R96-69 AUTHORIZING FINAL CONVEYANCE OF HOMESTEAD PROPERTY

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EINANCE SCHEDULE — DO NOT complete this schedule if FINANCE QUESTIONS 1 through 5 on Page 1 are all answered "No". . � TERM IV V VI � II III Amount of Term To Interest Type of Points Paid by SELLER' Principal Amortizatian galloon or Rate Interest To Obtain Financing �$.5� Period Renegotiation (%) Rate DO NOT SHOW POINTS PAID BY BUYER' (Years Remaming) �Years) � g�s A. XXXXXXXXX XXXXXXXX XXXXXXXX XXXXXXX XXXXX XXXXXX XXXXXXXXX B. XXXXXXXXX XXXXXXXX XXXXXXXX XXXXXXX XXXXX XXXXXX XXXXXXXXX �• XXXXXX XXXXXXXXX iF D. �i c E. �� A F. � u G. iE H. �o N �. � Y J.Use this space to explain replies in Finance Schedule if necessary and to explain any charocteristics of the financing of this transadion that may have impaded the sale i price. i BUYER*: I hereby declare the Finance Schedule on Pages 2 and 3 of this declaration to be true and corrett,(NOTE:Any person who wiUfully falsifies or omits any informa- tion required in this declaration sha/I be guilty of a Class B Misdemeanor.) Buyer or Name of person filling out the Finance Schedule for the buyer: Please Print Signature Address Telephone� � — Q(ynu p2/er the Department contad the lending mstdution if further financmg information is 2amied,also provide the mstdution's name,address,and telephone number below.) ( ) Name of Lending Institution Address Telephone BUYER* & SELLER*: I The buyer' and seller' hereby d¢clare the full actual consideration and above facts cantained in this dectaration(excluding the Fnance Schedule)to be true and cortec[. If this Uansaction irnvlres ary real estate bnted in Caok Courrty, the seller•or his a�nt hereby certifies that to the best of his knowledge,and the buyer' or his agent hereby certfies that,the name af the buyer' shown on the deed or assignment of benefiaai iMerest in a land trust is either a natural person,an Iliirais�rporation or fore�� corporation authorized to do bus�ness or acquire and hold title to real estate in Illinas,a partnership authorized to do business or acquire and hold titte to real estate in Illinas,or other errtity�ized as a person and authonzed to do business or acquue and hold tRle to 2al esYate under the laws af the State of Illirais.(NQlE.•Arry person � who wiRlulty falsifr�s or an�ts arry infarmation requi�ed in this declaratan sha/l be guilty of a pass B Misdemeanor.A�ry person who knawing/y submrts a false statement croncerning the�dentrty of a graMee shall be gwlty of a Class C Misdemeanor tor the fin7 aHense a�af a Class A Misdemeanor fa subsequent oHerues) City of Decatur, ��l Gary K. Anderson Plaza, Decatur, IL 62523 Name and Current Res�dence of Seller' (Please Pnnt) I Name and Pdd of Tru is is a tran er of benefic�al irrterest of a land trust. Tivst Number Signature: '� �f!!�. A/�1 u� Ier` or Agent ` Alissa R. Herron, 806 W. Elm St. , Decatur, IL. 62526 Name and Curtent Res�dence of Buyer• (Please prirrt) Signature: Buyer' or Agent Mad tax bill to: P�ame Street City PREPARER: Sectio�31•25 of the Roperty Tax Code(35 ILCS ZQOI31-25)requires the fdlowing infarmation to be oanpleted: Name of person filling out the r�l estate transfer declaration for the buyer' and seller•: Richard L. Heavner, Heavner — Handegan & Please Pnnt $COtt address P.O. Box 835, Decatur, IL 62525 Te��( 21] > 422— 1717 THIS BOX FOR USE BY DEPARTMENT OF REVENUE ONLY: Initial Date PfAX-203(R�/94) " If this transfer is an assignment of a beneficial iMe2st of a land trust, substitute the wad Ilssi�nr fa SeNer and Assigr�s br&yer. Page 3 ot 4