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, _ � 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 BR�EF LEGAL DESCRIPTION OF PROPERTY AS IT APPEARS ON ASSESSMENT BOOKS. <br /> 2. INSTRUCTIONS FOR COMPLETING PROPERTY DESCRIPTION CODES: <br /> (a) Enter Permanent Real Estate Index Number. Enter the property use code in the Unit No.boxes if using the IL Real Property Appraisal Manual,or cir�le the appro- <br /> priate letter if using the codes in the Il Property Tax Manual.Enter the assessment Quadrent if applicable. <br /> (b) County&Township: Use codes from Department Code Sheefs. (d) Date of Deed: Enter month and <br /> year from Page 1 of declaration. <br /> (c) Class of Property: For Cook County,see Property Type Code Sheet. (e) Acreage: For Class 51 and 61 Property,enter number of acres; <br /> for Class 71 and 81 Property, leave blank. <br /> For pownstate Counties: enter <br /> 51 (if assessed as farm(10-125)with no building) 71 (assessed as nonfarm with no buildin� <br /> 61 (if assessed as farm(30-125 and 14140)with a building) 81 (assessed as nonfarm with a building) <br /> PERMANENT REAL ESTATE INDEX N0. <br /> �a� a a � � �'B❑ � �PA�L� � � I❑ � / F� Cirtle�One I, R � <br /> QUAD. <br /> Commerits by Supervisor of Assessments or Courrty Aasessor: <br /> (b) County � � � <br /> Township � ❑ ❑ <br /> (c) Class � � <br /> Month Year <br /> (d) Date of Deed � � � � <br /> (e) Acreage(Round to ❑ ❑ � a <br /> nearest full acre) <br /> 3. ASSESSED VALUE DATA <br /> Enter assessed value as finally adjusted by the Board of Review or Appeals for the year prior to the date of sale. <br /> Where assessment is partial or split,designate with a large"P"or"S"on the assessment boxes. I hereby certify that the information shown relates <br /> YEAR PRIOR TO SALE 19 The following questions must be answered: to the property described in the declardtion and <br /> Book No. Page Line Yes No <br /> L ❑ ❑ Is this a 1Od25,fwmerty 20e,assessment?("Farm Bill'7 that the assessed valuations are for the property <br /> 2. ❑ ❑ Is this a partial assessment?(i.e.,improvement not com• induded in the transfer. <br /> pleted on assessrtient date) <br /> 3. ❑ ❑ Will a split(division)be required to reflect the legal <br /> description on this deed(or Trust Dowment)? Dated this day of <br /> 4. ❑ ❑ Has an imprtriement been added or rertwved since <br /> January 1 of the year prior to the sale,but before the <br /> sale date? , 19 . <br /> Land ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ 5. � ❑ Daes assessmeM shown reflect all Board of Review or <br /> Appeals action for the year indiwted(including Board <br /> Bldgs. ❑ , ❑ ❑ ❑ , ❑ � � ���'�Uualization fadors)? <br /> ❑ ❑ a a ❑ ❑ ❑ � 6. 0 ❑ Is this a 1Q30,formerty ZOg-4,assessment? Supervisor of Assessments or County Assessor <br /> Total 7. 0 ❑ If sale inwlves a mobile home,is the mobile home <br /> assessed as real estate? <br /> FOR DEPARTMENT USE ONLY <br /> ❑ ❑ Multiple Parcel Indicator <br /> Full Consideration <br /> ❑ ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ <br /> Adjusted Considerotion File Maintenance <br /> � � r ❑ ❑ ❑ � LJ ❑ ❑ TabNumber: <br /> This fortn is authorized in accordance with 35 ILCS 200/t-1 et seq.Disclosure of this information is REQUIRED.This form <br /> Page 4 of 4 has been approved by the Forms Management Center. IL-492-0227 A SO"I BASE INK <br /> �i� RECYCLED PAPER RTAX-203(R-4/94) i <br />