R97-80 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 627949033 after being processed by county personnel. 1. ENTER BRIEF LEGAL DESCRIPTION OF PROPER'fY AS IT APPEARS ON ASSESSMENT BOOKS. 2. INSTRUCTIONS FOR COMPLETING PROPERTY DESCRIPfION 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 Quadrent if applicable. (b) County&Township: Use codes from Department Code Sheets. (d) Date of Deed: Enter month and year from Page 1 of declaration. (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(14125)with no building) 71 (assessed as nonfarm with no buildin� 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� a o o a ❑Bo o ❑PAa�❑ ❑ o,o ❑ / F ��Fo�e �. R o QUAD. ❑ ❑ ❑ Comme�s by Supervisor of Assesaments or Countp Asaeaaor: (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. •�hereby certify that the information shown r��aieo Where assessment is partial or split,designate with a iarge°'�"`or"'S�`on the assessment buxes:� YEAR PRIOR TO SALE 19 The following questions must be answe►ed: to the property described in the declaration and Book No. Page Line Yes No 1. ❑ O Is this a 10-125,formery 20e,assessrtient?("Farm Bill") that the assessed valuations are for the property 2. ❑ ❑ Is this a partial assessment?(is.,impm�ement not com- pleted on assessment date) included in the transfer. 3. ❑ ❑ �II a split(division)be required to reflect the legal description on this deed(or Trust DocumeM)? Dated this day of 4. 0 ❑ Has an improvement been added or rertioued since January 1 of the year prior to the sale,but before the sale date? , 19 . Land ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ 5' ❑ ❑ Does assessment shown reflect all Board of Review or ❑ � ❑ ❑ ❑ ❑ ❑ Appeals adion for the year indicated(induding Board Bldgs. of Review equaliration fadors)? ❑ ❑ � ❑ ❑ ❑ ❑ ❑ 6. ❑ ❑ Is this a 1Q30,formery 20g�4,assessment? Supervisor of Assessments or County Assessor Total 7. ❑ 0 If sale inwlves a mobib home,is the mobile home assessed as real estate? FOR DEPARTMENT USE ONLY ' ❑ ❑ Multiple Parcel Indicator I Full Consideration ❑ ❑ � ❑ ❑ ❑ , ❑ ❑ ❑ Adjusted Consideration ` File Maintenance ❑ ❑ , ❑ ❑ ❑ , L� ❑ ❑ Tab Number: This fortn is authorized in accordance with 35 ILCS 200/1-1 et seq.Disclosure of this information is REQUIRED.This form � �,�E INK Page 4 of 4 has been approved by the Forms Manageme�t Center. ��-492-022� �.J RECYCLED PAPER PTAX-203(R-4/94)