Form Ptax-343 - Application For The Homestead Exemption For Persons With Disabilities
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1
2PTAX-343
Application for the Homestead Exemption
for Persons with Disabilities
Step 1:
Complete the following information
1
________________________________________________
3
______/_____/____________
Provide your date of birth:
Property owner’s name
Month
Day
Year
________________________________________________
4
Enter the assessment year for which you are requesting this
Street address of homestead property
___ ___ ___ ___
exemption:
__________________________________ IL ___________
Year
City
State
ZIP
5
Enter the property index number (PIN) of the property for which
(_____)______-___________
_______________________
you are filing this form. Your PIN is listed on your property tax
Daytime phone
Email address
bill or you may obtain it from your Chief County Assessment
Send notice to (if different than above)
Officer (CCAO). If you are unable to obtain your PIN, attach a
copy of the legal description.
2
________________________________________________
a
Name
PIN ___________________________________________
________________________________________________
PIN is parcel number and can be found on the top right corner on property tax bill
6
Did you receive this exemption on this property
Mailing address
________________________________________________
in the prior assessment year?
Yes
No
City
State
ZIP
(_____)______-___________
_______________________
NOT REQUIRED
Daytime phone
Email address
Step 2:
Complete eligibility information
10
7
On January 1, were you a resident of a facility
Check your type of residence.
licensed under the ID/DD (intellectually disabled/
Single-family dwelling
Duplex
developmentally disabled) Community Care Act,
Townhouse
Condominium
Nursing Home Care Act, Specialized Mental
Other____________________________________________
Health Rehabilitation Act of 2013, or MC/DD (Medically
Complex for the Developmentally Disabled) Act?
a
Is the residence operated as a cooperative?
Yes
No
Yes
No
b
Is the residence a life care facility
If Yes,
under the Life Care Facilities Act?
Yes
No
a enter the name and address of the facility.
c
If Yes to a or b above, is the person with the
_________________________________________________
disability liable by contract with the owner(s)
_________________________________________________
for payment of property taxes?
Yes
No
b
was this property occupied by your spouse?
Yes
No
8
On January 1, were you the owner of record or
did you have a legal or equitable interest in this
c
did this property remain unoccupied?
Yes
No
property or did you have a life care contract
with a facility under the Life Care Facilities Act?
Yes
No
11
On January 1, were you liable for the payment
a
If No, enter when you acquired
of real estate taxes on this property?
Yes
No
______/_____/____________
interest in this property:
Month
Day
Year
Note: You may attach a separate sheet describing your
9
On January 1, did you occupy this
specific factual situation. You must provide the documents
property as your principal residence?
listed on the back of this form as proof of your disability. See the
Yes
No
section “What documentation is required?” on the back of
this form.
Step 3:
Attach proof of ownership
12
Check the documentation you are attaching as proof you are the
13
Enter the date the written
owner of record or have legal or equitable interest in the property.
______/_____/____________
instrument was executed:
Month
Day
Year
Deed
Contract for deed
14
If known, enter the date recorded and document number from the
Trust agreement
Life care contract
county records.
Other written instrument
Lease
______/_____/____________
______________________
____________________
Specify:
Month
Day
Year
Document number
Step 4:
Sign below
I state that to the best of my knowledge, the information on this application is true, correct, and complete.
____________________________________________________
______/_____/____________
Property owner’s or authorized representative’s signature
Month
Day
Year
This form is authorized in accordance with the Illinois Property Tax Code. Disclosure of this information is required.
Failure to provide information may result in this form not being processed and may result in a penalty.
PTAX-343 (R-08/15)
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