STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 FILING INSTRUCTIONS The following instructions must be followed when completing the Land Sales Registration Act of 1999 [765 ILCS 86] Questionnaire/ Application. FAILURE TO COMPLY WITH THESE INSTRUCTIONS WILL RESULT IN A DELAY IN THE PROCESSING OF YOUR APPLICATION. 1. All questions on the Land Sales Questionnaire/Application must be answered fully. If the question does not apply, so indicate by stating “NOT APPLICABLE.” Spaces may be enlarged or extended to provide a comprehensive explanation. Additional pages may be used to fully explain a question and additional information may be added, if necessary. An amendment to an existing registration may incorporate by reference information or documentation contained in a previous filing if such filing was on property contiguous to the present filing. 2. Registration applications shall be filed on good quality, unglazed, 8 ½ x 11 or legal size white paper, with a 1” margin at the top and sides. Information shall be typed in black ink, using a standard size of type. Deeds, title policies, maps, plots, and other supporting documents must be reduced to a size which allow them to be neatly folded and bound with the application. The filing must be in stiff folder through which a metal fastener will bind the entire filing at the top. 3. Attachments I, II, and III set forth the supporting documentation required for each type of registration. The supporting documentation shall be attached as exhibits. Each exhibit shall be identified by affixing a tab on the right side of the cover sheet of the exhibit. Such identification shall conform to the alphabetical format of Attachment I, II, or III. There shall be an “Index to Exhibits” which shall be the cover page and should list in order all of the exhibits and supplementary materials in the filing. 4. If the information in an exhibit is applicable to more than one part of the Questionnaire, the developer may incorporate that information by reference to the appropriate exhibit. 5. If an item in the Questionnaire is supported by information in an exhibit, place the appropriate identification in the space immediately following the item in the Questionnaire. Whenever an item in the Questionnaire requires a summary or statement of terms, such summary or statement must be presented in a clear and concise manner. 6. Where documentation required in Attachment I, II, or III does not apply, in lieu of an exhibit, the application shall insert a page reciting the exhibit identification and description as set forth in Attachment I, II, or III hereof and indicate thereon “NOT APPLICABLE.” Where required documentation cannot be obtained, the applicant must furnish a letter of explanation. 7. There shall be a balance sheet and profit and loss statement dated within 90 days of this application and certified by the Chief Financial Officer of the applicant. 8. If the subdivision is not registered with the U.S. Department of Housing and Urban Development, Interstate Land Sales Registration Division, refer to Attachment I for supporting documentation requirements. FILINGS APPROVED BY HUD – ILSRD If the subdivision is registered with the U.S. Department of Housing and Urban Development, Interstate Land Sales Registration Division, or similar federal agency, a shortened filing procedure is available. Refer to Attachment II. FILINGS APPROVED BY ANOTHER JURISDICTION AUTHORIZED BY IDFPR If the subdivision is registered in another jurisdiction authorized by the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation, a shortened filing procedure is available. Refer to Attachment III. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION LAND SALES QUESTIONNAIRE/APPLICATION DIVISION OF PROFESSIONAL REGULATION 320 WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 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 result in a delay in processing. Submission of false information may subject the affiant to prosecution under applicable perjury statutes. This form has been approved by the agency Form Coordinator. PLEASE CHECK ONE: CHECK TYPE OF OWNERSHIP: INITIAL REGISTRATION AMENDMENT TO PREVIOUS REGISTRATION INDIVIDUAL PARTNERSHIP CORPORATION FOREIGN CORPORATION LIMITED LIABILITY COMPANY 1. APPLICANT a. Name of applicant:___________________________________________________________________________ Address of applicant:_________________________________________________________________________ _________________________________________________________________________ b. Telephone No:___________________________ c. F.E.I.N. or Social Security No:________________________ d. If incorporated, state where and when:___________________________________________________________ e. If a foreign corporation, have you qualified to do business in Illinois? f. Indicate status of applicant: OWNER DEVELOPER YES NO AGENT g. If other than owner, explain and fully identify owner:_________________________________________________ _________________________________________________________________________________________ h. Indicate name and mailing address to whom correspondence should be directed:__________________________ __________________________________________________________________________________________ 2. SUBDIVISION a. Common promotional name: ___________________________________________________________________ b. List properties in this filing: ____________________________________________________________________ c. Indicate number of lots in this filing: _____________________________________________________________ d. Indicate number of lots in any previous filing for this subdivision: ______________________________________ e. Indicate, in square feet, the dimensions of the smallest lot: __________________________________________ f. Indicate minimum road frontage: _______________________________________________________________ g. Indicate acreage in entire subdivision: ___________________________________________________________ h. Indicate gross acreage in this filing: _____________________________________________________________ i. Indicate number of dwellings in the subdivision at the time of filing:_____________________________________ IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com 3. LOCATION a. Indicate county and state or county in which subdivision is located:_____________________________________ b. What is the nearest town:______________________________________________________________________ c. Give the route and road mileage from the nearest town to the lands in the filing:___________________________ __________________________________________________________________________________________ 4. TITLE a. Are there any mortgages, trusts, liens or other encumbrances? YES NO b. If yes, give full particulars:______________________________________________________________________ __________________________________________________________________________________________ 5. PLATTING a. Are the lands in this filing platted of record? YES NO b. If yes, did such plating require prior approval or acceptance by a government agency? YES NO c. If yes, indicate name and location of government agency:_____________________________________________ __________________________________________________________________________________________ d. What government entity, if any, has agreed to accept maintenance of the roads and drainage?_______________ __________________________________________________________________________________________ e. Will you be required to obtain permits, licenses or approvals in order to develop the property in this offering? YES NO If yes, please give full details including whether you have already obtained such, and the name and address of the government entity requiring them:_______________________________________________________________ __________________________________________________________________________________________ 6. IMPROVEMENTS a. What improvements have been promised or completed on the lands in this filing? Indicate by placing an "X" in the appropriate square. Enter the percentage completed and the completion or projected completion date. X Description % Completed Date Completed Projected Completion Date X Description Graded Roads Gas Supply Central Water Telephone Service Sanitary Sewers Projected Completion Date Street Lighting Electrical Supply Date Completed Sidewalks Paved Streets % Completed Other: Drainage Curbs and Gutters American LegalNet, Inc. www.FormsWorkflow.com 6. IMPROVEMENTS (continued) b. If assurances have been posted to secure the completion of any improvements, state type and with whom and list improvements so secured:_____________________________________________________________________ __________________________________________________________________________________________ c. If any promised improvements are not completed and no assurances have been posted to secure completion, what means, if any, shall be employed to guarantee completion?___________________________________________ d. Have the parcels in this subdivision been offered for sale by any media of advertising or sales promotional plan, either within the State of Illinois, or elsewhere, at any time prior to the date thereof? If yes, please explain. YES NO __________________________________________________________________________________________ e. Are all improvements promised to purchasers included in the sales contract? YES NO If yes, explain:_______________________________________________________________________________ 7. TAXES, ASSESSMENTS a. Are current real property taxes paid? YES NO b. Date next payment due:_______________________________________________________________________ c. How is the tax based? RAW ACREAGE VALUATION SUBDIVISION LOT VALUATION d. Who is to pay taxes until such time as the title is conveyed?___________________________________________ e. Are there any assessments levied by any governmental authority? YES NO If yes, explain:_______________________________________________________________________________ f. Is the land located in a special district or affected by any bond issue? YES NO If yes, explain:_______________________________________________________________________________ 8. TERMS AND CONDITIONS OF SALE a. Are cash sales allowed? YES NO b. Minimum down payment on installment sales:______________________________________________________ c. Maximum term of installment contracts:___________________________________________________________ d. Annual interest rate:___________ Is interest charge included in payment? YES NO e. When does purchaser take title?________________________________________________________________ f. If there is a penalty for prepayment, explain:________________________________________________________ g. If there is a refund provision, explain:_____________________________________________________________ h. If all improvements promised are not included in the sales contract, explain:______________________________ __________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com 8. TERMS AND CONDITIONS OF SALE (continued) i. Will purchaser be required to pay an improvement maintenance charge or any YES NO other sum than purchase price and interest and taxes or assessments validly levied by a government authority? If yes, explain:___________________________________________________ ___________________________________________________________________________________________ j. Sales prices range from: $ __________________________ to $ __________________________ k. Are there any inducements such as gifts, free offers or any other promises YES NO offered to prospective purchasers? If yes, explain:__________________________________________________ 