do a!
K 240-4214-5603 01-08-45 ExPir«. 01-08^1:3*,
issued:. 01 :'05-% >
JANET A KOZUI- - ' 899 S PlYM'OUTH CT' CHICAGO 11.60605 '
Female o'Oi';' 160 lbs BLUE eyas.
" Jlhi: ' Best: B " TV(ie: ORG
Chicago City Council -
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 |
1 |
Claimant Name |
Edith P Goldman |
2 |
Claimant Address |
910 S Michigan Avenue Uniyl613 |
3 |
Claimant City, State & Zip Code |
Chicago , IL 60605 |
4 |
Claimant Telephone |
Office 3123609899 |
Home 3123609899 |
Cellular 3127711789 |
5 |
Claimant Birthdate: |
01/07/1940 |
6 |
Property Tax Number: |
PIN 17 - 15 - 307 - 036 - 1217 |
7 |
Water Account Number: |
58-87-255-887-25 |
8 |
Building Type: |
Condo |
Com Units |
Res Units |
|
|
|
|
|
11
i. EDIT/-) c^OLDh AN
_(print your name), the undersigned on
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 ofthe Municipal Code of the City of Chicago. that/SHwater taxes, property taxes, and all other fees, penalties or assessments owed to the city V Chicago have been paid and that I understand I am subject to penalties for perjury or falsificatyon heVeli
OWNER SIG DATE
i-EdifiForfn';
|5Rrjht?;th'is;;ciaj
Please print this and return application to your aldermanic office before July 1
PAY ONLY THIS AMOUNT
$ 1,681.28
BV 12/13/10 (on time)
2009 Second Installment Property Tax Bi
Property Indea Number (PIN)
17-15-307-036-1217
Volume Code Tu Year (Payable in) TowfUhip
510 76027 2009 (2010) SOUTH CHICAGO
IF PAID LATE 12/14,11) - 01/13/11
$ 1,706 50
IF PAID LATE 01/14/11 - 02/13/11
$ 1,731.72
IF PAID LATE 02/14/11 - 03/13/11
$ 1,756.94
THANK YOU FOR YOUR FIRST INSTALLMENT PAYMENT OF.
Property location and classification for this PIN
910 S MICHIGAN AVE CHICAGO IL
LATE PfNALTY IS 1.S% PER MONTH, BV STATE LAW.
Property Classification 2-99
Taxing District
2009 Tax 2009 Rate 2009 *A
Pension
MISCELLANEOUS TAXES
Metio Water Reclamation District Parks-Museum/Aquarium Bond Chicago Park District M/ace/ianeous Taxes Total
200. 15 10. 74 226 22 437. 11
0. 261 0. 014 O. 295 0. 670
5. 64% 0. 30'i
6. 38* 12 32X
11. 50 9 20
SCHOOL TAXES
Board of Education 1.814.39 2.366 51.137.
Chicago Community College Dist 508 115. 03 0. 1 &0 3. 24%
School Taxes Total 1,929.42 2 516 54 37X
MUNICIPALITY/TOWNSHIP TAXES
TIF-Chicago-Near South ■ ■ * *
Chicago Special Service Area 12 0 00 0.000 0.00%
Chicago School Bldg & Imp Fund 85.89 0.112 2
Chicago Library Fund 75.92 0.099 2.14%
City of Chicago - 680.20 0.887 19.177.
UuntctpaUtylTowathlp Taxts Total 842.01 1.098 23 73%
312. 87
COOK COUNTY TAXES
Cook County Forest Preserve District 37 .58 0.049 1.06%
County of Cook 150.30 0.196 4.24%
Cook County Public Safety 87.42 0.114 2.467.
