City of Chicago
Commiltee on Finance
Alderman Edward M. Burke City Hall • Room 302 • 60602 Telephone
Chairman www.comniilleeonfinance.org
312-744-3380
February 18, 2011
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017*003*********3-DIGIT 606 LEWIS, DWIGHT 1812 S FEDERAL ST APT 15 CHICAGO, IL 60616-1652
For Official Use Only: Ward:_
Intro. Date:.
Status:_
Reason:_
Claim Number: 1022420
Index Number: 1721408029 1015
Water Account Number: 518445518445
2011 SENIOR CITIZENS SEWER REFUND RENEWAL
Dear Senior Citizen:
Your 2011 application for the Senior Citizen's Sewer Rebate was presented to the City Council by: PAT DOWELL of Ward 03.
To determine whether your condo/co-op/townhouse qualifies for a $50.00 rebate under the Senior Citizens Rebate Ordinance, the Committee on Finance must verify that you occupied this property as your principal residence on the first day of January, 2011. If the properly meets these requirements, you must sign and date this application and return it to your ward office before July 1, 2011.
.the undersigned, on oath,
Please Print Name
depose and slate that I am the applicant in the application, that this is my principal place of residence as of January 1, 2011 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.! am subjecLto penalties for perjury of falsification herein.
OWNER SIGNATURE //V--77(/? * DATE '2-/2*2,
Very Truly Yours,
Edward M. Burke
MAIL 1 SIGNED AND DATED COPY DIRECTLY TO YOUR WARD OFFICE AT:
Alderman PAT DOWELL Attn: AUDREY WADE 5046 S. STATE STREET Chicago, IL 60609
Please do not send it to the Committee on Financ...
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