9. TYPE OF OFFERING IN THIS FILING a. Zoning classifications:_________________________________________________________________________ b. Have you entered or do you plan to enter into a home building project in this subdivision? If yes, provide type of homes, price, terms of sales, etc. YES NO __________________________________________________________________________________________ c. State uses if improved or unimproved lot:__________________________________________________________ d. Has the land been offered for sale at any time to the date of this filing in this or any other jurisdiction? YES NO If yes, explain:_______________________________________________________________________________ e. Type of offering: HOMESITE RV PARK CAMPSITE MOBILE HOME PARK IMPROVED ACREAGE UNIMPROVED ACREAGE 10. AREA FACILITIES AND SERVICES a. Facilities – Distances should be expressed in mileage over roads accessible by conventional automobiles. FACILITY TYPE DISTANCE Schools Shopping Medical Churches Police Fire b. Public Utilities TYPE JURISDICTION RATES American LegalNet, Inc. www.FormsWorkflow.com 11. FILINGS WITH STATE/FEDERAL/PROVINCE AUTHORITIES a. Has this filing been approved by O.I.L.S.R., H.U.D.? YES NO If yes, please provide O.I.L.S.R. file number:_______________________________________________________ If no, explain why not and if such approval is expected:_______________________________________________ __________________________________________________________________________________________ b. Has this filing been approved by any state regulatory agency? YES NO If yes, state the jurisdiction:____________________________________________________________________ c. Has the filing been rejected, suspended or revoked by the federal government YES NO or any state regulatory agency? If yes, state the jurisdiction and the present status:_____________________________________________________________________________________ 12. BROKER a. Do you have an Illinois Real Estate Broker who will handle sales in this state? YES NO If yes, provide name, address and license number:__________________________________________________ __________________________________________________________________________________________ 13. RESALE PROGRAM a. Do you intend to engage in a resale program for purchasers who wish to sell their contract interest in lots which they have purchased? YES NO If yes, explain the program in full:________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com CERTIFICATION STATE OF ____________________________) COUNTY OF __________________________) CORPORATION SEAL (if applicable) I hereby certify that I personally completed this application; that the statement contained in said application and in all statements accompanying same are true, correct, and complete in all respects and in compliance with the provisions of the Illinois Land Sales Registration Act to the best of my knowledge and belief; and that I am the person legally authorized to sign for this firm. ___________________________________________ Signature of Person Designated to Sign for Firm ___________________________________________ Type or Print Name of Person Designated to Sign for Firm NOTARY SEAL Subscribed and sworn before me this _______day of __________________, 20_____. ___________________________________________ Signature of Notary Public SUBMISSION OF A FALSE AFFIDAVIT MAY SUBJECT THE AFFIANT TO PROSECUTION UNDER APPLICABLE STATUTES. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com ATTACHMENT I - SUPPORTING DOCUMENTATION The following exhibits must accompany an application for registration of any subdivision not registered with the U.S. Department of Housing and Urban Development, Interstate Land Sales Registration Division. EXHIBIT A -- If a Corporation -- submit a copy of Articles of Incorporation amendments hereto and a current list of all names and addresses of officers and directors with their principal occupations for the past 5 years. Submit name and address of any person whose interest in the application is 10 percent or more and the extent and nature of such ownership. EXHIBIT J -- Encumbrances 1. 2. 3. 4. Copy of mortgage. Copy of trust deed. Copy of any other encumbrances. Copy of offset statement or release clause. EXHIBIT K -- Covenants If a Foreign Corporation -- submit a Certificate of Authority to Transact Business in Illinois, if applicable. (contact the Illinois Secretary of State’s Office for additional information) If a Partnership or Association – submit a copy of Articles of Partnership or Association or other organizational Documents. State the name, address, and telephone number of the Individual in Illinois who shall hold copies of the Instruments executed in connection with sales to Illinois Residents. EXHIBIT B – A certified financial statement dated within 90 days of the application and certified by the Chief Financial Officer of the applicant. EXHIBIT C -- Consent to Service of Process. EXHIBIT D -- A general location map showing total land offered or to be offered, drawn to scale, indicating lands included in this filing and land previously registered, if any, in the subdivision being developed. EXHIBIT E -- Topographic map of lands included in this filing. EXHIBIT F -- Copy of plat, map, survey or record, or other form of map or survey if property is not platted or mapped of record. 1. 2. 3. 4. Copy of restrictions. Copy of reservations. Copy of easements. Copy of any other conditions. EXHIBIT L -- Improvements 1. Copy of performance bonds or agreements assuring the completion of promised improvements. 2. Copy of the construction schedule for all promised improvements. 3. Copy of the contract with a public utility for the installation of any improvements. 4. Copy of engineer's statement as to roads, water, power, soil, drainage, flood control, and sewage disposal. 