Form Ptax-762 - Application For Model Home Assessment
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1PTAX-762
Application for Model Home Assessment
Who should complete this form?
You should complete this form to request an alternate assessment if your property is used for model home purposes. The
property must be a single-family residence, townhome, or condominium, used solely as a model home for prospective buyers,
and not occupied as a dwelling. The model home may contain home furnishings, appliances, office equipment, and offices to
further sales activities. No more than 3 model homes can be located within a 3-mile radius, the center of which is the model
home that has been used for the longest period of time.
No model home can be used for model home purposes longer than 10
years. You must file this form with the chief county assessment officer (CCAO), at the address shown below by December 31
of each assessment year. Note: When any portion of this property no longer qualifies as a model home, you must notify the
CCAO by completing Form PTAX-762-C, Certificate of Ineligibility for Model Home Assessment, within 60 days.
Step 1:
Complete the following information
_____
Single-family residence
____________________________________
_____
This model home is a
Townhome
1
5
Property owner’s name
_____
Condominium
_________________________________________________
Street address
Have you applied for other model home assessments in this
6
county?
NO
YES
_________________________________________________
City
State
Zip
Write the property index number (PIN) of the property for
(______)________________________________________
7
Phone
which you are requesting this model home assessment.
Send notice to (if different than above)
_______________________________________
2
PIN
__ __ - __ __ - __ __ __ - __ __ __
Name
_________________________________________________
Mailing address
Lot
Block
_________________________
_______________________
Subdivision Name_______________________________
_________________________________________________
City
State
Zip
8 Write the address of the property, if different than
the address in Item 1.
(______)_________________________________________
Phone
Write the assessment year for
_______________________________________________
3
which you are requesting this
Street address
model home assessment.
____ ____ ____ ____
Write the date the property
_______________________________________________
4
began to be used for
City
State
Zip
model home purposes.
________/_______/_________
Month
Day
Year
Step 2:
Sign below
Under penalties of perjury, I state that, to the best of my knowledge, the information contained in this application is true, correct, and
complete.
_____________________________________________ ______/______/______
Property owner’s or authorized representative’s signature
Date
Subscribed and sworn to before me this
________day of ____________,___ ___ ___ ___.
________________________________________________
Notary public
Mail your completed Form PTAX-762 to:
If you have any questions please call:
MCHENRY COUNTY
(815) 334-4290
CHIEF COUNTY ASSESSMENT OFFICER
2200 N SEMINARY AVENUE
WOODSTOCK IL 60098
For use by the CCAO
(Do not write in this space)
Approved
Denied
Reason for Denial ___________________________________________
__________________________________________________________
PTAX-762 (R-8/2000) IL-492-3076
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