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Email
*
Water
Agent Name
Address
Pay Later
Status
Property Identifer
425 North Hillside Ave
Property Identified As
City, State, ZIP
Property Owner Information
Phone #
City, State, ZIP
I, the undersigned, hereby affirm that I am duly authorized to act on behalf of all ownership interests in the above-referenced property. I hereby attest/swear that the information contained herein is accurate and complete to the best of my knowledge. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment under the violations section of §18-601. Liability.
Property Type
*
Number of Stories
Name
Hillside, IL 60162
Email
*
Property Details
Hillside Village Hall
Please attach a valid Certificate of Insurance.
Phone Number
Company Name
Account Number
Certification
or
Assessment
Applicant Signature
*
Address
Number of Garages
Financial Institution/Bank Information
City, State, ZIP
*
Gas
In order to receive your license, you must first pay the $100 Registration Fee.
Address
*
Email
City, State, ZIP
*
Company Name
Phone #
*
425 Hillside Avenue
Hillside, IL 60162
(708) 449-6450 / (708) 236-5110
www.hillside-il.org
Email
Company Name
Representative
*
Mailing Address
*
Name
*
Agent/Representative
Property Address
*
Address
*
If you need to make your payment by mail or in person, our office is located at:
Unit #
Utilities
Phone #
Village of
Hillside
Phone #
*
Vacant Property
Registration
Maintenance Company
Contact Agent
Electric
Date of Vacancy
*
Square Footage
Reference Number:
Your request has been submitted successfully.
Property Address:
Date Submitted: