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� � STATE�OF ILLINOIS <br /> DEPARTMENT (fi� TRANSPORTATION <br /> DIVISION OF HIGHWAYS <br /> City of Decatur <br /> Owner(s) <br /> Parcel No. �DD0012 <br /> RECEIPT FOR DONATION <br /> Receipt for ponation covering .0960 acres of land being part of in Section 34, Township _ <br /> 17N, Range 2E, of the 3�d P.M. in Macon County, State of Illinois as right of way for FA Route <br /> 710, Section 50R, dated December 5 , 20 05 , and executed by the <br /> undersigned grantors, is hereby acknowledged. <br /> Payment of the sum of One Dollar ($1.00) to the Grantors as total consideration for the <br /> donation, by the Department of Transportation, State of Illinois, is subject to the approval of <br /> title. _ <br /> Disposition of Improvements NONE <br /> Possession Date Upon receipt of pavment <br /> Name (If joint names, list first and circle the name of the person or entity whose number you enter below.) <br /> Citv of Decatur <br /> Address (number and street) <br /> #1 Gary K Anderson Plaza <br /> City, state and zip code - <br /> Decatur IL 62523 <br /> Taxpayer ldentification Number (TIN) _ <br /> SS#___-__-^___ OR EIN 3 7 _6 0 0 1 3 0 8 <br /> i 1. The GrantorslTransferors certify under penalties of perjury that the number is their correct <br /> taxpayer identification number. - <br /> 2. Please identify, by checking the appropriate box, the I.R.S. category the <br /> GrantorslTransferors fall within. <br /> ❑ Individual � Government Entity <br /> ❑ Corporation ❑ Land Trust <br /> ❑ Other (explain) <br />