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�� Illinois Department of Revenue or se y oun y eco ers �ce <br /> County <br /> Property Tax Administration Bureau <br /> REAL ESTATE TRANSFER DECLARATION �ate <br /> THE FOLLOWING INFORMATION IS REQUIRED BY TfiE REAL ESTATE TRANSFER TAX ACf(CHAP. DOC. No. <br /> 120,PAR.1003,IL REV.STAT.).PAGES 1 THROUGH s ARE TO BE FILLED OUT BY THE SELLERS* <br /> AND BUYERS* OR THEIR AGENTS.ANY WILLFUL FALSIFICATION OR WILLFUL OMISSION OF <br /> INFORMATION IS A CLASS B MISDEMEANOR(CHAP.120,PAR.1005,IL REV.STAT.). V01. <br /> EXCEPT AS TO EXEMPT TRANSACTIONS,ThE COUNTY RECORDER OF DEEDS IS PROHIBITED <br /> BY LAW FROM At;CEPTING ANY DEED OR TRANSFER OF BENEFICIAL INTEREST OF A LAND �ge <br /> TRUST (TRUST DOCUMENT) FOR RECORDATION UNLESS IT IS ACCOMPANIED BY THIS <br /> DECLARATION CONTAINING ALL OF THE INFORMATION REQUESTED HEREIN(CHAP.120,PAR. <br /> 1003, IL REV.STAT.). Rec'd. By: <br /> PROPERTY IDENTIFICATION <br /> Address of Property N/A N. 22nd Street Decatur Decatur <br /> Street City or Village Township <br /> Permanent Real Estate Index No. None Assi�ned Date of Deed 5� �88 <br /> (or Trust Document) (Month/Year) <br /> Enter Legal Description on Page 2 of this form. Type of Deed �t»t rl a i m <br /> (or Trust Daument) <br /> PROPERTY CHARACTERISTICS SALE INFORMATION (The following questions must be answered) <br /> Lot Size 58 � X 30�� NpTE: If the answer to any of the following questions is"Yes",you do not have to complete the Finance Schedule at <br /> the top of pages 2 and 3 of this declaration or the Finance Questions at the bottom of this page. <br /> Acreage <br /> Check type of improvement on property ves No <br /> �VaCant land/lot 1. Is this a transfer between relatives or related corporations? ❑ �1 <br /> ❑ Residence(Single family or duplex) 2. Is this a compulsory transaction in Iieu of foreclosure, <br /> ❑ Mobile home divorce,court order,condemnation, probate,etc.? ❑ �I <br /> ❑ Apartment bldg. (6 units or less) 3. Was this a transfer in settlement of an installment contract <br /> ❑ CommerCial apar'tment(Over 6 units) for deed initiated prior to the CURRENT year? ❑ �1 <br /> ❑ Store, office, commercial bldg. Enter contract year <br /> ❑ Industrial bldg. 4. Was the deed any of the following types: �l ❑ <br /> � Farm, land only <br /> •Sheriff's Deed •Judge's Deed •Quit Claim Deed •Conveyance of Less than Y< Interest <br /> ❑ Farm, with bldgs. •Trust Document which Refers to COLLATERAL ASSIGNMENT of Beneficial Interest of Trust <br /> ❑ Other S ecif <br /> TERMS OF SALE <br /> Full Actual Consideration (Sale Price) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g 4, 350. 00 <br /> Less amount of personal property included in purchase (Do not deduct value of beneficial interest of a land trust) $ <br /> Net consideration for real property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $4, 350. 00 <br /> Less value of other real property transferred to seller as part of full consideration . . . . . . . . . . $ <br /> Less amount of mortgage to which the transferred real property remains subject . . . . . . . . . . . $ <br /> Net taxable consideration subject to transfer tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �4, 350. 00 <br /> CALCULATION OF TRANSFER TAX <br /> Amount of State of Illinois tax stamps ($.25 per $500 or part thereof of taxable consideration) . $_ N/A <br /> Amount of county tax stamps ($ per $500 or part thereof of taxable consideration) . . . . . $_ N�A <br /> Total Transfer Tax Collected $_ N A <br /> Use t is space to escribe any specia circumstances ir�vo vmg t is transaction: <br /> Exempt under provisions of Paragraph b, Section 4, Real Estate Transfer <br /> Tax Act . <br /> FINANCE QUESTIONS: The buyer* and seller° (or their representatives)must answer all the following questions unless one o•more of the Sale Information <br /> questions above was checked "Yes". If the Sale Information questions are all marked "No"and any of the following questions are answered "Yes",the buyer* or buyer's* <br /> representative MUST complete the FINANCE SCHEDULE on pages 2 and 3. If the answer to all of the questions below is"No",omit compl�tion of the FINANCE <br /> SCHEDULE and go directly to the LEGAL DESCRIPTION on page 2 and signature spaces on page 3. <br /> Yes No <br /> 1. Did the buyer assume the seller's mortgage? OR If this transaction is a transfer of <br /> If FINANCE QUESTIONS a beneficial interest of a land trust,does property REMAIN SUBJECT to a mortgage? ❑ ❑ <br /> i through 5 2. Did the seller' provide a mortgage in partial or full consideration? G ❑ <br /> are answered "NO", 3. Did the seller* pay points to secure the buyer's* mortgage, including VA and FHA insured loans? ❑ ❑ <br /> DO NOT complete 4. Did the seller's* mortgagee make interest concessions to the buyer*, i.e.,offer a "blended" <br /> Finance Schedule interest rate below market but greater than the seller's existing mortgage rate? ❑ ❑ <br /> 0� P2g@S 2 dfld 3. 5. Was the financing in any other manner unique or specifically associated with the property <br /> being transferred, e.g., builder"buy down"of interest,etc.? ❑ ❑ <br /> PTAB-203(R-12/85) <br /> IL-492-0027 ' If this transadion is a trensfer of a beneficial interest of a land trust read Assignor for Seller and Assignee for Buyer. page 1 <br />