AFFIDAVIT OF COMPLIANCE WITH ILLINOIS PLAT ACT REQUIREMENTS THIS IS A LEGAL DOCUMENT AND MUST BE FILED WITH EVERY DEED RECORDED. Consult an attorney if you do not understand what you are signing. The Grantor(s) or the Grantor(s) authorized representative in a deed transferring interest in the real estate described in the accompanying deed, state the following: _____ A. NOT A DIVISION OF LAND (no change of parcel boundary lines) If A is marked above, approval by the Chief County Assessment Office is not required and no further questions apply. _____ B. A DIVISION OF LAND (change of parcel boundary lines) If B is marked above, approval by the Chief County Assessment Office is required. In accordance with Illinois law (225-ILCS 330/5 Sec C)., beginning January 1, 2004, all legal descriptions for land divisions must be prepared by a registered Illinois Land Surveyor. Has this legal description for this division been prepared in accordance with this law? ______________________________________________ Name and company of surveyor ______________________________________________________________ AND, has this division been approved by Jackson County or a city municipality with jurisdiction? _________ OR, is this a division of land that meets one of the following exceptions to the Plat Act: _____ a. A division or subdivision of land into tracts of five (5) acres or more not involving new streets or easements of access with a minimum of five (5) acres residue. _____ b. A division of lots or blocks of less than one (1) acre in a recorded subdivision not involving new streets or easements of access. _____ c. A sale or exchange of land between owners of adjoining and contiguous land. _____ d. A conveyance of land for use as a right-of-way for public utilities and other pipelines not involving new streets or easements of access. _____ e. A conveyance of land owned by a public utility not involving new streets or easements of access. _____ f. A conveyance of land for highway or other public purpose, or relating to a dedication of land, or for vacation of land subject to a public use. _____ g. A conveyance made to correct a description in prior conveyance. _____ h. The sale or exchange of parcels of land following the division into no more than two (2) parts of a parcel existing on July 17, 1959, and not involving any new streets or easements of access. (Does not apply to the City of Carbondale or its 1-1/2 mile jurisdiction boundary.) _____ i. The sale of a single lot less than five (5) acres from a larger tract, but not a subsequent lot from the same larger tract as determined by the dimensions and configuration of the tract as it existed October 1, 1973. (Does not apply to the City of Carbondale or its 1-1/2 mile jurisdiction boundary.) Under the penalties of perjury I swear that the statements contained here are true and correct. NAME _____________________________________________________DATE ____________________________ SIGNATURE _________________________________________________________________________________ PARCEL NUMBER ____________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com