5. Copy of engineer's statement as to estimate costs of any promised improvements not completed. 6. Copy of documents or letters showing what governmental entity has agreed to accept maintenance of the roads and drainage, if applicable. EXHIBIT M -- Sale Documents 1. Copy of all sales contracts, agreements, options, or lease forms. 2. Copy of promissory notes. 3. Copy of form of deed to be used to convey property. EXHIBIT N – Property Reports EXHIBIT G – Evidence of Title 1. Illinois Public Property Report, and 1. 2. 3. 4. Copy of Certificate of Title Copy of Title Insurance Policy. Opinion of Title, or Other evidence of Title. EXHIBIT H -- Copy of conveyance bearing recordation data by which the owner acquired title to the lands in this filing. 2. Property report filed with Office of Interstate Land Sales Registration, U.S. Department of Housing and Urban Development, or 3. Property Report approved in another jurisdiction. (see Section 1260.125 of the Administrative Rules) EXHIBIT I -- Legal description of property in this filing. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com ATTACHMENT II – SUPPORTING DOCUMENTATION The following exhibits must accompany an application for registration of any subdivision currently registered with the U.S. Department of Housing and Urban Development, Interstate Land Sales Registration Division. EXHIBIT A -- A Statement of Record supplied by HUDILSRD. This will be mailed directly to us upon your Payment of their customary fee. At a minimum the Statement of Record shall include the following Documents: 1. Certification of Registration. 2. Federally approved property report, and 3. Copy of the signed Questionnaire known as "Additional Information and Documentation" or similar federally accepted information form. EXHIBIT D – Consent to Service of Process. EXHIBIT E -- Recent evidence of title by one of the following: 1. 2. 3. 4. Copy of Certificate of Title. Copy of Title Insurance Policy. Opinion of Title, or Other evidence of Title. EXHIBIT F -- Encumbrances EXHIBIT B -- If a Foreign Corporation – provide certificate of authority to transact business in Illinois, if applicable. (contact the Illinois Secretary of State’s Office for additional information) 1. 2. 3. 4. Copy of mortgage. Copy of trust deed. Copy of any other encumbrances, and Copy of offset statement or release clause. State the name, address, and phone number of the Individual in Illinois who shall hold copies of the Instruments executed in connection with sales to Illinois residents. EXHIBIT G -- Improvements -- Submit copies of letters of credit, performance bonds or agreements assuring the completion of promised improvements. Submit background information of any person whose interest in the applicant is 10 percent or more and the extent and nature of the ownership. A copy of form accepted by HUD-ILSRD will be accepted. EXHIBIT H -- Sale Documents EXHIBIT C – A certified financial statement dated within 90 days of the application and certified by the Chief Financial Officer of the applicant. 1. Copy of all sale contracts, agreements, options, or lease forms. 2. Copy of promissory notes. EXHIBIT I -- Statement to Illinois Buyers with receipt. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com ATTACHMENT III – SUPPORTING DOCUMENTATION The following exhibits must accompany an application for registration of any subdivision currently registered and in good standing with another jurisdiction which has been authorized by the Illinois Department of Financial and Professional Regulation, whereby the requirements for registration are substantially the same or exceed the requirements of the Land Sales Registration Act of 1999 [765 ILCS 86]. EXHIBIT A -- A Certificate of Registration and good standing from other jurisdiction authorized by the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. EXHIBIT B -- If a Foreign Corporation – provide certificate of authority to transact business in Illinois, if applicable. (contact the Illinois Secretary of State’s Office for additional information) State the name, address, and phone number of the Individual in Illinois who shall hold copies of the Instruments executed in connection with sales to Illinois residents. Submit background information of any person whose interest in the applicant is 10 percent or more and the extent and nature of the ownership. A copy of form accepted by HUD-ILSRD will be accepted. EXHIBIT C – A certified financial statement dated within 90 days of the application and certified by the Chief Financial Officer of the applicant. EXHIBIT F -- Encumbrances 1. 2. 3. 4. Copy of mortgage. Copy of trust deed. Copy of any other encumbrances, and Copy of offset statement or release clause. EXHIBIT G -- Improvements -- Submit copies of letters of credit, performance bonds or agreements assuring the completion of promised improvements. EXHIBIT H -- Sale Documents 1. Copy of all sale contracts, agreements, options, or lease forms. 2. Copy of promissory notes. EXHIBIT I – Public Property Report approved by other jurisdiction. The Report must include an Addendum for Illinois Buyers disclosing the required language as set forth in Section 1260.125 of the Administrative Rules. EXHIBIT D – Consent to Service of Process. EXHIBIT E -- Recent evidence of title by one of the following: 1. 2. 3. 4. Copy of Certificate of Title. Copy of Title Insurance Policy. Opinion of Title, or Other evidence of Title. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DIVISION OF PROFESSIONAL REGULATION 320 WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 DISCLOSURE STATEMENT (FOR DIRECTORS, OFFICERS, & PARTNERS) IMPORTANT NOTICE: Completion of this form is necessary to accomplish the requirements outlined in [765 ILCS 86], and must be completed by all partners, officers, directors, or persons occupying similar status or function for the subdivider or anyone whose interest in the applicant exceeds 10 %. For corporations or partnerships owning in excess of 10%, attach latest financial statement (balance sheet and income statement). Failure to provide any information will result in a delay in processing and the submission of false information may subject the affiant to prosecution under applicable perjury statutes. This form has been approved by the Agency Form Coordinator. 