Land Sales Annual Encumbrance Report-A {IL 505-0442}

NOTE: This form is to be used if no encumbrance exists. IMPORTANT NOTICE: Completion of this form is necessary to accomplish the requirements outlined in [765 ILCS 86]. Disclosure of this information is REQUIRED. Failure to provide any information will delay the processing of this form. Submission of false information may subject the affiant to prosecution under applicable perjury statutes. This form has been approved by the Agency Forms Coordinator. LAND SALES ANNUAL ENCUMBRANCE REPORT --- A ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION Division of Real Estate 320 West Washington Street Springfield, IL 62786 REGISTRATION NUMBER: SUBDIVIDER: 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) American LegalNet, Inc. www.FormsWorkFlow.com