of Birth:______/_______/_________
Is the property owned in Trust? Yes_____
No_____
If yes, a copy of the portion of the trust agreement indicating the beneficiary is required.
Applicant Name:__________________________________________ Date of Birth:______/_______/_________
Is the property owned in Trust? Yes_____
No_____
If yes, a copy of the portion of the trust agreement indicating the beneficiary is required.
A homestead exemption is requested on the grounds that the requirements of Chapter 35 (ILCS), Act 200, Section 15-
170, relative to the Senior Homestead Exemption have been met as set forth below.
1. The undersigned states that the above-described real property is occupied as the primary residence by the undersigned.
2. The undersigned states that he/she will be 65 years of age or older during the assessment year in question. One owner must
meet this requirement to apply.
3. The undersigned also states that no other application for Homestead Exemption has been or will be filed by him/her on any
other real property in Illinois or elsewhere.
4. The undersigned also states that he/she is liable for paying real estate taxes on the above described property and is the owner
of record of said property, or is a lessee of said real property which is a single family residence. Attach one of the following
written instruments supporting these statements (check one):
____ Recorded Deed – Document # _________________ Signature Date of Deed (not recording date):______________
____ Lease Agreement on a Single Family Residence
If ownership is under two years, was a Senior Exemption granted at the previous address: Yes____ No____
Previous Address:_________________________________________________________________________________
THE FOLLOWING DOCUMENTS MAY ONLY BE USED IF THE ABOVE ARE NOT AVAILABLE
____ Contract for Deed – Document #_______________________________________
____ Title Guarantee Policy
____ Beneficial Interest in a Trust – Document #_______________________________
____ Will (Indicate date of death and date executor was appointed.)
____Inheritance By Laws of Descent (Indicate date of death & relationship.)
NOTE: The exemption application is subject to review and approval by the Lake County Board of Review.
Owner (or Lessee’s) Signature:__________________________________ Dated:_____________________________
Owner (or Lessee’s) Signature:__________________________________ Dated:_____________________________
Street Address:_________________________________________________________________________________
City, State, Zip: _______________________________________Phone #: (_______)_________-________________
Township use only: Begin Exemption on (date):______/_______/____________
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