Jennifer Gomric Minton 
St. Clair County Assessor’s Office   
Demolition Affidavit 
Property Owner’s Name: _______________________________________________ 
Site Address: ______________________________________ 
     _____________________________________ 
  _____________________________________ 
Parcel(PIN) Number: _____________________________ 
Contact Number: (_______) _______________________ 
Date of Demolition: ____________________ 
Description of Real Property Demolished: ________________________________________________ 
____________________________________________________________________________________ 
Please attach the following to verify the date of demolition:  
1)  Pictures – before and after if possible.  
2)  Permit – if your local municipality requires a permit before demolition.  
3)  Fire Report – if your demolition is due to fire, please submit the report for the fire 
deparment.  
4)  Demolition Invoice  
Under penalties of perjury, I state that, to the best of my knowledge, the information contained 
in this affidavit is true, correct, and complete. 
_______________________________________ ____ ____/____ ____/____ ____ ____ ____ 
Signature of applicant               Date (month, day, year) 
 
Mail completed application to: Jennifer Gomric Minton, St. Clair County Assessor 
      t  A o  t n  t :  e    n Demolition Department   i
       10 Square   Public 
       Belleville,   IL      62220    
Or  
 
E-mail to Kathi Johnson at   kathi.johnson@co.st-clair.il.us   
 
If you have any questions, please call Kathi at 618-825-2508.    

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