← 9634 S Green St, Chicago, IL 60643 · All properties

Owner Name Mailing Address Change Form - 9634 S Green St, Chicago, IL 60643.pdf

This page is a searchable text preview. Use the Dropbox link for the full original file.

Open full file in Dropbox

What This File Appears To Be

Owner Name/Mailing Address Change Form *Account Number: ____________ _______________ Customer Code Premises Code *Premises Address: 9634 S Green St_________________________________ *Current Owner Name: Lofty Holding 9634 S Green Street LLC ___________________________________ (as currently listed on bill) * Property Index Number: 25-08-214-032-0000 ______________________________________ (Found on Property Tax Bill) *Phone Number: work:213-880-5204 Email Address: work:ashley@lofty.ai If requesting

Text Preview

Owner Name/Mailing Address Change Form
*Account Number: ____________ _______________
Customer Code Premises Code

*Premises Address: 9634 S Green St_________________________________
*Current Owner Name: Lofty Holding 9634 S Green Street LLC ___________________________________
(as currently listed on bill)

* Property Index Number: 25-08-214-032-0000 ______________________________________
(Found on Property Tax Bill)

*Phone Number: work:213-880-5204 Email Address: work:ashley@lofty.ai

If requesting to change Mailing Address, please complete this section:
Mailing Address: 219 E Irving Park Rd
Number Dir Street Suite #/Floor

Roselle, IL 60172
City State Zip Code

office@gcrealtyinc.com
Email Address

If requesting to change owner name, please complete this section:
New Owner Name: ____________________________________
Last First

Date of Purchase/Closing: ______________________
Was a Full Payment Certificate obtained Yes/No? ______________
Please note: If the Department does not have a record of the Full Payment Certificate from your closing, you may
be required to provide us with a copy of the deed, closing statement and/ or full payment certificate.

The undersigned Applicant on oath deposes and says that (s)he is responsible for utility bills for the above
premises and that (s)he is subject to penalties for perjury or falsification herein.

Print Name:
Jerry Chu ____________________________________________________
Owner Signature:[

s:a:r

11/12/2021]
] Date: [ d:a:r

*Required Field

rev. 22 feb 2016

REFERENCE NUMBER
4E6587A5-82AA-43D4-BCB7-00300BE25DB8

SIGNATURE CERTIFICATE
TRANSACTION DETAILS

DOCUMENT DETAILS

Reference Number
4E6587A5-82AA-43D4-BCB7-00300BE25DB8

Document Name
City Of Chicago Water Billing Change Form

Transaction Type
Signature Request

Filename
changeform.pdf

Sent At
11/12/2021 15:11 EST

Pages
1 page

Executed At
11/12/2021 15:38 EST

Content Type
application/pdf

Identity Method
email

File Size
54.4 KB

Distribution Method
email

Original Checksum
23328de0c5236efa44ae12e9cc415eeadd095922519d8d52c4a56b1c8c163b30

Signed Checksum
6bcdfb352ed666f566166ce7711dba910afdf67248c126b1458d156ed3007f00

Signer Sequencing
Disabled
Document Passcode
Disabled

SIGNERS
SIGNER

E-SIGNATURE

EVENTS

Name
Lofty Holding 9634 S Green Street LLC

Status
signed

Viewed At
11/12/2021 15:38 EST

Email
ashley@lofty.ai

Multi-factor Digital Fingerprint Checksum

Identity Authenticated At
11/12/2021 15:38 EST

b9cc85b578deb9a4cbd5ad48ce76ec9f6d1fb6f044a8fb6f5fd227a1e9ea1075

Components
2

IP Address
76.216.230.174

Signed At
11/12/2021 15:38 EST

Device
Safari via Mac
Typed Signature

Signature Reference ID
0559AE65

AUDITS
TIMESTAMP

AUDIT

11/12/2021 15:11 EST

Lofty Holding 9634 S Green Street LLC (ashley@lofty.ai) was emailed a link to sign.

11/12/2021 15:38 EST

Lofty Holding 9634 S Green Street LLC (ashley@lofty.ai) viewed the document on Safari via Mac
from 76.216.230.174.

11/12/2021 15:38 EST

Lofty Holding 9634 S Green Street LLC (ashley@lofty.ai) authenticated via email on Safari via Mac
from 76.216.230.174.

11/12/2021 15:38 EST

Lofty Holding 9634 S Green Street LLC (ashley@lofty.ai) signed the document on Safari via Mac
from 76.216.230.174.