Illinois Transfer on Death Deed

Prepared by:

____________________________

____________________________

____________________________

____________________________

When recorded, mail to:

____________________________

____________________________

____________________________

Space above this line for recorder’s use only

Illinois Transfer on Death Deed

This TRANSFER ON DEATH INSTRUMENT is an exempt transaction under the provisions of 35 ILCS 200/31-45, paragraph (e) of the Illinios Real Estate Transfer Tax Law.

I/we, __________________________________________________ (Owner(s)), being of sound mind and legal capacity, hereby convey, effective upon my/our death, the following real property located in Illinois:

A complete legal description of the real property being conveyed by this instrument is attached hereto on page 4 as EXHIBIT A.

I/we designate the following beneficiary:

Beneficiary: ____________________________________     Relationship: _________________

Address: ____________________________________________________________________

If the beneficiary does not survive me, I/we designate the following alternate beneficiary:

Beneficiary: ____________________________________     Relationship: _________________

Address: ____________________________________________________________________

Mail tax bills to:

I reserve the right to revoke or change this transfer on death deed at any time, and the transfer to the beneficiary shall not occur until my death.

Signature: ___________________________________________________________________

Grantor Printed Name: _______________________________________ Date: ____________

Signature: ___________________________________________________________________

Grantor Printed Name: _______________________________________ Date: ____________

The Owner(s) has/have executed this instrument before two witnesses identified below. The witnesses attest that the owner’s execution is their own free and voluntary act, and at the time of this execution, the owner(s) is/are believed to be of sound mind and memory.

Witness Signature: ___________________________________________________________

Printed Name: ______________________________________________ Date: ____________

Witness Signature: ___________________________________________________________

Printed Name: ______________________________________________ Date: ____________

NOTARY ACKNOWLEDGMENT

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of Illinois }

County of ________________________ }

On ________________________, 20____, before me, ________________________ (insert name and title of the officer), personally appeared ________________________ (seller’s name) who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed within the Transfer on Death Deed and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the state of ________________________ that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Notary Public: ________________________

Print Name: ________________________

My Commission Expires: ________________________, 20____

(seal)

EXHIBIT A

Legal Description