Application for the Homestead Exemption
for Persons with Disabilities
Complete the following information
Provide your date of birth:
Property owner’s name
Enter the assessment year for which you are requesting this
Street address of homestead property
___ ___ ___ ___
__________________________________ IL ___________
Enter the property index number (PIN) of the property for which
you are filing this form. Your PIN is listed on your property tax
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.
PIN is parcel number and can be found on the top right corner on property tax bill
Did you receive this exemption on this property
in the prior assessment year?
Complete eligibility information
On January 1, were you a resident of a facility
Check your type of residence.
licensed under the ID/DD (intellectually disabled/
developmentally disabled) Community Care Act,
Nursing Home Care Act, Specialized Mental
Health Rehabilitation Act of 2013, or MC/DD (Medically
Complex for the Developmentally Disabled) Act?
Is the residence operated as a cooperative?
Is the residence a life care facility
under the Life Care Facilities Act?
a enter the name and address of the facility.
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?
was this property occupied by your spouse?
On January 1, were you the owner of record or
did you have a legal or equitable interest in this
did this property remain unoccupied?
property or did you have a life care contract
with a facility under the Life Care Facilities Act?
On January 1, were you liable for the payment
If No, enter when you acquired
of real estate taxes on this property?
interest in this property:
Note: You may attach a separate sheet describing your
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
section “What documentation is required?” on the back of
Attach proof of ownership
Check the documentation you are attaching as proof you are the
Enter the date the written
owner of record or have legal or equitable interest in the property.
instrument was executed:
Contract for deed
If known, enter the date recorded and document number from the
Life care contract
Other written instrument
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
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.