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									Sample Affidavit Form
.                                                                                        .

(DATE)


Department of Inspectional Services
9500 West Belmont Avenue
Second Floor
Franklin Park IL 60131

RE: (ADDRESS OF PROPERTY BEING SOLD, Franklin Park, Illinois)

Dear Sir or Madam,

I, (NAME OF PURCHASER), am purchasing the property located at (ADDRESS
OF PROPERTY BEING SOLD). I will assume responsibility for all violations listed
on the pre sale inspection report. I will rectify the violations within thirty (30) days
of closing.


    (Signature of Purchaser)                           (Printed Name of Purchaser)


State of Illinois          )
                           ) ss
County of Cook             )

I,                          , a Notary Public in and for said County and State;
personally appeared                               known to me to be the same
person who executed the foregoing instrument, and (s)he acknowledged that (s)he
executed and delivered said instrument as (his) (her) a free and voluntary act and
deed for the uses and purposes therein set forth.

Given under my hand and notarial.

Seal this                  day of                      , 20         .


       (Notary Public)

My Commission expires:




VILLAGE OF FRANKLIN PARK                 PAGE 1 OF 1                          FORM DIS5001

								
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