CHECK BOX OF APPLICABLE PROVISION:
( ) A. That the attached deed does not represent any type of division of an existing parcel of
      land.
    APPROVED BY:_______________________________________
                                                                         Supervisor of Assessments
( ) B. That the attached deed does represent a division of property but none of the divided
      parcels of the remaining parcel is less than five (5) acres in size and the division does not
      involve any new streets or easements of access.
( ) C. That the attached deed does represent a division of property in which at least one of the
      parcels of land is less than five (5) acres but the resulting parcels do not lie in a district
      presently zoned agricultural under the Zoning Ordinance of Boone County. A plat has been
      approved by the appropriate local governmental agency and submitted to the Recorder of
      Deeds of Boone County, IL.
( ) D. That the attached deed does represent a division of property in which at least one of the
      parcels of land is less than five (5) acres and the property is located in a district zoned
      agricultural but the division does not require a plat and does not require a zoning variance
      because it falls within one of the following exceptions: (Circle one of the following)
          1. The division of lots or blocks of less than one acre in any recorded subdivision which
          does not involve any new streets or easements of access.
          2. The sale or exchange of parcels of land between owners of adjoining and contiguous
          land.
          3. The conveyance of parcels of land or interest therein for use as right of way for railroads
         or other public utility facilities which does not involve any new streets/easements of access.
          4. The conveyance of land owned by a railroad or other public utility which does not
          involve any new streets or easements of access.
          5. The conveyance of land for highway or other public purpose or grants or conveyances
          relating to the dedication of land for public use or instruments relating to the vacation of
          land impressed with a public use.
          6. Conveyance made to correct descriptions in prior conveyances.
          7. The sale or exchange of parcels or tracts of land following the division into no more
          than two parts of a particular parcel or tract of land existing on July 17, 1959 and not
          involving any new streets or easements of access.
          8. The sale of a single lot of less than five (5) acres from a larger tract when a survey is
          made by a registered surveyor; provided, however, that this exemption shall not apply to
          the sale of any subsequent lots from the same larger tract of land, as determined by the
          dimensions and configuration of the larger tract on October 1, 1973. The survey has been
            presented to the Boone County Supervisor of Assessments or the Recorder of Deeds in
            Boone County, IL.
( ) E. Other - Must have approval of State's Attorney or County Planner.
     AFFIANT is aware that the Zoning Ordinance of Boone County, IL requires a minimum lot
size of five (5) acres in every tract zoned "Agricultural" and that no building permit will be issued
for any lot which violates this minimum lot size requirement.
     AFFIANT further states that this Affidavit is made for the purpose of inducing the Recorder
of Deeds of Boone County, IL to accept the attached deed for recording.