Senior Freeze Exemption - Cook County Assessor

Senior Freeze Exemption - Cook County Assessor - 2016

OOK

OUNTY

SSESSOR

OSEPH

ERRIOS

SENIOR FREEZE EXEMPTION

On January 1, 201 , I was (check one):

Separated

Single

Property Index Number(s)

Widowed

Married

Divorced

Property Owner(s) Name(s)

The address of my spouse, if different than the

property address listed, is:

Property Street Address

Zip

City

State

Street Address

Zip

Daytime Phone Number

City

State

Sworn under oath, I state that:

1. The property described above was my principal residence

on January 1, 201 and January 1, 201 .

2. On January 1, 201 and January 1, 201 , I:

a. was the owner of record for the above described property, or

b. had legal or equitable interest in the property, or

Date of Purchase (month/year)

c. had leasehold interest in the property that was used

as a single family residence.

3. I was born in 19

or earlier.

You must include a copy of a recent property tax bill and

Date of Birth

one of the valid forms of proof of age listed below:

Valid forms include:

- Illinois Driver’s License

- Illinois Identification (ID) Card

NOTE: Individuals using forms indicating a previous name must demonstrate a connection to the current name by

including a copy of a marriage certificate or other supporting documents. Owners of Cooperative Apartments must

also submit a copy of their Stock Certificate, Occupancy or Trust Agreement.

4. I was liable for paying 20

and will be liable for paying 201 property taxes on the property described.

5. I have not applied for a Senior Freeze Exemption for any other property for 201 .

6. On January 1, 201 the following

individuals used the property

listed for their principal residence.

Your Name

(List your spouse if he/she used

the property as his/her principal

residence on January 1, 201 .)

Attach an additional sheet if

Name

necessary.

SENIOR FREEZE APPLICATION CONTINUED ON NEXT PAGE

Senior Freeze Exemption - Cook County Assessor - 2016

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