Land Sales Annual Encumbrance Report-A
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Land Sales Annual Encumbrance Report-A Form. This is a Illinois form and can be use in Department Of Professional Regulation Secretary Of State.
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Tags: Land Sales Annual Encumbrance Report-A, IL 505-0443 A, Illinois Secretary Of State, Department Of Professional Regulation
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
STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
Division of Professional Regulation
320 West Washington Street
Springfield, IL 62786
SUBDIVIDER:
REGISTRATION NUMBER:
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 (Rev. Apr 2009)
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