COOK COUNTY ASSESSOR
FRITZ KAEGI
Cook Seal
COOK COUNTY ASSESSOR's OFFICE
118 NORTH CLARK STREET, CHICAGO, IL. 60602
PHONE 312.603.4137 FAX 312.603.6584
www.cookcountyassessor.com

COOK COUNTY ASSESSOR’S OFFICE
AFFORDABLE HOUSING SPECIAL ASSESSMENT PROGRAM
ANNUAL AFFIDAVIT

Before you begin, please make sure you have the following required items::
  • The Property Address.
  • The PIN (search for it by address here).
  • The name of and valid e-mail address as the authorized agent or owner filing this affidavit.
  • Curent Rent Roll(s) for the property as either a Word (.doc or .docx), PDF (.pdf), or as an Excel (.xls or .xlsx) document.
Note: Additionally, you must select either 35% or 15% for the property's incentive.
As the owner of a property in the Affordable Housing Special Assessment Program, you are required to file an annual affidavit with the Cook County Assessor’s Office. Please complete the affidavit and include all Permanent Index Numbers participating in the program.
The deadline for returning the affidavit is August 30, 2023.*
Failure to file a completed affidavit, with the correct information by the required deadline can result in the loss of the Affordable Housing Special Assessment Incentive.
Please provide the following information:
Property and PIN(s)
Address of the Property:
Property Index Number
(up to 15 PINs):
pin icon
Owner
Owner Name:
Owner Address:
Owner City:
Owner State:
Owner Zip:
Contact
Contact Name:
Contact Address:
Contact City:
Contact State:
Contact Zip:
Contact Telephone Number:
Contact Email Address:

I, as the owner or agent of the subject property, swear that the following is true and correct:

  1. The subject property is in compliance with local building codes, or if there are no local building codes, Housing Quality Standards, as determined by the United States Department of Housing and Urban Development. If the property was found not to be in compliance with applicable building, safety and health codes since the property was admitted into the program, I have attached copies of such outstanding building safety or health code violations. Additionally, I have attached as documentation from the relevant government agency to confirm that a subsequent inspection confirmed the property is in compliance with the applicable building, safety and health codes.

    Please note: Only Word documents (.doc, .docx) or PDF (.pdf) will be accepted

  2. Attached is a complete Rental Information/Tenant Household Income Report Form which identifies the affordable units in residential real property and household income. I attest that the affordable units are comparable to the market rate units in terms of unit type, number of bedrooms per unit, quality of exterior appearance, energy efficiency, and overall quality of construction.

    Please note: Only Word documents (.doc, .docx) or PDF (.pdf) will be accepted

  3. I attest that these maximum rents and income do not exceed the maximum rents allowable for the area in which the residential real property is located. For current rent/income restrictions, click here.
  4. I have attached documentation from an administering agency (if applicable) of my continuing participation in another qualifying income-based rental subsidy program through the City of Chicago or another governmental agency.

    Please note: Only Word documents (.doc, .docx) or PDF (.pdf) will be accepted

  5. I attest that as the owner, I have verified and retained documentation of household income for every household occupying an affordable unit. (PLEASE SELECT 35% or 15% based on your incentive):
  6. Rents for at least thirty-five (35%) or fifteen (15%) of the units at the subject property have not, and will not exceed the applicable Affordable Housing Special Assessment maximum rents for the calendar year in question.
    PLEASE SELECT 35% or 15% based on your incentive:
  7. Total household income for at least thirty-five (35%) or fifteen (15%) of the units at the subject property have not and will not exceed the applicable Affordable Housing Special Assessment maximum income levels for the calendar year in question.

COOK COUNTY ASSESSOR’S OFFICE
2023 AFFORDABLE HOUSING ANNUAL AFFIDAVIT

Legal Notice:

The filer of this form certifies and attests to the accuracy of all of the information provided in the form, either from personal knowledge or from knowledge derived from others whom the filer has ascertained do have personal knowledge of the information provided in the form. Additionally, the filer certifies that he or she has reviewed all the information provided and certifies that the information accurately represents the facts pertaining to the habitation or leasing of the real estate in question. The filer acknowledges that filing false or fraudulent information with the Assessor's Office, with the intent to defeat or evade the law in relation to the assessment of the property, is a Class A misdemeanor under section 25-40 of the Property Tax Code. 35 ILCS 200/25-40

All submitted information is subject to review in accordance with applicable law and the policies of the Cook County Assessor’s Office If any information you have provided in this certification changes, you must notify the Cook County Assessor’s Office immediately. We recommend that you keep a copy of this certification for your records.

Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he verily believes the same to be true.

Current Owner or Authorized Agent
Name of Current Owner of Authorized Agent:
Title:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Email Address:
Signature of Current Owner or Authorized Agent:

After submitting this affidavit online, you will be able to download a copy as well.