1. NAME OF FIRM MAKING APPLICATION: 2. FEDERAL EMPLOYEE IDENTIFICATION NUMBER: 3. ADDRESS OF FIRM (include Street, City, State, Zip): 4. DATE AND PLACE OF BIRTH OF DIRECTOR, OFFICER, OR SHAREHOLDER: 5. NAME OF DIRECTOR, OFFICER, OR SHAREHOLDER: 6. ARE YOU AN OFFICER, DIRECTOR, PARTNER OR EMPLOYEE OF ABOVE NAMED FIRM? YES 7. RESIDENCE ADDRESS OF #5 ABOVE (include street, city, state, zip): Check one: President Vice President Secretary Director Treasurer NO Other________ 8. RECORD OF PREVIOUS OCCUPATION (PAST 5 YEARS). NAME AND ADDRESS OF BUSINESS DATES FROM - TO 8a. IF LICENSED, HAS YOUR LICENSE AS A REAL ESTATE BROKER OR SALES PERSON EVER BEEN REVOKED OR SUSPENDED IN THIS STATE OR ANY OTHER STATE? YES NO 8b. LIST STATES IN WHICH LICENCED AS A REAL ESTATE BROKER OR SALESPERSON. BRIEF DESCRIPTION OF DUTIES PERFORMED 9a. DO YOU AS PRINCIPAL OF THE FIRM HAVE AN INTEREST IN THE APPLICANT? YES NO 9b. INDICATE EXTENT AND NATURE OF INTEREST (Within 30 days of filing of application): No. of Shares Owned: _______ % of Ownership: _______ 10. HAVE YOU ANY WRITTEN AGREEMENT COVERING ACQUISITION OF ADDITIONAL INTEREST? (If "Yes", give full explanation on separate sheet marked Exhibit "A".) IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com 11. STATE IN FULL OUR ARRANGEMENTS WITH THIS ORGANIZATION REGARDING COMPENSATION, SALARY, COMMISSION, PROFIT SHARING, BONUS, ETC. (If necessary, attach a separate sheet market Exhibit “B”.) 12. LIST AFFILIATED COMPANIES OF THE REGISTRANT WITH WHICH YOU ARE ASSOCIATED AND INDICATE YOUR RELATIONSHIP AS AN OFFICER, DIRECTOR, PRINCIPAL, OR HOLDER OF INTEREST IN EXCESS OF 10%. (If additional space is needed, attach a separate sheet marked as exhibit "C".) NAME AND ADDRESS OF AFFILIATED COMPANY POSITION HELD 13. ANSWER THE FOLLOWING QUESTIONS. (If "yes", provide an explanation on a separate sheet providing marked exhibit "D".) a. Have you ever as an individual filed a petition in voluntary bankruptcy or has an involuntary petition in bankruptcy been filed against you? c. Have you ever been convicted of any crime? (Disregard minor traffic violations.) d. Have you or the applicant ever been subject to any injunction or administrative order (including consent order) of any kind? e. NO Have you ever been an officer or director in a company which has become insolvent or has voluntarily or involuntarily declared bankruptcy? b. YES Has the applicant company or any of its officers and directors ever been convicted of a crime involving land disposition or any aspect of the land sales business, in this state, the Unites States or foreign country? STATE OF _____________________________) ) COUNTY OF ___________________________) I, ______________________________________________________, do solemnly swear that the foregoing answers and statements have been knowingly made by me and that the same are true, and that I have not omitted to state any material facts touching upon such matters. ________________________________________________________ Signature of Principal Subscribed and sworn before me in __________________ County, in the State of______________________, by the said _____________________________________________, who personally appeared before me in the aforesaid County and State this _______________ day of _________________________, _______________. ________________________________________________ Notary Public NOTARY SEAL My Commission Expires: ____________________________ IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DIVISION OF PROFESSIONAL REGULATION 320 WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 CONSENT TO SERVICE OF PROCESS 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 result in a delay in processing. Submission of false information may subject the affiant to prosecution under applicable perjury statutes. This form has been approved by the Agency Form Coordinator. KNOW ALL THESE MEN BY THESE PRESENTS: That I, ____________________________________________, being a nonresident of the State of Illinois and a registrant under the provisions of the Illinois Land Sales Registration Act of 1999 [765 ILCS 86] and having filed herewith my application as required by said statute, do hereby irrevocably consent that if, in any lawsuit or action commenced against me in the State of Illinois arising out of a violation of 765 ILCS 86, personal services of summons or process upon me cannot be made in the State of Illinois after the exercise of due diligence, a valid service may thereupon be made by delivering the summons or process to the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation (IDFPR - DPR), providing that the IDFPR - DPR shall then mail a true copy of such summons or process to me by registered mail, at last known address as it appears on the copy of this form on the file with the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. I understand that this address may be changed by filing a new copy of this form. The address where I will be available for service by mail is as follows: _____________________________ ___________________________________________________________________________________________. _________________________________________ Signature _________________________________________ Title Subscribed and sworn to before me this_______________day of________________________, 20____________. NOTARY SEAL ___________________________________________________ Notary Public My commission expires:________________________________ IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 [765 ILCS 86] ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DIVISION OF PROFESSIONAL REGULATION 320 WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 CUSTODIAN OF RECORDS 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 result in a delay in processing. Submission of false information may subject the affiant to prosecution under applicable perjury statutes. This form has been approved by the Agency Form Coordinator. State the name, address, telephone number, and Illinois real estate license number of the individual in the State of Illinois who shall hold copies of the instruments executed in connection with sales to Illinois residents. Name: ___________________________________________________ Address: ___________________________________________________ ___________________________________________________ Telephone: __(_________)_______________________________________ Illinois Real Estate License No.: _____________________________________ Date: ______________________________ IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 [765 ILCS 86] PUBLIC PROPERTY REPORT FILED BY: FOR: DATE OF THIS REPORT:____________________ THIS REPORT HAS BEEN FILED WITH THE STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION AS REQUIRED BY LAW. THE DEPARTMENT DOES NOT APPROVE OR RECOMMEND THE PURCHASE OF ANY LAND DESCRIBED IN THIS REPORT AND ADVISES PROSPECTIVE PURCHASERS TO VISIT THE SUBDIVISION BEFORE PURCHASING OR ENTERING ANY CONTRACT TO PURCHASE ANY PROPERTY IN THE SUBDIVISION. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com PART 1 GENERAL INFORMATION 1. Name of developer: _____________________________________________________________________ Principal address: ______________________________________________________________________ 2. Name of subdivision: ____________________________________________________________________ 3. Location or principal address of the subdivision: ________________________________________ _______ _________________________________________________________________________________________________________ a) Nearest city with population of 10,000 or more: ______________________________________________ 4. This offering consists of _____________ lots. 5. The specific lot numbers included in this offering are: ___________________________________________ 6. Type of offering: Improved Acreage Home Site Unimproved Acreage Other: __________________ PART 2 LAND USE 1. Give a brief description of the overall subdivision, including the present topographical characteristics of the land and whether or not subsurface improvements or special foundation work will be required to construct residential or commercial structures on the land: _____________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 2. List all permissible uses of the property based upon local zoning ordinances: _______________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 3. List all existing or proposed unusual conditions, material circumstances, or features relating to the location of the subdivision: _____________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 4. What is the average annual rainfall and, if applicable, the average annual snowfall for the area in which the subdivision is located: ___________________________________________________________________ _________________________________________________________________________________________________________ 5. Does the develooper have a comprehensive program to control soil erosion, sedimentation, and flooding throughout the entire subdivision? Explain: __________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com 6. State the temperature ranges for the summer and winter seasons: Summer Winter Low Temperature: __________ __________ High Temperature: __________ __________ PART 3 IMPROVEMENTS 1. Indicate the promised improvements in this filing, the percentage completed and the expected completion date. Percentage Completed Graded Roads Paved Streets Electricity Central Water Sewage Disposal Drainage Expected Percentage Expected Completed Completion Date Completion Date Curbs and Gutters Sidewalks Street Lighting Gas Garbage Disposal Telephone 2. Indicate the extent to which financial arrangements have been provided for the completion of all promised improvements: _______________________________________________________________ ________________________________________________________________________________________________________ PART 4 BUILDINGS, UNITS AND AREA FACILITIES 1. Number of homes constructed or under construction as of the cover date: _____________________ a) Average square footage of these homes: _____________________________________________ 2. What common areas and facilities will be available? _______________________________________ 3. Are common facilities physically accessible for handicapped persons? Yes No 4. Are the following available in the subdivision? If not, state the distance from the subdivision. a) Schools: ________________________________________________________________________ b) Medical facilities (hospitals, doctors, dentists): __________________________________________ c) Shopping facilities: ________________________________________________________________ d) Churches: _______________________________________________________________________ e) Fire and police protection: __________________________________________________________ f) Public Transportation: _____________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com PART 5 TITLE 1. Describe any liens, defects or encumbrances on or affecting the title to the property: _______________________________________________________________________________________________________ a) Does the encumbrance contain random release clauses upon payment of the purchase price for individual lots? ____________________________________________________________________ ___________________________________________________________________________________ 2. Summarize all restrictions and easements affecting the property: ________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ PART 6 CONTRACT/DEED/METHOD OF SALES 1. Describe any financing that is offered by or is available through the developer: _____________________ ________________________________________________________________________________________________________ 2. State prepayment privileges or penalties, if any: _____________________________________________ 3. Is there a refund privilege? If so, explain: __________________________________________________ 4. Is there any initial or special fee due from the purchaser at closing? _____________________________ a) Describe the purpose of the fee: ______________________________________________________ b) Describe the method of calculating the fee: _____________________________________________ 5. Describe the manner by which title, use or other interest contracted for, is to be conveyed to the purchaser: _________________________________________________________________________ 6. Has an escrow account been established for purchaser's deposits? Yes No If yes, where: _______________________________________________________________________ IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DIVISION OF PROFESSIONAL REGULATION 320 WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 RECEIPT OF PUBLIC PROPERTY REPORT On this_________day of_________________, 20________, the undersigned acknowledges receiving a copy of the Illinois Public Property Report furnished by______________________. NOTE: The Illinois Land Sales Registration Act of 1999 [765 ILCS 86] provides that if an Illinois Public Property Report was received by a purchaser prior to the execution of a contract, a purchaser has an unconditional right to rescind the contract by giving notice to the seller any time before midnight of the seventh day following the signing of the contract or agreement. If the purchaser did not receive this report before signing a contract or agreement, the purchaser may cancel the contract or agreement any time within 2 years from the date of signing. _______________________________ __________________________________ (Signature of Prospective Purchaser) (Signature of Salesperson) _______________________________________ (Typed or printed name of Prospective Purchaser) _________________________________________ (Typed or printed name of Salesperson) THE STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DOES NOT APPROVE OR RECOMMEND THE PURCHASE OF LAND DESCRIBED IN THIS REPORT AND ADVISES PROSPECTIVE PURCHASERS TO VISIT THE SUBDIVISION BEFORE PURCHASING OR ENTERING A CONTRACT TO PURCHASE ANY PROPERTY IN THE SUBDIVISION. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR PREPARING STATEMENT TO ILLINOIS BUYERS (for HUD-Registered Subdivisions) THE COVER PAGE 1. In the space following the words "FILED BY" insert the name and address of the developer/owner. 2. In the space following the word "FOR" insert the common promotional name of the subdivision and the lots that are covered by this report. 3. After the words "DATE OF THIS REPORT" insert the most recent date of approval by the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation (IDFPR -DPR). All material changes to this report must be submitted to IDFPR - DPR for approval within 30 days of the change. THE STATEMENT TO ILLINOIS BUYERS Print the first three paragraphs exactly as they appear in the sample. A. Blanket Encumbrances 1. If there is no blanket encumbrance on the lots you are selling, print the following paragraph after the words “Blanket Encumbrances:” The lot you are purchasing is not encumbered by a mortgage. Then proceed to line B. 2. If there is a blanket encumbrance on the lots you are selling, after the words "Blanket Encumbrances," insert the following paragraph: The lot you are purchasing is encumbered by a mortgage. After this paragraph please print a brief narrative which tells how the purchaser will be protected in lieu of this encumbrance. Refer to the Illinois Land Sales Registration Act of 1999, Section 10-20 for guidance. Whichever of the four conditions you have chosen to meet, print a short paragraph which explains the procedure to the buyer. B. Print the information exactly as shown in the sample. C. Print the information exactly as shown in the sample. CONTRACT PROVISIONS Type of Contract A. In this section describe the contract. Provide information as to the following: Is it a contract for deed? A purchase money mortgage? A vendor's lien? When will this agreement be recorded? Where? Who will pay for recordation? Title Insurance A. State whether the buyer will be given a title insurance policy subject only to the conditions in the contract and the standard pre-printed exceptions contained in the title policy. B. State who must pay for this policy and when the purchaser may expect to receive it. American LegalNet, Inc. www.FormsWorkflow.com Language Requirement A. Print the information exactly as shown in the sample. Improvements A. Print the information as shown in the sample and complete the second sentence by filling in the date. Rescission Rights A. Print the information exactly as shown in the sample. THE DEED Please explain to the buyer who will prepare the deed, who will record it, who will pay the cost of recordation and when this will be completed. UTILITIES A. If the water, sewer, electric and telephone lines are already adjacent to the lot, so state. If the above utility lines are not adjacent to the lot, please insert the following paragraph at this point: The purchaser is strongly advised to check with the developer as well as each of the utility companies as to how far the sewer, water, electric and telephone lines are from the lot you are