PTAX-203-NR (R-6/05) Page 1 of 2
PTAX-203-NR
Illinois Real Estate Transfer Tax Payment
Document (non recorded transfers)
Affix Revenue stamps here
Property information
____________________________________________________
Street address of property (or 911 address, if available)
____________________________________________________
City or village ZIP Township
Parcel identifying number __________________________________________________________________________________________
__________________________________________________________________________________________________________________
Legal description___________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Date of transferring document: ____ ____ / ____ ____ ____ ____
Month Year
Type of transferring document: _____________________________________________________________________________________
Signature
________________________________________________________________________________________________________________
Seller, Buyer, Agent, or Preparer Date
Preparer Information (Please print.)
________________________________________________________________________________________________________________
Preparer’s and company’s name Preparer’s file number (if applicable)
________________________________________________________________________________________________________________
Street address City State ZIP
_________________________________________________________________________ ______________________________________
Preparer’s signature Preparer’s daytime phone
_______________________________________________
Preparer’s e-mail address (if available)
Transfer Tax
Net consideration subject to transfer tax $
______________________
Illinois Tax $
______________________
County Tax $
______________________
Total amount of transfer tax due $
______________________
If stamps are not affixed, please state the exemption provision under 35 ILCS 200/31-45 (see Page 2). _______________________________
Do not write in this area.
This space is reserved for the County Recorder’s Office use.
County:
Date:
Doc. No.:
Vol.:
Page:
Received by:
This form is authorized in accordance with 35 ILCS 200/31-1
et seq.
Disclosure of this information
is REQUIRED. This form has been approved by the Forms Management Center. IL-492-4443
This document is recorded for the purpose of affixing Real Estate
Transfer Tax stamps that were purchased for the following transferring
document under provisions of Public Act 93-1099.