Do not write in this area. This space is reserved for the County Recorders Office use. PTAX-203-B County: Illinois Real Estate Transfer Declaration Supplemental Form B Date: (Beneficial interest transfers - do not use for deeds or trust documents) File this form with Form PTAX-203 and the transferring document at the Doc. No.: county recorders office where the property is located. On PTAX-203: Vol.: write the type of beneficial interest transfer in the Other field on Step 1, Line 5.  do not complete Step 2. Page:  substitute the appropriate terms for seller and buyer in Step 4.  add PTAX-203-B to the list of required submissions in Step 4. Received by: Please read the instructions on the back of this form. Mark if taxpayer cannot prove prior payment. ____ Step 1:Identify the property 1 Write the propertys street address, city or village, and township from Line 1 on Form PTAX-203. ________________________________________________________________________ _______________________________ Street address of property (or 911 address, if available) City or village Township 2 Write the parcel identifying number from Line 3a on Form PTAX-203. Parcel Identifier: _________________________________ 3 Mark the interest transferred. ___ Ground lease (go to Step 2) ___ Controlling interest in real estate entity (go to Step 3) ___ Co-op unit (go to Step 4) ___ Other (specify):______________________ (go to Step 4)Step 2: Ground lease information 4 Does the ground lease provide for a term of 30 or more years including any expired portion and all options to renew or extend? 4 ___ Yes ___ No 5 Does the lessee have an interest in any improvements on the parcel? 5 ___ Yes ___ No 6 Write the beginning and ending dates of the initial lease term. Lease term: _____ / _________ to _____ / _________ Month Year Month Year 7 Briefly describe any extension or renewal options. ________________________________________________________________________ ________________________________________________ ________________________________________________________________________ ___________________________________________________ Step 3: Real estate entity information (Attach additional sheet if needed.) 8 Mark type of transfer. ___ Single transfer ___ Series of related transfers (Skip Lines 9a and 9b if single transfer.) 9a Write the date and the percent of interest transferred. Mark if the state transfer tax has been paid for any prior transfer. Date transferred ____ ____/____ ____/____ ____ ____ ____ %_________________ Prior Pa yment ___ Yes ___ No Date transferred ____ ____/____ ____/____ ____ ____ ____ %_________________ Prior Pa yment ___ Yes ___ No Date transferred ____ ____/____ ____/____ ____ ____ ____ %_________________ Prior Pa yment ___ Yes ___ No Date transferred ____ ____/____ ____/____ ____ ____ ____ %_________________ Prior Pa yment ___ Yes ___ No Aggregate percent transferred %_________________ 9bWrite the amount of transfer taxes paid for all prior transfers of any interests included on Line 9a. 9b $ ___________________10a Is the real estate entity liable for corporate franchise taxes as a result of this transfer? 10a ___ Yes ___ No10b Write the amount of corporate franchise tax paid (excluding fees, interest, and penalties). 10b $ ___________________10c Identify corporate franchise tax return information. ________________________________________________________________________ _______________________________ Corporate Name File No. BCA Form No. Date paid Step 4:Calculate the amount of transfer tax due. (Round Lines 11a through 15 to the next highest whole dollar.) 11a Full actual consideration 11a $___ ________________ 11b Does Line 11a include a contingent payment for any interest on which state transfer taxes have been paid? 11b ___ Yes ___ No 12a Amount of personal property included in the purchase. 12a $_________ __________ 12b Was the value of a mobile home included on Lines 11a and 12a? 12b ___ Yes ___ No 13 Subtract Line 12a from Line 11a. 13 $ ___________________14 Amount for other real property transferred to the seller (in a simultaneous exchange) as part of the full actual consideration on Line 11a. 14 $ ___________________15 Outstanding mortgage amount to which the transferred real property remains subject. 15 $ ___________________16 If this transfer is exempt, use an X to identify the provision. 16 _____b _____k _____m17 Subtract Lines 14 and 15 from Line 13. 17 $ ___________________18 Illinois tax $.50 per $500 of value or fraction thereof on Line 17. 18 $ ___________________19 County tax. 19 $ ___________________20 Amount of transfer taxes paid (amount from Line 9b). 20 $ ___________________21 Amount of corporate franchise tax paid (amount from Line 10b). 21 $___ ________________22 Add Lines 18 and 19, then subtract Lines 20 and 21. Total amount of transfer tax due. 22 $ ___________________ This form is authorized in accordance with 35 ILCS 200/31-1 et seq. Disclosure of this information PTAX-203-B (R-05/05) is REQUIRED. This form has been approv ed by the Forms Management Center.IL-492-0227 Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com>>>> 2 Instructions for Form PTAX-203-B General Information You must file Form PTAX-203, Illinois Real Estate Transfer Declaration, and any required documents at the county recorders office within the county where the property is located. It is due within three business days after the transfer or at the time ofrecordation, whichever is earlier. You must prove that the tax was paid (or pay the tax again) if you record this transfer at a later date.Note: You must file Form PTAX-203-B, Illinois Real Estate Transfer Declaration Supplemental Form B, if you are transferring a beneficial interest in real property without using a deed or trust document. Definitions The tax is imposed on the privilege of transferring title to real estate or a beneficial interest in real property that is located inIllinois. A beneficial interest includes, but is not limited to, the lessee interest in a ground lease, the indirect interest in realproperty as reflected by a controlling interest in a real estate entity, or any other type of interest with the right to use or occupyreal property or the right to receive income from real property. A ground lease (including any interest of the lessee in the related improvements) is subject to tax if it provides for a term of 30 or more years when all options to renew or extend are included, whether or