Plat Act Affidavit 18 N County St � 6th Floor Waukegan, IL 60085-4358 Phone: (847) 377-2575 FAX: (847) 984-5860 STATE OF ILLINOIS COUNTY OF LAKE } SS I, (name) that I reside at , being duly sworn on oath, state , and that the attached deed is not in violation of the Plat Act, Ch. 765 ILCS 205/1.1(b), as the provisions of this Act do not apply and no plat is required due to the following allowed exception (Circle the number applicable to the attached deed): 1. The division or subdivision of land into parcels or tracts of 5 acres or more in size which does not involve any new streets or easements of access; 2. The division of lots or blocks of less than 1 acre in any recorded subdivision which does not involve any new streets or easements of access; 3. The sale or exchange of parcels of land between owners of adjoining and contiguous land; 4. The conveyance of parcels of land or interests therein for use as a right of way for railroads or other public utility facilities and other pipe lines which does not involve any new streets or easements of access; 5. The conveyance of land owned by a railroad or other public utility which does not involve any new streets or easements of access; 6. The conveyance of land for highway or other public purposes 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; 7. Conveyances made to correct descriptions in prior conveyances; 8. The sale or exchange of parcels or tracts of land following the division into no more than 2 parts of a particular parcel or tract of land existing on July 17, 1959, and not involving any new streets or easements of access; 9. The sale of a single lot of less than 5 acres from a larger tract when a survey is made by an Illinois Registered Land Surveyor; provided, 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, and provided also that this exemption does not invalidate any local requirements applicable to the subdivision of land; 10. The conveyance of land does not involve any land division and is described in the same manner as title was taken by grantor(s). AFFIANT further states that this affidavit is made for the purpose of inducing the RECORDER OF LAKE COUNTY, ILLINOIS to accept the attached deed for recording. (This affidavit is not applicable to Facsimile Assignment of Beneficial Interest.) day SUBSCRIBED and SWORN to before me this of , Notary: (Signature) Revised: September 7, 2010 11:40 AM American LegalNet, Inc. www.FormsWorkFlow.com (seal)