St. Clair County Mobile Home Division 
 
Application for Reduction of Mobile Home Privilege Tax 
 
I hereby make application for a reduction to 80% of the total tax imposed under “An act to 
provide for a privilege tax on mobile homes”.  
 
Check all that apply 
_____  I actually reside in the mobile home. 
 
_____  I hold title to the mobile home as provided in the Illinois Vehicle Code 
 
_____  I reached the age of 65 on or before either January of the year in which this statement is 
filed. My date of birth is _________________.  
 
_____  I was totally disabled on _____________________ and have remained disabled until the 
date of this application. My Social Security, Veterans’, Railroad, or Civil Service Total 
Disability claim number is ________________________________________________.  
 
Proof of age (Copy of Birth Certificate or State Driver’s License or ID card)   a Doctor’s   or
Statement will be required for proof of age   disability.     or
 
The undersigned declares under the penalty that the above statements are true and correct.  
 
Dated: ________________________ 
            
 ____________________________    ____________________________________ 
   Signature of Mobile Home Owner    Mobile   Home   Address 
 
 ________________________  ____________________________________ 
 City/State/Zip       Phone   Number 
 
 
Official Use – Do not write below this space 
 
Date Received __________________ 
 
Denied    ______             Reason for Denial ______________________________________ 
 
Approved    ______    PIN _________________________________________________ 
 
 
 
 ______________________________        ___________________________________________ 
 Printed Name of Assessor’s Staff               Signature of Assessor’s Staff 

 = Page 1 =