purchasing. If these lines are not adjacent to your lot you should determine if the lines will be extended, when they will be extended, who will extend them and who will pay for the extensions. B. If the purchaser must pay for line extensions to the lot line, also insert the following warning: WARNING: If the cost of extending utility lines to the lot line must be paid by you, these costs could be extremely expensive. You may find that it is economically unfeasible to build on your lot. OTHER INFORMATION A. Optional. American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 [765 ILCS 86] PUBLIC PROPERTY REPORT (for HUD-ILSRD Registered Subdivisions) FILED BY: FOR: DATE OF THIS REPORT:____________________ THIS REPORT HAS BEEN FILED WITH THE STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION, DIVISION OF PROFESSIONAL REGULATION AS REQUIRED BY LAW TO PROVIDE THE PURCHASER WITH INFORMATION ABOUT THE SUBDIVISION. THE DIVISION OF PROFESSIONAL REGULATION DOES NOT APPROVE OR RECOMMEND THE PURCHASE OF ANY LAND DESCRIBED IN THIS REPORT AND ADVISES PROSPECTIVE PURCHASERS TO VISIT THE SUBDIVISION BEFORE PURCHASING OR ENTERING ANY CONTRACT TO PURCHASE ANY PROPERTY IN THE SUBDIVISION. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATEMENT TO ILLINOIS BUYERS The following information was prepared by the subdivider/owner in compliance with the Illinois Land Sales Registration Act of 1999. It is being given to you in addition to the property report complied under the rules and regulations of the Department of Housing and Urban Development, Interstate Land Sales Registration Division. We urge you to carefully read that report. The Illinois Land Sales Registration Act of 1999 extends certain protections to the Illinois consumer which are particularly important. Information relating to these protections follows: BLANKET ENCUMBRANCES A. See instructions. B. It would be a violation of the Land Sales Registration Act of 1999 for the subdivider to encumber a lot after a contract for its sale has been signed. C. A copy of the developer's certified financial statements must be made available to you upon your request. CONTRACT PROVISIONS A. Type of Contract See instructions. B. Title Insurance See instructions. C. Language Requirement If the contract was presented to you in a language other than English you must be given a copy of the contract in that language. D. Improvements The latest date by which improvements must be completed is stated in the contract. That date is _______. E. Rescission Rights If you received this report before you signed a contract or agreement, you may cancel your contract or agreement by giving notice to the seller any time before midnight of the seventh day following the signing of the contract agreement. If you did not receive this report before you signed a contract or agreement you may cancel the contract or agreement any time within 2 years from the date of the signing. American LegalNet, Inc. www.FormsWorkflow.com THE DEED A. See instructions. UTILITIES Availability A. See instructions. B. See instructions. OTHER INFORMATION A. Optional. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DIVISION OF PROFESSIONAL REGULATION 320 WEST WASHINGTON STREET SPRINGFIELD, ILLINOIS 62786 STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 RECEIPT OF PUBLIC PROPERTY REPORT (HUD-ILSRD registered projects) On this_________day of_________________, 20________, the undersigned acknowledges receiving a copy of the Illinois Public Property Report furnished by______________________. The accepted Illinois Public Property Report consists of two documents: a. The HUD approved property report which is given simultaneously with “b” below, and b. The Statement to Illinois Buyers. (DO NOT SIGN THIS RECEIPT UNLESS YOU HAVE RECEIVED BOTH DOCUMENTS.) NOTE: The Illinois Land Sales Registration Act of 1999 [765 ILCS 86] provides that if an Illinois Public Property Report was received by a purchaser prior to the execution of a contract, a purchaser has an unconditional right to rescind the contract by giving notice to the seller any time before midnight of the seventh day following the signing of the contract or agreement. If the purchaser did not receive this report before signing a contract or agreement, the purchaser may cancel the contract or agreement any time within 2 years from the date of signing. _______________________________ (Signature of Prospective Purchaser) _______________________________________ (Typed or printed name of Prospective Purchaser) __________________________________ (Signature of Salesperson) _________________________________________ (Typed or printed name of Salesperson) THE STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION, DIVISION OF PROFESSIONAL REGULATION DOES NOT APPROVE OR RECOMMEND THE PURCHASE OF LAND DESCRIBED IN THIS REPORT AND ADVISES PROSPECTIVE PURCHASERS TO VISIT THE SUBDIVISION BEFORE PURCHASING OR ENTERING A CONTRACT TO PURCHASE ANY PROPERTY IN THE SUBDIVISION. IL 505-0444 (Rev. Apr 2009) American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS LAND SALES REGISTRATION ACT OF 1999 REGISTRATION FEES CHECK ALL THAT APPLY FEE 1. INITIAL REGISTRATION : a) SUBDIVISION/DEVELOPER $ 1,500.00 2. AMENDMENTS: a) ADDING LOTS $ 750.00 b) ANY OTHER AMENDMENT TO AN EXISTING REGISTRATION $ 150.00 3. RENEWAL: a) SUBDIVISION/DEVELOPER 4. $ 750.00 MISCELLANEOUS: a) APPLICATION FOR EXEMPTION $ 250.00 b) ROSTER OF REGISTRANTS $ Check No. _____________ TOTAL AMOUNT ENCLOSED 10.00 $ _____________ NOTE: Please return the completed form along with a check made payable to the IDFPR - Division of Professional Regulation for total amount due. Please remit to: Illinois Department of Financial and Professional Regulation Division of Professional Regulation Attn: Timeshare/Land Sales 320 West Washington Street Springfield, Illinois 62786 American LegalNet, Inc. www.FormsWorkflow.com