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. <br /> • �'� � ASSESSMENT INFORMATION ON SOLD PROPERTIES <br /> This page is to be completed by the County Assessor or Supervisor of Assessments. The form is to be mailed to <br /> Illinois Department of Revenue, 101 West Jefferson, P.O. Box 19033, Springfield, IL 62794-9033 <br /> after being processed by county personnel. <br /> 1. ENTER BRIEF LEGAL DESCRIPTION OF PROPERTY AS IT APPEARS ON ASSESSMENT BOOKS. I <br /> 2. INSTRUCfIONS FOR COMPLETING PROPERTY DESCRIPf10N CODES: I <br /> (a)Enter Permanent Real Estate Indez Numbec Errter the property use code in the Unit Na boxes if using the IL Real Property Appraisal Manual,a circfe the appro- I <br /> priate letter'rf using the codes in the IL Properry Tax Manual.Enter the assessment Quadrant if applicable. <br /> (b) County&Township: Use codes from DepartmeM Code Sheets. (d) Date of Deed: Enter month and year from Page 1 of declarotion. <br /> (�) �tass of ProDertY: For Cook County,see Property Type Code$heet. (e) Acreage: For Class 51 and 61 Property,enter number of acres; <br /> For pownstate Counties: enter for Class 71 and 81 Property,leave blank. � <br /> 51 (if assessed as farm(14125)with ra buildin� 71 (assessed as nonfarm with no buildin� II <br /> 61 (ff assessed as farm(14125 and 14140)with a buildin� 81 (assessed as nonfarm with a buildin� i <br /> PERMANENT REAL ESTATE INDEX NO. <br /> �a� � � � � � � � � � � � � � � / F, F0. FI. C, I, R �_, ' <br /> �P SEG BLACK PARCEL UNIT Circle One q�M�T <br /> QUAD. , <br /> CommeMs by Supervisor of Aasesamerrts a Cour�ty p�: <br /> (b) County ❑ ❑ ❑ I <br /> Township ❑ � ❑ <br /> (c) Ctass � ❑ <br /> Mo�th Year <br /> (d) Date of Deed � � ❑ � , <br /> (e> Acreage(Round to ❑ ❑ ❑ ❑ <br /> nearest full acre) <br /> 3. ASSESSED VAWE DATA <br /> Enter assessed value as finally adjusted by the Board of Review or qppea�s for the year prior to the date of sale. <br /> Where assessment is partial or split,designate with a targe"P"or"S"on the assessment boxes. I hereby certify that the information shown relates <br /> YEAR PRIOR TO SAIE 19 The following questions must be ansYvered: to the property described in the declaretio�ana <br /> Book No. PaBe Line � �0 ' <br /> L � ❑ IS this a 14125,formerly 20e,assasrnentl("Farm gfU•� that the assessed valuations are for the property <br /> 2. ❑ 0 Is this a partial assessment?(i.e,impro�ert�ent not com- i��luded in the transtec <br /> pkted an assasment date) <br /> 3. ❑ ❑ WN a split(division)bs required to retlect the legal <br /> desaiption on this deed(�Trust pocument)? Dated this day ct <br /> 4. ❑ ❑ Has an impro�nent been added or remo�ed sinoe <br /> January 1 of the yesr prio►to the sale,but before the <br /> sab date? , 19 <br /> land ❑ . ❑ ❑ ❑ , ❑ ❑ ❑ 5. � ❑ Does assessrnent st�owm reflect all Board of Reviaw or <br /> ❑ . ❑ ❑ ❑ . ❑ ❑ ❑ Appeals adion far the year indipted(induding Board <br /> Bldgs. of Review equalvation factors)T <br /> ❑ � � ❑ ❑ ❑ � � 6. ❑ 0 Is this a 1430,forn�erly 20g�4,assessment? <br /> TO�� 7. ❑ ❑ Ii sab irnolves a mobile home,is the mobile home Superv�sor of/lqsessments or County l�ssessor <br /> assessed as real estate? <br /> FOR DEPARTMENT USE ONLY <br /> Full Consideration ❑ ❑ Multiple Parcel Indicato► <br /> ❑ ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ <br /> Adjusted Consideratan Fle Maintenance <br /> � � + � � � r ❑ ❑ ❑ TabNumber: <br /> This fortn is authorized in accordance with 35 ILCS 200/t-1 et seq.Discbsure of th�s infortnation is REQUIRED.This fortn <br /> Page 4 oi 4 has been approved by the Fortns Managemern�en�e�. IL-492-02p7 � SOv BASE INK <br /> �.�RECICLED PAPER PfAX-203(R-4�94� <br />