R97-94 AUTHORIZING FINAL CONVEYANCE OF HOMESTEAD PROPERTY

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. ASSESSMENT INFORMATION ON SOLD PROPERTIES This page is to be completed by the County Assessor or Supervisor of Assessments. The form is to be mailed to Illinois Department of Revenue, 101 West Jefferson, P.O. Box 19033, Springfield, IL 62794-9033 after being processed by county personnel. 1. ENTER BRIEF LEGAL DESCRIPTION OF PROPERf`(AS IT APPEARS ON ASSESSMENT BOOKS. 2. INSTRUCTIONS FOR COMPLETING PROPERTY DESCRIPTION CODES: (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 circle the appro- priate letter if using the codes in the IL Property Tax Manual.Enter the assessment Quadrant if applicable. (b) County&Township: Use codes from Department Code Sheets. (d) Date of Deed: Enter month and year from Page 1 of declarotion. (c) Class of Property: For Cook County,see Property Type Code Sheet. (e) Acreage: For Class 51 and 61 Property,enter number of acres; for Class 71 and 81 Property,leave blank. For pownstate Counties: enter 51 (if assessed as farm(10-125)with no building) 71 (assessed as nonfarm with no building) 61 (if assessed as farm(10-125 and 10-140)with a building) 81 (assessed as nonfarm with a building) PERMANENT REAL ESTATE INDEX NO. �a� � � � � �B� � �PA�L� � � I❑ � / F' C'��rcleFOne I R ASS❑M'T. QUAD. � ❑ ❑ ❑ Commerrts by Supervisor of Assessme�s or County Aasessor: (b) County Township � � � (c) Class � � Month Year (d) Date of Deed � � � � (e) Acreage(Round to ❑ ❑ ❑ ❑ nearest full acre) 3. ASSESSED VALUE DATA Enter assessed value as finally adjusted by the Board of Review or Appeals for the year prior to the date of sale. I hereby certify that the information shown relates Where assessment is partial or split,designate with a large"P"or"S"on the assessment boxes. YEAR PRIOR TO SALE 19 The following questions must be answered: to the property described in the declaration and Book No. Page Line Yes No 1. � ❑ Is this a 14125,formerly 20e,assessment?("Farm Bill") that the assessed valuations are for the property 2. � ❑ Is this a partial assessment?(is.,improvement not com- included in the transfer. pleted on assessment date) 3. ❑ ❑ Will a splk(division)be required to reflect the Iegal ' descriptan on this deed(or Trust Document)? Dated this day of 4. ❑ ❑ Has an improvement been added or rertaved since January 1 of the year prior to the sale,but before the sale date? , 19 ' Land ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ 5. ❑ ❑ Daes asseument shown reflect all Board of Review or I ❑ ❑ ❑ ❑ ❑ ❑ a Appeals adan for the year indiwted(including Board i Bldgs. of Review equalizatan fadors)? � � ❑ ❑ ❑ ❑ ❑ ❑ 6. ❑ O Is this a 1430,formerly 20g-4,assessment? Supervisor of Assessments or County Assessor � Total 7. ❑ O If sale inwlves a mobile home,is the mobile home I assessed as 2al estate? I FOR DEPARTMENT USE ONLY ' ❑ ❑ Multiple Parcel Indicator Full Consideration I � � ' � � � ' � � � File Maintenance Adjusted Consideration ❑ ❑ , ❑ ❑ ❑ � LJ ❑ ❑ Tab Number: I This fortn is authonzed in accordance with 35 ILCS 200/1•t et seq.Disclosure of this information is REQUIRED.This fortn A �,�E INK has been approved by the Fortns Management Center. IL-492-0227 Page 4 of 4 �..� RECYCLED PAPER PTAX-203(R-4/94)