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Form Ptax-300 - Application For Non-Homestead Property Tax Exemption - County Board Of Review Statement Of Facts Page 7

Lake County Board of Review

Thomas D. Cooprider

, C.I.A.O.

Chairman

Linda M. Barbera-Stein, C.I.A.O.

Gunta Z. Hadac

Members

Martin P. Paulson, M.B.A., M.S.

Clerk

18 North County Street – 7

Floor

Waukegan, IL 60085-4335

Telephone: (847) 377-2100

CERTIFICATION

I, _______________________________________________, do hereby certify that copies

Owner, Agent, Attorney

of this Application for Tax Exemption to the Lake County Board of Review by

_____________________________________________________________________

Applicant

have been mailed to the municipality, school district and community college district in

which the property is situated on____________________________.

Date

SIGNED: ____________________________________

DATED: ___________________________

THIS FORM IS TO BE SUBMITTED IN DUPLICATE TO:

LAKE COUNTY BOARD OF REVIEW

18 NORTH COUNTY ST

WAUKEGAN IL 60085-4335

This form is authorized by the Lake County Board of Review pursuant to Chapter 35 (ILCS) 200/16-70. Any

Application for Tax Exemption filed with the Board requesting the removal of $100,000 or more in assessed valuation

will not be processed until receipt of this completed form. The Board reserves the right to deny a hearing to any

person(s) not in compliance with the aforementioned statute, as provided in the Rules Governing Hearings Before the

Board of Review of Lake County, Rule VII.

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Form Ptax-300 - Application For Non-Homestead Property Tax Exemption - County Board Of Review Statement Of Facts Page 7