Transfer On Death Instrument

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TRANSFER ON DEATH INSTRUMENT
Owner’s name and address and Taxes TO:
name
address
address
Beneficiary’s name and address:
name
address
address
recOrder’s sTamP
THis Transfer On deaTH insTrUmenT made this
day of
, 20
, by
[name of owner/s], of the city of
, county of
, state of illinois (herein
“Owner/Owners”), being the sole Owner(s) of the following legally-described residential real estate located in
county, illinois:
[legal description]
Property identification number:
Property address:
The Owner(s), being of competent mind and capacity, and waiving and releasing all rights under the homestead exemption laws of the
state of illinois, hereby convey(s) and transfer(s), effective on the death of the Owner last to die, the above-described real estate to:
______________________________________________________________________________________________________________
[beneficiary designation]
in wiTness wHereOf, the said Owner(s) has/have hereunto set his/her/their hand(s) and seal(s) the day and year first above written.
name, Owner
name, Owner
affix Transfer Tax sTamP
Or
exempt under provisions of 33 iLcs 200/31-45, Paragraph
, illinois real estate Transfer Tax Law.
date
Buyer, seller, or representative
we, the undersigned witnesses, hereby certify that the above Transfer on death instrument was on the date thereof signed and declared
by the Owner(s) as his/her/their Transfer on death instrument in our presence and that we, at his/her/their request and in his/her/their
presence and in the presence of each other, have signed our names as witnesses thereto, believing to the best of our knowledge that the
Owner(s) was/were at the time of signing of sound mind and memory, and under no undue influence.
, residing at
witness
address
, residing at
witness
address
sTaTe Of iLLinOis
)
)
ss
cOUnTy Of
)
i, the undersigned, a notary public in and for said county, in the state aforesaid, dO HereBy cerTify that Owner(s) and witnesses
personally known to me to be the same persons whose names are subscribed on the foregoing instrument, appeared before me this day

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