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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 627949033 <br /> after being processed by county personnel. <br /> 1. ENTER BRIEF LEGAL DESCRIPTION OF PROPERTY AS IT APPEARS ON ASSESSMENT BOOKS. i <br /> 2. INSTRUCfIONS FOR COMPLETING PROPERT`f DESCRIPfION 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 Approisal Manual,or ciRle the appro- <br /> priate letter'rf using the codes in the IL Property Tax Manual.Enter the assessment Quadrant if applicable. <br />• (b) County&Township: Use codes from Department Code Sheets. (d) Date of Deed: Enter month and year hom Page i 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 ('rf assessed as farm(10.125)with no buildin� 71 (assessed as nonfarm with no building) <br /> 61 (if assessed as farm(10-125 and 10-140)with a building) 81 (assessed as nonfarm with a buildin� <br /> PERMANENT REAL ESTATE INDEX N0. <br /> �a� � � � � �Ba � �PA❑L� � � I� � / F, F0,Ie�One �. R � <br /> QUAD. <br /> ❑ ❑ ❑ Commerds by Supervisor of AssessmeMs or Courrty Asseuor: <br /> (b) County <br /> Township � � � <br /> (c) Ctass � � <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. I hereby certify that the information shown relates <br /> Where assessment is partial or split,designate with a large"P"or"S"on the assessment boxes. <br /> YEAR PRtOR TO SALE 19 The fallawing questions must be answered: to the property destribed in the declaration and <br /> Book Na Page Line � N0 <br /> L � � Is this a 14125,formerly 20e,assessment?("Farm Bill'7 that the assessed valuations are for the property <br /> 2 ❑ ❑ Is this a partial assessment?(i.e.,impmvement not com- included in the transfer. <br /> pleted an assessment date) <br /> 3. ❑ ❑ wll a split(division)be required to reflect the legal <br /> desaiption on this deed(or Trust Dotument)? Dated this day of <br /> 4. ❑ ❑ Has an impmvement been added or rertio�ed since <br /> January 1 of the year prar to the sale,but before the <br /> sale date? � 19 . <br /> Land ❑ , ❑ ❑ ❑ , ❑ ❑ ❑ 5. ❑ ❑ Does assessment shown reflect all Board af Review or <br /> � ❑ ❑ ❑ ❑ ❑ ❑ Appeals aQion tor the year indicated(induding Board <br /> Bldgs. of Review eQualiration fadors)? <br /> ❑ � ❑ � ❑ ❑ � � 6. 0 ❑ Is this a 10�30,formery 20g-4,assessment? <br /> Supervisor of Assessments or Counry Ilssessor <br /> Total 7. ❑ p If sale inwl�es a mobile home,is the mobik home <br /> auessed as real estate? <br /> FOR DEPARTMENT USE ONLY <br /> ❑ ❑ MuRiple Par�el Indicator <br /> Full Consideration <br /> � ❑ ' ❑ ❑ ❑ ' a ❑ � ' Fle Maintenance <br /> Adjusted Conside2tion — <br /> ❑ ❑ , ❑ ❑ ❑ , L� ❑ ❑ Tab Number: <br /> This form is authonzed in accordance wrth 35 ILCS 200/1-1 et seq.Discbsure of this infortnation is REOUIRED.This form A �,�E INK <br /> Page 4 of 4 has been approved by the Fortns Management Center. IL-492•0227 ��RECYCLED PAPER FTAX-203(R-4194) <br />