(755 ILCS 27/100)
    Sec. 100. Form of notice of death affidavit and acceptance. The following form shall be used to give notice of the owner's death and to accept the transfer by the beneficiary:
(front of form)
NOTICE: This Notice of Death Affidavit and Acceptance form or equivalent form must be recorded by the beneficiary after the death of the owner to make the transfer on death instrument effective. You should consult a lawyer before using this form.
 
NOTICE OF DEATH AFFIDAVIT AND ACCEPTANCE OF
TRANSFER ON DEATH INSTRUMENT
PREPARED BY AND RETURN TO:
 
SEND SUBSEQUENT TAX BILL TO:
 
The undersigned beneficiary or beneficiaries, being duly sworn on oath, state as follows:
 
That [name of owner] died on ......... , 20...... , a resident of [name of county], [name of state], owning residential real estate legally described below:
 
[legal description or attach exhibit]
 
That the street address of the residential real estate is [address] and the property identification number is [PIN].
That the Transfer on Death Instrument is dated ............ and recorded as Document No. ........... in the Office of the Recorder for .............. County, Illinois.
 
That the undersigned whose names and addresses appear below are all beneficiaries entitled to receive under the Transfer on Death Instrument:
 
Name       Address                 Share
 
In witness whereof, the undersigned beneficiaries hereby accept the transfer of residential real estate under the transfer on death instrument this ........... day of ............, 20........
 
........................(Seal)     ....................(Seal)
[Print Name]                       [Print Name]
 
STATE OF ILLINOIS
COUNTY OF ..................
 
I, the undersigned, a Notary Public in and for the State aforesaid, DO HEREBY CERTIFY THAT [NAME OF BENEFICIARY OR BENEFICIARIES] personally known to me to be the same person or persons whose name or names are subscribed to the foregoing instrument, appeared before me this day in person and swore on oath to the above foregoing affidavit. Signed and sworn to before me this ............ day of ..............., A.D. 20....
 
My commission expires on .............
(SEAL)
.......................................
    Notary Public
(Source: P.A. 97-555, eff. 1-1-12.)