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�,.. t K�..Lu� cxn�oic c: <br /> iilinois Real Estate m r:=r���:�>.. . <br /> Transfer Declaration �� :��r�. � <br /> Piesse read#he instructions before compiet�ng thls form. �° <br /> This form can bs com leted electronicali at tax.illinots. ov/�etd. mE �t�v ;a<,,: <br /> Step 1: Identify the property and sale intormation, �� ._ <br /> 1 3915 East Faries paricway c°� <br /> Street address of property(or 911 address,if aveUeble) �� ,, <br /> dV rFi•:t2: i <br /> Decatur 62526 <br /> City or vptage ZIP <br /> �.�ii;t:c iv?t;h•... <br /> Decatur <br /> Township 9 Identify arn significant physical changes fn the property since <br /> 2 Write the totai number of parcets to be Vansterred. 1 January i of the previous year and wrfte the date of the change. <br /> 3 Write the parcel identifying numbers and lot sizes or acreage. Oate of signiiicant change: / _„ <br /> Property indez number(Pit� Lot size or acreage AAonih- Yee► <br /> a 04-t 3-OB-101-002 0.320 (Mark with an•x' <br /> b `Demolition/damage ,_,Additions _Major remodeling <br /> New constructlon Othe�(sPac+y): <br /> � 10 identify only the items that appiy to this sale.(Mark with an-x,•� <br /> d a Fulfiliment of instaliment coniraat-- <br /> Write add�ional propsrty index numbers,lot sizes or acreage in year cor�tract initiated:_______ <br /> Step 3. b Sale between related individuals or corporate affiliates <br /> 4 Date of instrument: _�/ 2 0 1 9 c Transfer of less than 100 percent interest <br /> Mo'—fi'nt Year d Court-ordered sale � <br /> 5 Type of insirument(Mar�wirn an•x�y: X Wananty deed e �le in lieu of foreclosure <br /> Quit ciaim deed Executor deed Trustee deed <br /> — f Condemnation <br /> Beneficiai interest Other�cpectt�: g Short sale <br /> 6 Yes X No 1M11 the property be the buyer's principai residence? h Bank REO(I'eal estate ownedj <br /> 7 �Yes X No Was the property adve�iised for sale? t Auction sale <br /> (i.e.,media,sign,�ewspapar,realtor) <br /> 8 identify the property's current and intended primary use. 1 Sellerlbuyer is a relacation company <br /> Cunent IMendad (Mark oniy one item pe�column wtth an•x.� k � SeUerlbuyer is a financiai institution or governmeni agency <br /> a� Land/iot oniy 1 Buyer is a real estate investme�t trust <br /> b_ Restdence(s��e-iem�iy,condominium,�ow�wme,or dupiex) m Buyer is a pension fund <br /> c Mobiie home residence n Buyer is an adjacent property owner <br /> dw Apartment building(e un�a or�ess�No.or w�ng: o Buyer is exercising an option to pu�chase � <br /> e Apartment building{over s un�sa Na ot�a,ns: P Trade of property(simuitaneous) <br /> t Office q Sale-leaseback � <br /> g Retafl estabtishrnent r Other�speciy�: <br /> h x Comrner'c(21 buliding(spedry):Aut enair.Storaoe <br /> i industrfal buitding s Nomestead exemptions on most recent tax bill: <br /> j Farm 1 GenerailAlternative $ <br /> k X Other�sped�y�: Rictht of Wav 2 Senior Citizens $ <br /> 3 Senior Citizens Assessment Freeze$ <br /> Step 2: Catculate the amount of transfer tax due. <br /> Note: Round Lines i1 ihrough 18 to the next highest whole doilar,lf the amount on Line 11 is over$1 miilion and the property's current use on Line 8 <br /> above is marked"e,""f,""g,""h,""f,'or"k,`complete Form PTAX-203•A,itlinois Reai Estate 7ransfer Oeclaration Suppiementat Form A.If you are record- <br /> 1ng a bene8ciai interest transfer,da noi complete this step.Compiets Form PTAX-203-B,Iltinois Reai Estate Transfer Declarat(on Suppiemental Farm B. <br /> f 1 Fuli actuai consideration 11 $ 80,000 <br /> 12a Amount of personat property inciuded in the purchase 12a $ 0 <br /> 12b Was the vatue ot a mobile home included on i.ine 12a? 12b Yes X No <br /> 13 Subiract Line i 2a from Une 11.This is the net consideration for rea{property. 13 $ 80.000 <br /> 14 Amount for other real property transferred to the seller(in a simuttaneous exchange) <br /> as part of the tull actual consideratio�on Line 11 14 $ 0 <br /> 18 Outstanding mortgage amount to which the transfeRed real property remains subject 15 $ <br /> 16 If this transfer is exempt,use an`X"to identffy the ptovision. 16 x b `k _m <br /> 17 Subtract Unes 14 and 15 from Une 13.Thts is the net constderatfon sub)ect to transfer tax. 17 $ Exemot <br /> 18 Divide Line 17 by 5p0.Round the resuit to the next highest whole number(e.y.,s1.002 rounds to 62). 18 Fxemot <br /> i 9 Iliinois tax stamps--muitiply Lins 1 S by 0.50. 19 $ Exempt <br /> 2Q County tax stamps--mui�piy line 18 by 0.25. 20 $ Exempt <br /> 21 Add Lines 19 and 20.7his ts the totai amount of transfer tax due. 2i $ Exempt , <br /> This torm is aulhorized in axorciarx:e with 351LCS 200131-t et seq.Disclosure of this inlormadon <br /> PTAX•203(R•10J10} is REaUiRED.This lonn has bean roved ihe Fams Mena ament Cenfer. It�492�0227 Page 1 of 4 � <br />