Form Ptax-764 - Application And Affidavit For Fraternal Organization Assessment Freeze - Cook County

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PTAX-764
2001 Application and Affidavit for
Fraternal Organization Assessment Freeze
What is the Fraternal Organization Assessment Freeze?
who provide, directly or indirectly, financial support for charitable
works, such as medical care, drug rehabilitation, or education.
The fraternal organization assessment freeze (35 ILCS 200/10-350)
allows qualified fraternal organizations chartered by the state of
How do I apply for the assessment freeze?
Illinois prior to 1900, or its subordinate organization or entity, to elect
The fraternal organization’s chief presiding officer should complete
to freeze the assessed value (AV) of the real property it owns and
and sign this Form PTAX-764, to apply for the assessment freeze.
uses. The AV is frozen by the chief county assessment officer (CCAO)
You are required to attach supporting documentation, listed in Item 12.
at 15% of tax year 2000 AV for property that qualifies in tax year
When should I file Form PTAX-764?
2001, or 15% of the AV for property for the tax year the property first
qualifies after tax year 2001. Any improvements or additions made to
For all counties but Cook County: You must file this Form
the property that increase the AV also are frozen at 15% of the AV of
PTAX-764, with your CCAO by December 31, 2001.
the improvement or addition in the year first assessed.
For Cook County: You must file this Form PTAX-764, with the Cook
County Assessor by January 31, 2001.
Who qualifies for this assessment freeze?
What if I need additional assistance?
To qualify, a fraternal organization must prohibit gambling and the use
of alcohol on the property, be an exempt entity under the Internal
If you need additional assistance, please contact your CCAO, whose
Revenue Code (IRC), Section 501(c)(10), and consist of members
address and phone number are at the bottom of this page.
Step 1: Complete the following information
Please type or print
2
Write the property index number (PIN) of the property for which
1
___________________________________________________
Name of fraternal organization
you are requesting this assessment freeze. Your PIN is listed on
your property tax bill or you may obtain it from the CCAO.
___________________________________________________
Street address of fraternal organization’s property
a
PIN __ __ - __ __ - __ __ __ - __ __ __ - __ __ __ __
___________________________________________________
Mailing address, if different than above
b
Write the legal description only if you are unable to
obtain your PIN. ____________________________________
___________________________________________________
City
State
ZIP
_________________________________________________
_________________________________________________
____________________________(______)_______________
Name of contact person
Phone
Step 2: Complete this affidavit
10
3
Write the dimensions or acreage of the property. ___________
Did your organization own or have a legal or equitable ownership
interest in the property on January 1, 2001?
Yes
No
11
Write for each building on the property the square feet of ground
If yes, check and complete the appropriate line.
area (SFGA), number of stories, and if there is a basement.
a
Deed or contract for deed executed __ __/__ __/__ __ __ __
No. of
Basement
Month
Day
Year
SFGA
stories
Y or N
b
Other (specify)
__ __/__ __/__ __ __ __
a
Month
Day
Year
Bldg. 1 _____________ ___________ _______
________________________________________________
b
Bldg. 2 _____________ ___________ _______
4
Is your organization liable for the property taxes
c
Bldg. 3 _____________ ___________ _______
on the property for the 2001 tax year?
Yes
No
12
You must attach copies of the following to your Form PTAX-764:
5
Does your organization lease any of the property
a
• Your organization’s Illinois charter, issued prior to 1900; or
to another person or entity not qualified to
• A certification that your organization either
receive this assessment freeze?
Yes
No
has an Illinois charter issued prior to 1900; or
If yes, you must attach a copy of the lease.
has been chartered by, or is subordinate to, a qualified
6
Does your organization prohibit gambling
fraternal organization holding an Illinois charter issued
and the use of alcohol on the property?
Yes
No
prior to 1900.
b
Proof of exempt status under IRC, Section 501(c)(10), such as
7
Describe your organization’s activities that take place on this
• An IRS group exemption letter to an organization, plus a
property. ____________________________________________
copy of an annual IRS filing by that organization, that lists
______________________________________
__________
your organization covered by the exemption letter; or
8
Do your members provide direct or indirect
• Your U.S. Form 990; or
financial support for charitable works, such as
• Your IRS determination letter, in response to your filing of
medical care, drug rehabilitation, or education?
Yes
No
U.S. Form 1024.
c
Proof of ownership or other legal or equitable interest in the
9
Is the principal building for your organization
property, such as a deed, contract for deed, or trust document.
located on this property?
Yes
No
Under penalties of perjury, I state that, to the best of my knowledge,
Mail your completed Form PTAX-764 to:
the information contained in this affidavit is true, correct, and complete.
__________________________________________ County CCAO
__________________________________________/____/____
Signature of chief presiding officer
Date
_________________________________________________
Mailing address
Subscribed and sworn to before me this
_____________________________________ IL _________
_______ day of ______________, 2000____.
City
ZIP
____________________________________
If you have any questions, please call:
Notary public
(______)_________________________
PTAX-764 (N-12/00)
IL-492-4160

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