Application For Year 2009

City of Country Club Hills Property Tax Rebate Program

(Please print or type)

Homeowner's Name:  

Homeowner's Address:

Homeowner's Property Index #:

Homeowners Water Bill Account #:

Homeowner's Home Telephone:    

Homeowner's Daytime Phone:       

                         E-mail Address:    

                                          Date:   

1. I hereby certify that I/We are the owner/owners of this property and have been since January 1, 2008 as defined in the Residential Property Tax Rebate Program Ordinance.

 I/We certify that all the above information is true
 I/We don't agree that all the above information is true

2. I further certify that I am the homeowner, currently reside at the above address, and have resided at the above address since January 1, 2008.

 I/We certify that all the above information is true
 I/We don't agree that all the above information is true

3. I further certify that I have received no rental income generated from this property.

 I/We certify that all the above information is true
 I/We don't agree that all the above information is true

4. I further certify that I am not in default on any obligation owed to the City of Country Club Hills including but not limited to: water bills, parking tickets, checks returned for non-sufficient funds, administrative adjudication violations, liens, etc.

 I/We certify that all the above information is true
 I/We don't agree that all the above information is true

5. I further certify that the undersigned has paid all 2008 real estate taxes, either directly or through my/our mortgage lender, and am not in default on any other prior property tax payment obligation.

 I/We certify that all the above information is true
 I/We don't agree that all the above information is true

Please note:

This applications must be filed on or before February 28, 2010. All applications received after February 28, 2010, will be null and void and will not be processed.

FILING OF THIS APPLICATION DOES NOT GUARANTEE APPROVAL BY THE CITY OF COUNTRY CLUB HILLS.

All applications are subject to verification. Incomplete applications will not be processed. Rejected applications may be appealed in writing to the City Manager within 10 days of the date of the rejection

 Please print form for your records before submitting.