Cook County Treasurer
Maria Pappas
CHANGE OF TAXPAYER NAME OR MAILING ADDRESS
Date: ______________
Property Index Number (PIN):
Do not exceed the spaces on this form. Leave a space in between names, streets, abbreviations, etc.
NAME(S)
MAILING ADDRESS (Include Unit Number, if needed)
CITY
STATE
ZIP + 4
PHONE
______________________________________________________
(Signature of applicant)
______________________________________________________
(Printed nam e of ap licant)p
________________________
Date
Last Revised 7/2018
EMAIL PROPERTY LOCATION (If different from above):
____________________________________________ ______________________________________________
SUBMIT BY MAIL (
THE APPLICATION MUST BE NOTARIZED)
S.S.: State of
____________________________________________
County of
_______________________________________________
I, a notary public, in and for the state and county aforesaid, do hereby certify that _______________________________________________
personally known to me to be the same person who executed the foregoing Application for Change of Name or Address of Cook
County Real Estate Tax Bill, appeared before me this day in person, and executed the foregoing document, under oath, as his/her
free and voluntary act for the uses and purposes therein set forth.
Upon oath, and under penalties of perjury as provided by law, I hereby affirm, represent, warrant and certify to the Office of the Cook
County Treasurer that I am the legal, beneficial or equitable owner, trust
ee or agent for the owner or trustee for the above captioned real
property, and that I possess the actual legal, equitable or actual authority to execute this instrument.
_____________________________________
Notar Pyublic
IMPRINT NOTARY STAMP HERE
SUBMIT IN PERSON
A notary’s signature is not required if you apply at the Treasurer’s Office, but identification is required.
________________________________________
My Commission Expires
Cook County Treasurer
Name Change Department
118 N. Clark Street – Room 112
Chicago, IL 60602
