Application For Certificate Of Payment Form printable pdf download

VILLAGE OF LANSING

3141 Ridge Road

Lansing, IL 60438

Phone: 708-895-7200

Fax: 708-895-6878

APPLICATION FOR CERTIFICATE OF PAYMENT

Deed Change Only

Sale of Property

(Please check one)

Ordinance #13-032 of the Village of Lansing Municipal Code establishing a Certificate of Payment requires anyone who sells

property or transfers real estate to pay all outstanding service charges, including but not limited to, water service, building code

violations, and other charges, due to the Village be paid in full before a Certificate of Payment Certificate is issued. This also

requires the Seller to give the Village three (3) days notice before the scheduled closing to allow sufficient time to obtain

a final meter reading and issue a certificate once all debts to the Village of Lansing have been paid. This procedure is also

required for Quit Claim deeds. Please complete this form and either fax or deliver this form to the Village Treasurer located at

3141 Ridge Road.

YOU MUST CALL PUBLIC WORKS AT 708-895-7190 TO SCHEDULE A FINAL WATER METER READ. You will

be notified of any monies due the Village. The final amount due may be paid in cash, credit card (MasterCard/Visa/Discover),

cashier’s check, certified check or money order. PERSONAL CHECKS NOT ACCEPTED. Once payment is made the

Village will issue a Certificate of Payment certifying that all amounts owed by the Seller have been paid in full.

SELLER’S NAME

____________________________________________________

MAILING ADDRESS

____________________________________________________

TELEPHONE NO.

____________________________________________________

ATTORNEY or AGENT ___________________________________________TELEPHONE___________________________

PROPERTY ADDRESS

_________________________________________________

PROP INDEX NUMBER (PIN) _____________________________________________

WATER ACCT NUMBER _________________________________________________

BUYER’S NAME__________________________________________TELEPHONE_________________________________

SCHEDULED CLOSING DATE ________________________TIME__________

If you wish to be faxed the final water bill, please provide a fax number and the name to which the bill should be sent:

Fax #__________________________

Attention of:_________________________________

YOU MUST CALL PUBLIC WORKS AT 708-895-7190 TO SCHEDULE YOUR FINAL WATER READ

SIGNED _____________________________________

DATE:__________________________

(May be signed by the seller or an authorized agent)

THE FOLLOWING IS FOR OFFICE USE ONLY:

Final Water Bill: $_________________

Judgment: $__________________

Building Dept. _______________

Rental Licensing: $________________

False Alarm: $_________________ Other: $__________________

TOTAL AMOUNT DUE:

$_______________________________

Revised 8/13/13

Application For Certificate Of Payment Form

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