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Application for Assessment As a Model Home KANE COUNTY ASSESSMENT OFFICE 719 South Batavia Avenue, Building C Geneva, Illinois 60134-3000 (630) 208-3818 Section 1: Instructions A. Property eligibility. You should complete this form to request an alternate assessment if your property is used for model home purposes. The property must be a single-family residence, townhome, or condominium, used solely as a model home for prospective buyers, and not occupied as a dwelling. The model home may contain home furnishings, appliances, offices, and office equipment to further sales activities. No more than 3 model homes can be located at the same time within a 3-mile radius, the center of each radius is the model home that has been used for the longest period of time. No model home can be used for model home purposes longer than 10 years. B. Annual Application Required. You must annually file this form with the county assessment office on or before December 31 of the year that the alternate assessment is requested. Failure to file in a timely manner will result in waiver of the model home assessment for that year. B. Taxpayer responsible for notification if property no longer used as a model home. When any portion of this property no longer qualifies as a model home, you must notify the County Assessment Office in writing within 60 days. Section 2: Property Identification (please print) Owner/Taxpayer Name(s): Mailing Address: Mailing City, State, ZIP: Daytime Telephone: For what year are you requesting assessment as a mode home? _______ year Parcel No. Property Address: Property City, State, ZIP: Have you applied for model home assessment on any other property in Illinois for the tax year in question? (check all that apply) . No, this is the only one. Yes, I have applied on other properties in Kane County. Yes, I have applied on other properties in the following counties: _______________________________________________________ _______________________________________________________ This property has been continuously used as a mode home since month/day/year This property is a Detached Single-Family Dwelling Townhouse or Duplex Unit Condominium Unit Section 3: Oath Under penalties of perjury, I state that, to the best of my knowledge, the information on this form is true, correct, and complete. Signature Print Name Date Subscribed and sworn to before me this day of , 20 . __________________________________________ Notary Public Notary Seal Official use. Do not write in this space. Approved: Yes No Reason for denial_____________________________________________________ By____________________________________ Revised 10-2010 American LegalNet, Inc. www.FormsWorkFlow.com