AFFIDAVIT FOR RECORDING DEED State of Illinois ) County of Boone )SS Document No. I, , residing at , being first duly sworn on oath, states as follows: CHECK BOX OF APPLICABLE PROVISION: A. That the attached deed does not represent any type of division of an existing parcel of land. APPROVED BY: Supervisor of Assessments B. That the attached deed does represent a division of property but none of the divided parcels of the remaining parcel is less than five (5) acres in size and the division does not involve any new streets or easements of access. C. That the attached deed does represent a division of property in which at least one of the parcels of land is less than five (5) acres but the resulting parcels do not lie in a district presently zoned agricultural under the Zoning Ordinance of Boone County. A plat has been approved by the appropriate local governmental agency and submitted to the Recorder of Deeds of Boone County, IL. D. That the attached deed does represent a division of property in which at least one of the parcels of land is less than five (5) acres and the property is located in a district zoned agricultural but the division does not require a plat and does not require a zoning variance because it falls within one of the following exceptions: (Check one of the following) 1 The division of lots or blocks of less than one acre in any recorded subdivision which does not involve any new streets or easements of access. 2 The sale or exchange of parcels of land between owners of adjoining and contiguous land. 3. The conveyance of parcels of land or interest therein for use as right of way for railroads or other public utility facilities which does not involve any new streets/easements of access. 4. The conveyance of land owned by a railroad or other public utility which does not involve any new streets or easements of access. 5. The conveyance of land for highway or other public purpose or grants or conveyances relating to the dedication of land for public use or instruments relating to the vacation of land impressed with a public use. 6. Conveyance made to correct descriptions in prior conveyances. 7. The sale or exchange of parcels or tracts of land following the division into no more than two parts of a particular parcel or tract of land existing on July 17, 1959 and not involving any new streets or easements of access. 8. The sale of a single lot of less than five (5) acres from a larger tract when a survey is made by a registered surveyor; provided, however, that this exemption shall not apply to the sale of any subsequent lots from the same larger tract of land, as determined by the dimensions and configuration of the larger tract on October 1, 1973. The survey has been presented to the Boone County Supervisor of Assessments or the Recorder of Deeds in Boone County, IL. American LegalNet, Inc. www.USCourtForms.com E. Other - Must have approval of State's Attorney or County Planner. AFFIANT is aware that the Zoning Ordinance of Boone County, IL requires a minimum lot size of five (5) acres in every tract zoned "Agricultural" and that no building permit will be issued for any lot which violates this minimum lot size requirement. AFFIANT further states that this Affidavit is made for the purpose of inducing the Recorder of Deeds of Boone County, IL to accept the attached deed for recording. Signature SUBSCRIBED AND SWORN TO before me this day of . Notary Public American LegalNet, Inc. www.USCourtForms.com