City of Chicago Claim Form
Application For Senior Citizens Sewer Charge Annual Refund
Fill in the fields below and print form. Sign and take this to your alderman's office.
FOR OFFICIAL USE ONLY
CLAIM*_
WARD_
DATE_
STATUS_
R_
Note: *AII Fields Must Be Filled In
Claimant Name
5■ NAsesn Annrth
Claimant Address
Claimant
City, State & Zip Code
, IL r &*£2-£>
Claimant Telephone
Office
Home
121
Cellular
Claimant Birthdate:
Property Tax Number:
PIN - - - -
Water Account Number:
Building Type:
Com Units
a
Res Units
_(print your name), the undersigned on
11
oath deposes and states that I am the applicant on this application, that I am the owner of record of said real estate property or that I have a legal or equitable interest therein, that I am 65 years of age or older, and otherwise qualify for a refund under Section 3-12-050 of the Municipal Code of the City of Chicago, that all water taxes, property taxes, and all other fees, penalties or assessments owed to the City of Chicago have been paid and that I understand I am subject to penalties for perjury or falsification herein.
OWNER SIGNATURE:.
5 -A/^^ AKy*^
DATE: ^^V^^S^/y^ W^^/d//
1 Edit Form
Please print this and return application to your aldermanic office before July 1
) 2007 Chicago City Council - Committee on Finanace. All Rights Reserved
Cook County Assessor s Office
118 North Clark Street, Chicago, IL 60602
We are pleased to inform you that the Cook County Assessor's Office has issued a Certificate of Error which may affect yo:;r property taxes. Please note that the issuance of the Certificate of Erro. is only the first step in the process. The Certificate of Error becomes final only after the Assessor's Office or the Circuit Court approves it.
The information below details the recommended tax amount due for your property The recommendation assumes that the Certificate of Error will be finally approved. If the Certificate of Error is denied, you will be liable for the entire amount of the original tax bill. Please refer to the enclosure for further details concerning Certificates of Error.
You will receive written notice of final approval or denial of your Certificate of Error. If the Certificate of Error receives final approval, your tax bill will be adjusted accordingly. If the final approval of the Certficate of Error entitles you to a refund, the Cook County Treasurer will send you a refund - or an application for a refund.
Please review the reverse side of this bill for detailed payment instructions and locations.
It is strongly advised that you retain a copy of this letter for your records.
Sincerely,
ames M. Houlihan Cook County Assessor
PROPERTY LOCATION: 1524 W FARWELL AVE CHICAGO IL 60626
DATE: NOV. 15, 2010 CERTIFICATE OF ERROR NO.: 0003032 TAX YEAR: 2009
If payment received or postmarked by:
11/18/2010 - 12/13/2010
12/14/2010 - 1/13/2011
1 /14/2011 - 2/13/20JU1_
2/14/2011 -^3rr3/2011
Original tax payment due
Adjusted Tax payment due
2,227.02 2,260.43 2,293.84 2,327.25
438.46 445.04 451.62 458.20
\
PROPERTY INDEX NUMBER:
Original Assessed Value: Original Equalized Assessed Value: Recommended Assessed Value: Recommended Equalized Assessed Value:
11-32-115-021-1003
24 58 24 20
543 712 543
,057
Total Original Tax * Total Taxes Paid Original Balance Due '
2,716.60 Total Recommended Tax
489.58 Total Taxes Paid 2,227.02 Recommended Balance Due
928.04 489.58 438.46
" Please note, if the Certificate of Error is denied and money is due on the original bill, interest and penalties wil to that delinquent amount.
d:ii.........................
additional be added
,.,r»-------
______lJ T~
City of Chicago
Department of Revenue-Water Division
P.O. Box 6330
Chicago, Illinois 60680-6330
Little bills.
METERED ACCOUNT
leaks cause big
Check for and repair leaks.
You must pay for all metered water.
FARWELL TERRACE CONDO ASSN
429812-429812
Oct-07-2010
Oct-28-2010
Service Address: 1522 24 W FARWELL AVE CHICAGO IL 60626-3646
Summary of Charges for Aug-02-2010 thru Oct-01 -2010
Total Current Water..................................................................................... $
Total Current Sewer.................................................................................. $
Penalty....................................................................................................... $
Total Current Charges............................................................................ $
Previous Balance....................................................................................... $
Adjustments............................................................................................... $
Payments................................................................................................... $
Total Due................................................................................................ $
Penalties accrue at a rate of 1.25% per month on late balances.
581.51 500.10 0.00 1081.61 604.20 0.00 604.20 1081.61
The Department of Revenue's Water Division offers a variety of flexible payment plans for water bills including a special circumstances/hardship plan for those who qualify. Avoid Water shut off or have your service restored by entering a plan. Visit us on-line or call us for more information.
Meter Reading Details
1000 OncA: :"e-st = 7430 Ga-fcns
Gallons
1550
1840
38.8
290
10532010 DQQMEiaiaQMaiflia 1 OOOOlOfllbl OOOOlOfllbl b
Keep this receipt as a record of your purchase.
for your protection save this copy Customer Copy
CASHIER'S CHECK
1349901736
Illinois 11/24/2010
Remitter S NASEEM AHMAD
Pay To The COOK COUNTY TREASURER Order Of 11321150211008
□rawer: JPMORGAN CHASE BANK, N.A.
NON NEGOTIABLE________________
TERMS
KEEP THIS COPY FOR YOUR RECORD "OTTHI TRANSACTION.
PLEASE CONTACT CHASE TO REPORT A LOSS OR FOR ANY OTHER INFORMATION ABOUT THIS ITEM.