Afdavit of Non-Participation
[ Month Day, Year ]
I, ____________________________________ [Owner Name], hereby certify under oath that I have an
ownership interest in ________________________________________________________ [Entity Name],
formed under the laws of the State of _________________________ [Name of State].
I afrm that I am not licensed to engage in the practice of real estate under the laws of the State of Illinois
and understand that my ownership interest in the above entity does not authorize me to do so.
I hereby further afrm that I have read the statutory provisions of 225 ILCS 454/5-15, and that this afdavit is
provided in accordance with the terms expressed therein.
I hereby further afrm that I shall not actively direct or engage in licensed real estate activity unless I am duly
licensed to do so.
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
Division of Real Estate
320 West Washington Street
Springeld, IL 62786
[ Full Legal Name ]
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