TRANSFER ON DEATH INSTRUMENT

OWNERS NAME AND ADDRESS AND TAXES TO:
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BENEFICIARY’S NAME & ADDRESS
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THIS TRANSFER ON DEATH INSTRUMENT made this 	_day of_	 A.D. 20	     , 
by _________________________________ [Name of Owner/Owners] ______________________ ,
of the City of__________________ County of __________ and State of Illinois, (herein "Owner/Owners") being the sole Owner(s) of the following legally described  residential real estate located in __________ County, Illinois.

Legal Description- (Schedule of Real Estate Attached)

Property Address: 	                                      Parcel Identification Number: 	                                                     

The Owner(s) being of competent mind and capacity, and waiving and releasing all rights under the homestead exemption laws of the State of Illinois, hereby convey(s) and transfer(s), effective on the death of the Owner last to die, the above described residential real estate, to:

[Beneficiary Designation]

IN WITNESS WHEREOF, the said Owner(s) has/ve hereunto set his/her/their hand(s) and seal(s) the day and year first above written.

 	(Seal)

	                           [Owner’s Name]

 	(,Seal)
 	[Owner’s Name]

STATEOFILLINOIS            )
  )ss
COUNTYOF ________    )
We, the undersigned witnesses, hereby certify that the above Transfer on Death Instrument was on the date
thereof signed and declared by the Owner(s) as his/her/their Transfer on Death Instrument in our presence and that we, at his/her/their request and in his/her/their presence and in the presence of each other, have signed our names as witnesses thereto, believing to best of our knowledge that the Owner(s) was/were at the time of signing of sound mind and memory, and under no undue influence.

WITNESS [Name][Address]

WITNESS [Name][Address]

STATE OF ILLINOIS	)
) ss
COUNTYOF	)

I, the undersigned, a Notary Public in and for the said County, in the State aforesaid, DO HEREBY CERTIFY THAT Owner(s) and witnesses personally known to me to be the same person(s) whose name(s) are subscribed to the foregoing instrument, appeared before me this day in person and acknowledged that they signed, sealed and delivered the said instrument as their free and voluntary act, for the uses and purposes therein set forth.

GIVEN UNDER my hand and notarial seal this 
day of _________ A.D. 20___.

Notary Public

My commission expires on _________________

PREPARED BY and
RETURN TO:	EXEMPT UNDER PROVISIONS OF PARAGRAPH_ 
	SECTION 31-45, REAL ESTATE TRANSFER TAX ACT

Date	Buyer, Seller or Representative