1 of 3 To the Assessor of Cook County: By signing below, I affirm that I have an interest in the property described in this petition. I request and authorize the Assessor to reconfigure () existing s as () cts on the Assessment Roll for the 20 tx year. () The required fee, as authorized under Section 32-1 of the Code of Ordinances of Cook County, Illinois, must be paid at the time of filing this division/consolidation. exact, concise, legal description of the property to be divided or consolidated and of each new tract to belisted. I also acknowledge that I have read and complied with the instructions on the third page of this form ALL PARTIES TO THE DIVISION AND/OR CONSOLIDATION MUST SIGN All original signatures must be notarized including the submitter222s NOTE: Tract owner(s) name and address listed below will be forwarded to the county collector for billing purposes. Subscribed and sworn to before me this day of 20 A.D. Notary Public Subscribed and sworn to before me this day of 20 A.D Notary Public (Use page 2 for additional notarized signatures) FOR OFFICE USE ONLY Township Volume Date Received By Petition No. Division MadeBy Land Division No. PETITIONS FOR DIVISIONS/CONSOLIDATIONS MUST BE RECEIVED OR POSTMARKED NO LATER THAN OCTOBER 31, 201PETITION FOR DIVISION AND/OR CONSOLIDATION Signature Print Name Address City State Zip Tel. No. (Submitter/Representative) Signature Print Name Address City State Zip Tel. No. (Owner of Tract Number 1) COOK COUNTY ASSESSOR COOK COUNTY ASSESSORS OFFICE 118 NORTH CLARK STREET,CHICAGO, IL 60602 PHONE: 312.443.7550WWW.COOKCOUNTYASSESSOR.COM American LegalNet, Inc. www.FormsWorkFlow.com 2 of 3 Subscribed and sworn to before me this day of 20 A.D. Notary Public Subscribed and sworn to before me this day of 20 A.D. Notary Public Subscribed and sworn to before me this day of 20 A.D. Notary Public Subscribed and sworn to before me this day of 20 A.D. Notary Public Signature Print Name Address City State Zip Tel. No. (Owner of Tract Number 4) Signature Print Name Address City State Zip Tel. No. (Owner of Tract Number 2) Signature Print Name Address City State Zip Tel. No. (Owner of Tract Number 3) Signature Print Name Address City State Zip Tel. No. (Owner of Tract Number 5) American LegalNet, Inc. www.FormsWorkFlow.com 3 of 3 SCHEDULE TO BE ATTACHED AS A PART OF LAND DIVISION/CONSOLIDATION PETITION Volume Tax Code(s) Permanent Real Estate Index No.(s) Please read the detailed rules for Filing Petitions and Consolidations, available on our web site and a. For information: Phone: 312-603-5323 Fax: 312-603-5247, Website: www.cookcountyassessor.com List original legal description(s) as now described on the County Clerk222s records and then list separately the new description of each divided or consolidated tract. Number each tract to correspond with the signatures on pages 1 and 2. If the new legal description is by metes and bounds, a plat of survey showing acreage MUST be attached to this petition. The Division Department may request and require, as necessary, the following additional documentation: deeds, plat act, and/or affidavits. THIS SECTION IS FOR EXEMPT PROPERTIES ONLY Check here if an exempt parcel is being divided or consolidated and the exemption is to be continued for all or some of the newly created parcels. An Exempt 223Continued Ownership and Use Affidavit224 MUST be filed as part of this petition. Continued Ownership and Use Affidavit forms are available in the Assessor222s Exempt Department or on the Assessor222s ebsite at www.cookcountyassessor.com. Check here if an exempt parcel is being divided or consolidated and it is not the intent of the exempt agency to continue the exemption to any of the newly created parcels. Check here if application for exemption has been filed with the Cook County Board of Review. Date of application . Signature Date American LegalNet, Inc. www.FormsWorkFlow.com