Space Above Reserved for Employer or Cook County Recorder of Deeds
NOTARIAL RECORD — RESIDENTIAL REAL PROPERTY TRANSACTIONS
The undersigned grantor(s) hereby certifies(y) that the residential real property identified in this notarial record
is residential real property as defined in the Illinois Notary Public Act.
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Type or Name of Document of Conveyance PIN Number of Residential Real Property
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Common Street Address of Residential Real Property City State ZIP
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Date of Notarization Notary Fee Additional Comments
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Notary Printed Name Notary Phone Number
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Notary Commission Expiration Date Notary Signature
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Notary Residential Street Address City State ZIP
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Notary’s Employer or Principal and Business Street Address City State ZIP
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Grantor (Signer) #1 Printed Name Grantor (Signer) #2 Printed Name
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Grantor (Signer) #1 Signature Grantor (Signer) #2 Signature
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Grantor (Signer) #1 Residential Street Address Grantor (Signer) #2 Residential Street Address
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City State ZIP City State ZIP
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Grantor (Signer) #1 Means of Identification Grantor (Signer) #2 Means of Identification
___________________________________ ___________________________________
___________________________________ ___________________________________
Description of Print if not Right Thumb Description of Print if not Right Thumb
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Additional Comments Additional Comments
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Right Thumbprint
of Grantor/Signer #1
Right Thumbprint
of Grantor/Signer #2
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op of thumb here
PROPERTY
NOTARY
GRANTOR #1 GRANTOR #2
Printed by authority of the State of Illinois. May 2009 — 1 — I 212