Cook County Health Facilities 64 42 0.084 1.82%
Coo* County Taxes TotaV 339.72 0.443 9.68%
0. 76 54. 44
(Do not pay those totals)
3, 648. 20
4 627 100. 00X
2008 Tax 2008 Rate
177. 62 10. 57 217. 09 406 28
1. 742 36 109. 96 1,862 32
0. 00 0 00 82 47 71.89 654. 09 808 46
35. 95 157. 88 74. 01 60. 62 328.46
3,394 61
0. 252 0. 016 0 306 0. 575
2. 472 0 156 2 628
000 000 117 102 928 147
0. 051 0. 224 0. 105 0. 086 0 466
4 816
TAX CALCULATOR
<i»*M Pk»»ii Jon
20OB
Value
36,655
2009 Property Value
267, 2Z0
2009 Assessment Level
X 10X
2033 Aacaasad Value
- i^ro 25 ■722
2009 State Equalization Factor
X 2 3 3701 -
2009 Equalized Assessed Value (EAV)
=» 7?Tr v 86 688
2009 tB»l IWHat*'-
X U fii 4 627X 2009 Total Tax Before Exemptions
= 4,010.96
Homeowner's Exemption
277.62
Senior Citizen Exemption
185.08
Senior Assessment Freeze Exemption
- 00
2O09 Total Tax After Exemptions
=__3,548.26
First Installment
1,866.98
Second Installment
+ 1 881 28
Total 2009 Tax (Payable In 2010)
= 3,548.28
c
c
7
? p
r C
7
EDITH GOLDMAN
910 S MICHIGAN AV 1613
CHICAGO IL 60605-2290
IF YOUR TAXES ARE PAID BY MORTGAGE ESCROW, BE SURE NOT TO DOUBLE PAY.
PAYMENT COUPON
$ 1,681.28
BY 12/13/10 (on time)
If paying later, rater to amounts above.
□
See the reverse side of this bill for detailed payment instructions. Please include only one check and one original payment coupon per envelope. Use of this coupon authorizes Treasurer's Office to reduce check amount to prevent overpayment.
UNO
Property Index Number (PIN) Volume 17-15-307-036-1217 510
Amount Paid
... , , Include name. PIN, address, location, phone and
Name/Mailing Address Change? Check bm: and complete form on back to update your name and'or mailing address. e-mail on check payable to Cook Counry Treasurer.
ODODlbfilSflk, l?lS307D3bl21?D 00125 00001701.501 0000173175,i 000017St»m3
ii
20 17 15-307-036-1217 3 09 4 550832 EDITH GOLDMAN OR CURRENT OWNER 910 S MICHIGAN AV 1013 CHICAGO IL 80806-2280
l.llll.,lillMi.l...l.ll.ll.lll,,.,lliitll
COOK COUNTY TREASURER PO BOX 44B8
CAROL STREAM IL 60197-4488 I.UII....Iil.ll.l.l»l.llll.ll.li.I(.i.!mII
17153a?03bl217/0/0ci/F/000Dlbai5o/5
Jesse White - Secretary of State
NUMBER ISSUED EXPIRES
43S2-1W0-787G 03-3006 EDITH PG0Lf»4AN
91 os Michigan *v
APT 1613. CHICAGO ll£B6?j8
Birrhdate 07-01-40 Female 504" 110bs BRN Eyes Type Class
_ LIFETIME
City of Chicago
Department of Revenue-Water Division
P.O. Box 6330
Chicago, Illinois 60680-6330
METERED ACCOUNT
Little leaks cause big bills.
Check for and repair leaks.
You must pay for all metered water.
Attn: 910 MICHIGAN AVE LOFT ASSN
588726-588726
Jan-14-2011
Feb-04-2011
:fi:
------------,--.J.JI
Service Address: 9qo.1^g§^ICH^
Summary of Charges-for " Deb:03-2010 thru Jan-06-2Q11
Total Current Watefo-.t..-.:..............:.~-.~:rr~.~ ....A $
Total Current Sew&.j................... :^L99.:-................J.'....... $
$ $ $ $
4....i I
.,.J,....4 $
if3:
Penalty..............-j^.,......................
