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Mail this form to:

Official Use Only

Board of Review

Appeal Nu mber:

18 North County Street - 7th Floor

Waukegan, IL 60085-4335

Revised 9/04

Telephone: (847) 377-2100

This form along with any additional documentation must be submitted in quadruplicate. You may

wish to keep an additional copy for your records. In the space provided below, write the name

and address to which the complainant’s notice of hearing should be mailed.

Owner’s Name:

Township:

PIN:

Mailing Address:

Property Address:

City, State, Zip:

City/Village, ZIP:

COMMERCIAL / INDUSTRIAL REAL ESTATE ASSESSMENT APPEAL FOR TAX YEAR 2004

Please note: The Township Assessor’s office is required to submit its evidence regarding your appeal to the Board of Review three

business days prior to a hearing. In addition, if this is a request for an assessment reduction of $100,000 or more, the Board of

Review must notify taxing districts of this appeal.

The reason for this appeal is as follows:

_______ The Assessment is Higher Than the Assessment of Comparabl e Properties

_______ The Assessment is Greater than 1/3 of Fair Market Value

_______ Other (Attach Explanation)

NOTE: For recent sales and/or appraisals, three copies of documentation must be submitted to the Board of Review and one copy

to the Assessor. Appraisals must be forwarded to the Board of Review within ten calendar days of the final filing date for

appeals in that Township. If this is income property, the taxpayer should furnish copies of the most recent three-year

income and expense statements along with occupancy information.

Information on the Subject Property

Property Type: _______Commercial _______Industrial

_______Vacant Land _______Owner-Occupied

_______Leased

The current assessment is:

The assessment should be (Required Information):

Land:

Building:

Total:

Land Size:

______________________________

Building Size:

______________________________

Subdivision Name: __________________________________ Purchase Date: _______________ Purchase Price:_________________

Please check ONE option below:

1. I do wish to appear - Please notify me of my designated hearing date and time.

______

I will not appear in person or telephone the Board. I am requesting that the Board decide this appeal

______

based on the information provided herein. I understand that I will not receive a hearing notice.

I will not appear, but will telephone the Board - Please notify me of my designated date and time to call.

______

Owner’s Signature:____________________________Daytime Phone: _______________ Email Address/Fax:___________________

Attorney’s or

Agent’s Signature:_____________________________Daytime Phone: _______________ Email Address/Fax:___________________

If represented by an attorney or agent, the owner’s signature or a letter of authorization is required. Be sure the attorney’s or agent’s

address is shown above to receive the hearing notice. For more information, visit our website address at:

Commercial / Industrial Real Estate Assessment Appeal For Tax Year 2004 - Lake County, Illinois

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