City of Chicago
Committee on Finance
Alderman Edward M. Burke Citv Hall • Room 302 • 60602 Telephone
Chairman mvw.committeeonfinanoe.org
312-744-3380
February 18, 2011
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019*001*********3-DIGIT 606 CARR, CLARENCE 5718 W LAKE ST CHICAGO, IL 60644-1805
For Official Use Only: Ward:_
Intro. Date:.
Status:_
Reason:_
Claim Number: 1023218
Index Number: 1608226019 0000
Water Account Number: 514157514157
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
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 properly as your principal residence on the first day of January, 2011. If the property meets these requirements, you must sign and date this application and return it to your ward office before July 1, 2011.
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, lhat 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 thai I understand I am subject to penalties for perjury of falsification herein.
OWNER SIGNATURF^^^^ ^^DATE A-M - 11
Very Truly Yours, Edward M. Burke
MAIL 1 SIGNED AND DATED COPY DIRECTLY TO YOUR WARD OFFICE AT:
Alderman l&AAG OU\mill2K3 3) B-OPO^H GC^tt* M £1* IflfrVU-Attn:
Chicago, IL
Please do not send it to the Committee on Finance; your alderman will introduce it on your behalf.
RETAIN 1 COPY FOR YOU...
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