R2019-93 Resolution Authorizing Conveyance Documents Regarding the Warranty Deed and Temporary Easement of Parcel No. 7704105 Located on the Northwest Corner of Eldorado Street and Fairview Avenue for the State of Illinois

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. 5. NON-FOREIGN CERTIFICATION — FIRPTA. Section 1445 of the Internal Revenue Code provides that a transferee (buyer) of a U.S. real property interest must withhold tax if the transferor is a foreign person. For purposes of this paragraph, "Transferee" shall mean "Grantee" and "Transferor" shall mean "Grantor". To inform the Grantee that withholding of tax is not required upon the disposition of a U.S. real property interest by Grantor, the Grantor hereby certifies the following: a. Transferor is the owner of the real property being conveyed; b. Transferor is not a foreign person, entity, or disregarded entity (as such terms are defined in the Internal Revenue Code and Income Tax Regulations); and c. Transferor's U.S. Taxpayer ldentification Number and address set forth above are true and correct. Transferor understands that this certification may be disclosed to the Internal Revenue Service by Transferee and that any false statement contained herein could be punished by fine, imprisonment or both. nitial 6. Illinois law (15 ILCS 405/10.05 to 405/10.05b) requires the State of Illinois Comptroller to deduct from any State of Illinois warrants or payments the amount of any outstanding account or claim in favor of the State of Illinois and any amount necessary to satisfy past due child support or delinquent student loan and financial aid obligations on any loan guaranteed by the Illinois Student Assistance Commission. 7. This Receipt of Conveyance Documents and Disbursement Statement is the entire and exclusive agreement between the parties and supersede any written or oral understanding, promise or agreement, directly or indirectly related to the conveyance of parcel and improvements. The parties agree that any changes to this Receipt may only be made in writing and signed by the parties. Date: ��'�e- �� '�� G ra ttest: ��1 Signature Si a re ulie Moore Wolfe, Mayor Kim L. Althoff, City Clerk Print Name (and Title, if applicable) Print Name (and Title, if applicable) Signature Signature Print Name (and Title, if applicable) Print Name (and Title, if applicable) Date: G rantee: The People of the State of Illinois, Department of Transportation for State of Illinois, Department of Transportation Page 2 of 2 LA 4112A Template(Rev.02/9/16)