(Individual)
Recorder’s Use
Airport
County
Project
Parcel
KNOW ALL MEN BY THESE PRESENTS, That I,
of / County of / and State of / ,
hereby certify that I have received full payment of all sums due on a certain / , dated the
day of / , / executed by
and recorded in book of Records, on page / , of the records of the County of / ,
and State of / or on the notes therein mentioned and described; and do hereby
acknowledge full satisfaction of said / , to the intent that the same may be discharged of
record, and the undersigned here by remises, releases, conveys and quitclaims unto / all
the right, title and interest I may have, in the following described premises, including any and all interest acquired pursuant to the aforementioned mortgage and notes.
WITNESS my hand and seal, this / day of / , / .
State of Illinois / )
) ss.
County of / )
I, / , a Notary Public, in and for said County and State aforesaid, do
hereby certify that / who / , personally known to
me to be the same person / , whose name / , subscribed to the
foregoing instrument, appeared before me this day in person and acknowledged that he/she / signed,
sealed and delivered the said instrument as / free and voluntary act, for the uses and
purposes therein set forth.
Given under my hand and notarial seal this / day of / , / .
(SEAL)
Notary Public
My commission expires:
Signature
Printed Name
The recorded copy of this form must be submitted to the Illinois Department of Transportation, Division of Aeronautics,
1 Langhorne Bond Drive, Springfield, IL 62707-8415, Attn: Land Acquisition. To expedite processing this completed signed form may be scanned and emailed to or faxed to (217)785-4533.
Printed 7/15/2010AER 2487 (07/15/10)