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Application for Model Home Assessment
PTAX-762
Who should complete this form?  When and where must I file?
You should complete this form to request an alternate assessment if  You must annually file this form with the chief county assessment
your property is used for model home purposes. The property must  officer (CCAO), at the address shown below, on or before   April 30   in
be a single-family residence, townhome, or condominium, used solely  Cook County and   December 31   in all other counties. Failure to file in
as a model home for prospective buyers, and not occupied as a  a timely manner will result in waiver of the model home assessment
dwelling. The model home may contain home furnishings, appliances,  for that year.
offices, and office equipment to further sales activities. No more than
Note:  When any portion of this property no longer qualifies as a
3 model homes can be located at the same time within a 3-mile
model home, you   must   notify the CCAO within 60 days by
radius, the center of each radius is the model home that has been
completing Form PTAX-762-C, Certificate of Ineligibility for
used for the longest period of time. No model home can be used for
Model Home Assessment.
model home purposes longer than 10 years.
Step 1:  Complete the following information
1  _______________________________________________  4  Write the date the property
Property owner’s name
began to be used for model
_______________________________________________  home purposes.         ___ ___/___ ___/___ ___ ___ ___
Street address of model home property
5  This model home is a
__________________________________IL ___________  Single-family residence
City                           ZIP
Townhome
(_______)______________________________________  Condominium
Daytime phone
6  Have you applied for other
Send notice to   (if different than above)
model home assessments
2  _______________________________________________
in this county?  Yes  No
Name
_______________________________________________  7  Write the property index number (PIN) of the property for
Mailing address
which you are requesting this model home assessment.
_______________________________________________  Your PIN is listed on your property tax bill   you may  or
City      State                        ZIP  obtain it from the CCAO. If you are unable to obtain your
PIN, write the legal description on Line b.
(_______)______________________________________
Daytime phone
a  PIN   ___ ___-___ ___-___ ___ ___-___ ___ ___-___ ___ ___ ___
b  Write the legal description only if you are unable to
3  Write the assessment year for
obtain your PIN. (attach a separate sheet if needed)
which you are requesting this
______________________________________________
model home assessment.   ___ ___ ___ ___
______________________________________________
Step 2:  Sign below
Under penalties of perjury, I state that, to the best of my knowledge, the  Subscribed and sworn to before me this _____day
information on this form is true, correct, and complete.
of ________________________, ____ ____ ____ ____.
__________________________________________/____/_____  _______________________________________/____/________
Property owner’s or authorized representative’s signature            Date  Notary public                                                                 Date
If you have any questions, please call:  Mail your completed Form PTAX-762 to:
___________________ County Chief County Assessment Officer
(________)__________________________
_________________________________________________
Mailing address
______________________________________ IL ________
City                                           ZIP
For use by the CCAO
Date received  ___ ___/___ ___/___ ___ ___ ___  Reason for denial __________________________________
Approved
___________________________________________________
Denied
Decision Date  ___ ___/___ ___/___ ___ ___ ___
___________________________________________________
____________________________________________________
PTAX-762 (R-09/03)    IL-492-3076
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