Land Sales: Annual Encumbrance Report - A - Affidavit printable pdf download

Land Sales: Annual Encumbrance Report - A - Affidavit

NOTE: This form is to be used if no encumbrance exists.

LAND SALES

IMPORTANT NOTICE: Completion of this form is

ANNUAL ENCUMBRANCE REPORT --- A

necessary to accomplish the requirements outlined in

[765 ILCS 86]. Disclosure of this information is

REQUIRED. Failure to provide any information will delay

ILLINOIS DEPARTMENT OF

the processing of this form. Submission of false

FINANCIAL AND PROFESSIONAL REGULATION

information may subject the affiant to prosecution under

Division of Real Estate

applicable perjury statutes. This form has been approved

320 West Washington Street

by the Agency Forms Coordinator.

Springfield, IL 62786

SUBDIVIDER:

REGISTRATION NUMBER:

SUBDIVISION:

DATE:

1. There are no encumbrances or liens (mortgages, lis-pendens, development loans, tax liens of any type, etc.)

recorded or unrecorded, affecting title to property registered for sale under the Illinois Land Sales Registration Act

of 1999 [765 ILCS 86].

2. There are no delinquent real estate taxes.

AFFIDAVIT

The following signatory does swear the information contained in this report is true and correct and constitutes a complete

statement of matter to which it relates.

Signature:

Please type name and title:

State of _______________________

County _______________________

Subscribed and sworn to before me this _________________ day of __________________________, 20____________.

NOTARY

SEAL

Commission Expires: ___________________

_________________________________________

(Notary Public Signature)

SUBMISSION OF A FALSE AFFIDAVIT MAY SUBJECT THE AFFIANT

TO PROSECUTION UNDER APPLICABLE PERJURY STATUTES

IL 505-0442 (Revised June 2014)

Land Sales: Annual Encumbrance Report - A - Affidavit