Application For Senior Citizen'S Homestead Exemption - Lake County - State Of Illinois Form - 2004

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Application for Senior Citizen's Homestead Exemption
Lake County, Illinois
1. Township: ____________________________________________
2. Applicant Name: _____________________________________
3. Permanent Index Number: __________________________________
4. 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.
5. The undersigned states that he/she will be 65 years of age or older during the assessment year
in question, having been born on the following date:
_______________________________
Month / Date / Year
6. The undersigned also states that the above-described real property is occupied as the primary
residence by the undersigned.
7. 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 #______________________ Dated: ________________
.
If the parcel is held in trust, a copy of the trust agreement indicating the beneficiary is required
____ Lease Agreement on a Single Family Residence
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.)
8. 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.
____________________________
___________________
Owner (or Lessee’s) Signature:
Dated:
_________________________________________
Street Address:
________________________________________
______
City, State, Zip:
Phone #: ________________
Township use only
Begin exemption on (date): _______________________
Rev. 10/04

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