FOR OFFICIAL CLAIM#_ USE ONLY WARD__
: . DATE_
. STATUS_ R
APPLICATION FOR SENIOR CITIZENS SEWER CHARGE ANNUAL REFUND JER NAME:—
Last Name First Name . M.I.
ygp AnORRSS: 6/0/ *£$£&/7^/ £ ^>£>B
Apt#
:AG.O, IL 606^0 HOME PHONE #: (773). 74/ -7/a^
•JER BIRTHDATE: J? I £-/ /£ <T?R A rrOT-TNT NUMBER: ^5"c2 ^> 6r?" .¥£" 26> "3 id on water bill)
PERTY TAX NUMBER: id on property tax biff)
E OF STRUCTURE: (£XJ> Condominium Unit
2. ) Townhouse
3. ) Cooperative Apartment
/P/& £>OJ> the undersigned on oath depose and state that I am
print name here) -
applicant on this application, that I am the owner of record of said real estate property or that I have al or equitable interest therein, that I am 65 years of age or older, and otherwise qualify for a refund :r Section 3-12-050 of the Municipal Code of the City of Chicago. That all water taxes, property s, and all other fees.^enalties or assessments owed to the City of Chicago have been paid and that I :rstand I am subject to penalties for perjury or falsification herein.
NERSIP-NATURE: ^^^^ _DATE:- £,///£-&//
PLEASE RETURN TO YOUR ALDERMAN'S OFFICE BEFORE JULY 1
Alderman Mary Ann Smith 48th Ward
5533 North Broadway Chicago Illinois 60640 ATTN: Ann Felger
TSf RUCTIONS TO BE ELIGIBLE FOR THE SEWER CHARGE ANNUAL — REFUND
u must be 65 years of age or older as of January 1 for the year you are applying;
u must be the sole owner, or owner in joint tenancy, or tenancy in:'tommon of the property;
u must occupy the property as your principal place of residence;
u must own a townhouse, condominium unit, or cooperative apartment that shares a common water
ree documents must be submitted with your application: You can choose 1 item from each of the lowing lists:
>st recent WATER LL
can obtain by ting your building don)
will verify the water or assessed account the water account r
• 2nd Installment of most recent tax bill indicating you are receiving the Senior Citizen Homestead Deduction;
or
• Copy of the approved ...
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