Total Current Ch^rge|AGP.I!.*iWjpS |, Previous Balance, Adjustments Payments.. Total Due..
BLDG,.#3f3.............:...:,.
BLDG. # . -. .: -S
DME:.nij^]ii,:,.......
APPROVED:
1367:55 1176.09
0.00 2543.64 2152.04
0.00 2152.04 2543.64
Penalties accrue at a rate of 1.25% per month on late balances. ) ■ *
vision pRenTa variety of flexible payfrient plans for water bHIs including a special circumstances/hardship plan for
£ The Department of Revenue's Wal
' those who qualify. Avoid Water shut off or have ywr service restored by entering a plan Visit us on-line or call us for more information.
Meter Reading Details
1000 Cubic Feet = 7480 Gallons
Gallons
16313
16995
91.2
682
□E04E011 □0D5ao7SbDSflfl72b 3 ODD LIES1* 3 b 4 0lJ[]DE543b4 5
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT. ALLOW 5 DAYS FOR PAYMENT BY MAIL.
MAKE CHECK OR MONEY ORDER PAYABLE TO: City of Chicago
Department of Revenue-Water Division P.O. Box 6330
Chicago, Illinois 60680-6330 Service Address: 900 12 S MICHIGAN AVE CHICAGO IL 60605-2201
588726-588726
Feb-04-2011
$2543.64
1.2.113 04509Dll.p01
"H'hi'llM'iT'H'''''"ill''iil''lil1i'lllil"llilillil'li Amount Paid: $
Attn: 910 MICHIGAN AVE LOFT ASSN C/O JAMIE MANAGER 910 S MICHIGAN AVE CHICAGO IL 60605-2356
304246
Dfiu4E0.ll DDD5flfl7EbD5a67Eh 3 □Q0D2543b4 □□□02543b4 5
City of Chicago
Department of Revenue-Water Division
P.O. Box 6330
Chicago, Illinois 60680-6330
METERED ACCOUNT
Little leaks cause big bills.
Check for and repair leaks.
You must pay for all metered water.
i:^USTOMER?NAME:vV;te:^^!%
Attn: 910 MICHIGAN AVE LOFT ASSN 588725-588725
Service Address: 900 12 S f^lGA^^C^ Summary of Charges for' Nov-15-2010 thru Dec-15-2010 Total Current Water
Dec-22-2010
Jan-12-2011
Total Current Sewer..{". '
Penalty.....................
Total Current Charg
Previous Balance.....
Adjustments............
Payments.................
Total Due.................
VENDOR"'£'"J _
■acct:»;;lc,H'S ■jSLDG:"'#"3q
BLDG.tf
DATE":"'" V" j' 3' J" 'l'l
APPROVE./:
660.00 567.60 0.00 1227.60 1813.50 0.00 1813.50 1227.60
Penalties accrue at a^rate^of 1.25% per month on late balances.
-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 Cubic Feet = 7480 Gallons
Cubic Feet
7241
7285
44
329.1
01122011 0005flfl72505flo725 5 00001227b0 0QD01227b0 0
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT. ALLOW 5 DAYS FOR PAYMENT BY MAIL.
MAKE CHECK OR MONEY ORDER PAYABLE TO: City of Chicago
Department of Revenue-Water Division P.O. Box 6330
Chicago, Illinois 60680-6330 Service Address: 900 12 S MICHIGAN AVE CHICAGO IL 60605-2201
^COUNTaUMBERS |§MfpATJE^ ^^^OTAL-DUE;^
588725-588725
Jan-12-2011
$1227.60
1.1.73 01426D13.p01 "SNGLP
l---ii|-liI-i-rllliili-i-ll-ll-Bi-il-ilii|iIlli>--ft->-f-JI-lfP-
Attn: 910 MICHIGAN AVE LOFT ASSN C/O JAMIE MANAGER 910 S MICHIGAN AVE CHICAGO IL 60605-2356
Amount Paid: $
01122D11 0005307250500725 5 00001227b0 00001227b0 0