2. Property Address *
4. City*
5. State
6. Zip Code

8. 
   

   Eligibility Requirements

    

   1. Applicant must be 65 years of age or older or disabled 
   2. Property must be applicant’s primary residence 

    

   Documentation Requirements

    

   1. Proof of age:                                                                                             
      • Valid Illinois Driver’s License or State ID with North Riverside address 
   2. Proof of disability 
      • Latest 2^nd Installment Cook County Tax Bill showing Disabled Exemption.  Tax bill must be in applicant’s name 
   3. Proof of primary residence 
      • Latest 2^nd Installment Cook County Tax Bill with Senior Homestead Exemption.  Tax bill    must be in applicant’s name. 

                                    ^OR 

   • Current lease in applicant’s name. 

    

   
   

10. I certify the above information is accurate and the property is my principal residence. 

12. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
14. Electronic Signature*

16. Discount will be applied within 1 billing cycle of application approval  

    Village Of North Riverside 

    2401 S. DESPLAINES AVENUE ● NORTH RIVERSIDE, IL  60546

    PHONE: 708-447-4211 ● FAX:  708-447-4292

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