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Senior/Disabled Discount Application Water Operations Fee

  1. Property Address:   ___________________________________________ 



    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 2nd Installment Cook County Tax Bill showing Disabled Exemption.  Tax bill must be in applicant’s name 
    3. Proof of primary residence 
      • Latest 2nd Installment Cook County Tax Bill with Senior Homestead Exemption.  Tax bill    must be in applicant’s name. 


    • Current lease in applicant’s name. 


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



    ______________________________________________                      ______________ 

    Signature                                                                                                            Date 


    Discount will be applied within 1 billing cycle of application approval  

    Print and Submit TO: Village Of North Riverside 


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

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