R96-158 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 PROPERTY 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 declaratio�. (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,Ieave 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' CiOrcleFOne �, R �❑ 'i QUAD. _ ❑ � � Commerrts by Supervisor of Assessments or Courrty Assessor: (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. 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 YEAR PRIOR TO SALE 19 The following questions must be answered: to the property described in ths declaration and Book No. Page , ,T 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.,impmvement not com- included in the transfer. pleted on assessment date) 3. ❑ ❑ Will a split(division)be required to reflect the legal description on this deed(or Trust Document)? Dated this day of 4. ❑ ❑ Has an improvement been added or removed since January 1 of the year prar to the sale,but before the sale date? , 19 . Land ❑ , ❑ ❑ ❑ , � � � 5. ❑ ❑ Does assessment shown reflect all Board of Review or Appeals action for the year indicated(including Board Bldgs. ❑ , ❑ ❑ ❑ , � � � of Review equalisation fadors)? ❑ � ❑ � ❑ ❑ ❑ ❑ 6. ❑ ❑ Is this a 10-30,formerly 20g-4,assessment? Supervisor of Assessments or County Assessor Total 7. ❑ ❑ If sale inwlves a mobile home,is the mobile home assessed as real estate? FOR DEPARTMENT USE ONLY ❑ ❑ Multiple Parcel Indicator Full Consideration ❑ ❑ � ❑ ❑ ❑ � ❑ ❑ ❑ Adjusted Consideration File Maintenance ❑ ❑ , ❑ ❑ ❑ � �1 ❑ ❑ TabNumber: This torm is authorized in accordance with 35 ILCS 200/1-1 et seq.Disclosure of this information is RE�UIRED.This fortn Page 4 Of 4 has beer,approved by the Forms Management Center. IL-492-0227 A SOK BASE INK �i� RECYCIED PAPER PfAX•203(R-4/94)