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+7448817 T-^TJl P 03/03 Job-701
FOR OFFICIAL CLAIM#.
USE ONLY WARD_
DATE_
STATUS_
R
APPLICATION FOR. SENIOR CITIZENS SEWER CHARGE ANNUAL REFUND
OWNER NAME: _<9<%l{ SZ_
fifflatstNaMd /MJT&kt Name M.I.
OWNER ADDRESS:
Apt #
CHICAGO, IL 606_ HOME PHONE #: ([Y] ) #3 7 - /(OWNER BIRTHDATE: f)( I (P) I f.f$4
WATER ACCOUNT NUMBER:, (found on water bill)
PROPERTY TAX NUMBER:
/.7/ ,101 Mb ////7
(found on property tax bill)
TYPE OF STRUCTURE: 1.) Condominium Unit
2. ) Townhouse
3. ) Cooperative Apartment
the undersigned on oath depose and state that I am
(print name here)
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 ot assessments owed to the City of Chicago have been paid and that 1 understand I am subject to penalties for perjury or falsification herein.
OWNER SIGNATURE:
'£31_DATE: J/dd/^/S
PLEASE RETURN TO YOUR ALDERMAN'S OFFICE BEFORE JULY 1
Alderman William Banks
36th Ward
6839 West Behnoat
Chicago Illinois 60634
ATTN: -jtia^JUtUe/Josephine Gordils
City of Chicago
Department of Revenue-Water Division
P.O. Box 6330
Chicago, Illinois 60680-6330
Customer Service: 312-744-4426 E-mail: waterbill@cityofchicago.org
Always include your name, account number, and a call back number. Web: www.cityofchicago.org/revenue
METERED ACCOUNT
Little leaks cause big bills.
Check for and repair leaks.
You must pay for all metered water.
PAY ONLINE: Pay your bill online from the convenience of your home or office:
OAKFIELD WEST CONDO 499321-499321 Dec-23-2010 Jan-13-2011
Service Addres...
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