LONGTIME HOMEOWNER EXEMPTION APPLICATION FOR TAX YEAR 2018

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Longtime Homeowner ExemptionYou must have owned and occupied your residence from January 1, 2008 through January 1, 2018 as well as have a total household income of $100,000 or less for Income Tax Year 2017. If this is correct, fill in your total household income and date of occupancy to determine your level of relief. You must include a copy of a recent property tax bill and a copy of one of the following valid forms ofresidency with this application: an Illinois Driver's License OR an Illinois Identification (ID) Card.

(To determine your total Household Income, please use the income worksheet found on the next page.)

/ Date of Occupancy (month/year)

$ Total Household Income

NOTARY STAMP

Subscribed and sworn before me this day of

Notary Signature

,

Date / /

Applicant’s Name

Applicant’s Signature

Signature

Under penalty of perjury, I state that, to the best of my knowledge, the information contained in this application is true, correct and complete.

Please note: This exemption is subject to audit by the Cook County Assessor’s Office.

Notary (A notary is required when applying for the Long-Time Occupant Exemption)

Daytime Phone Number ( ) -

Subject Property Permanent Index Number Property Owner(s) Name(s)

City

Property Address

State Zip

C/E Number

Please return this form to: Cook County Assessor’s Office 118 N. Clark, Room 320 Chicago, IL 60602

Longtime Homeowner Income Verification You must have a total household income of $100,000 or less for the income tax year 2017 to qualify for the Longtime Homeowner Exemption. Please use this worksheet to determine your total household income for theincome tax year 2017. Total household income is your income PLUS the income of all individuals who used theproperty as a principal residence in 2018.

If Line 14 is MORE THAN $100,000, you do not qualify for the Longtime Homeowner Exemption.

1.. Social Security, SSI benefits. Include Medicare deductions in this total (household total).........

2.. Railroad Retirement benefits. Include Medicare deductions in this total (household total)........

3.. Civil Service benefits (household total)......................................................................................

4.. Annuity benefits and federally taxable pension and IRA benefits (household total)...................

5.. Veterans' benefits (household total) (federally taxable portion only)......................................

6.. Human Services and other governmental cash public assistance benefits (household total)....

7.. Wages, salaries, and tips from work (household total) ____________ + ____________ =

8.. Interest and dividends received (household total)......................................................................applicant applicant's spouse

$

Total Household Income

9.. Net rental, farm, and business income (or loss). Do not include any loss carryover...................

10.0. Net capital gain (or loss). Do not include any loss carryover........................................................

11.1. Other income (or loss). Do not include any loss carryover...........................................................

12.2. Add Lines 1 through 11...............................................................................................................

13.3. Certain subtractions --- You may subtract only the reported adjustments to income totalon U.S. 1040, Line 37, or U.S. 1040A, Line 21.

(Specify:______________________________)............................................................................14.4. Subtract Line 13 from Line 12, and write the result. This is your total income for 2017. If

Line14 is greater than $100,000, STOP. You do not qualify for this program. If Line 14 is $100,000 or less, please sign and date the application below........................................................