HomeMy WebLinkAboutRESOLUTION - 64-88 - 10/11/1988 - LOC/DEED OF CONVEY/BILL OF SALE RESOLUTION NO. 64-88
A RESOLUTION RELEASING AN IRREVOCABLE LETTER OF CREDIT NO. LC-
EGV-1986-1 ADOPTED BY RESOLUTION NO. 32-86 (IN THE AMOUNT OF
$83,100.00) AND AMENDED BY RESOLUTION NO. 64-87; AND ACCEPTING
A DEED OF CONVEYANCE/BILL OF SALE FROM BETTER LIVING SUBDIVI-
SION (SYLVAN COURT) ; AND LETTER OF CREDIT NO. BLC-1988-3 FROM
ARLINGTON FEDERAL SAVINGS AND LOAN ASSOCIATION IN THE AMOUNT OF
$7,555.00 EXPIRING SEPTEMBER 2, 1990 GUARANTEEING MAINTENANCE
OF PUBLIC IMPROVEMENTS FOR BETTER LIVING SUBDIVISION
WHEREAS, the Developer (Better Living Company, Inc. ) has requested the
release of an Irrevocable Letter of Credit No. LC-EGV-1986-1 from Arlington
Federal Savings and Loan in the amount of $83,100.00; and
WHEREAS, the Developer has submitted a Deed of Conveyance/Bill of sale
and Irrevocable Letter of Credit No. BLC-1988-3 in the amount of $7,555.00,
expiring September 2, 1990, to the Village of Elk Grove Village as required by
the Subdivision Control Ordinance and fully complied with all provisions of any
and all Ordinances pertaining; and
WHEREAS, the Developer has satisfactorily submitted all necessary items
as required by the Village and has submitted As-Built Engineering Plans.
NOW, THEREFORE, BE IT RESOLVED by the President and Board of Trustees of
the Village of Elk Grove Village, Counties of Cook and DuPage, Illinois:
SECTION 1: That the President and Board of Trustees do hereby
authorize the release of an Irrevocable Letter of Credit No. LC-EGV-1986-1,
which expired July 1, 1987, from Arlington Federal Savings and Loan Association
adopted by Resolution No. 32-86 and amended by Resolution No. 64-87 in the
amount of $83,000.00.
SECTION 2: That the Village of Elk Grove Village does hereby accept a
Deed of Conveyance/Bill of Sale and Irrevocable Letter of Credit No. BLC-1988-3
from Arlington Federal Savings and Loan Association, Arlington Heights,
Illinois in the amount of $7,555.00, expiring September 2, 1990, guaranteeing
the maintenance of public improvements as described on the "As-Built"
Engineering Plans prepared by Norman J. Toberman Associates, and dated April
14, 1986 for Better Living Subdivision.
SECTION 3: That this Resolution shall be in full force and effect
from and after its passage and approval according to law.
PASSED this 11th day of October , 1988.
APPROVED this 11th day of October , 1988.
Charles J. Zettek
Village President
ATTEST:
Patricia S. Smith
Village Clerk
J
cAAingt= Federal J
Campbell and Evergreen Streets,Arlington Heights,111.60005(312)255-9000
Village of Elk Grove village Maintenance Guaranty
901 Wellington Avenue
Elk Grove, Illinois 60007 Letter of Credit No. BLC-1988-3
IEITER OF CREDIT Da te: Sept. 2. 1988
Amount: $ 7-555.00
Expiration Date: Sept. 2. 1990
Gentlemen:
We hereby establish our irrevocable Straight Letter of Credit in your favor
for the account of —Better Living Company, Inc.
, hereafter called the "Developer", in the aggregate amount
of $ 7,555.00 , U. S. Currency, available by your draft drawn on sight and
marked "Drawn under Letter of Credit No. BLC-1988-3 dated Sept. 2. 1988
These monies are to guarantee the maintenance of public improvements for the following
project: Better Living Subdivision described in the engineering
plans and specifications with revisions dated April 14, 1986 , prepared by
Norman J. Toberman Associates , and agree-
ments (including any amendments thereof) on the property legally described in Exhibit
A (attached hereto and made part thereof). monies nay be drawn on sight by the Village
of Elk Grove when accompanied by the following document:
A sianed statement bu the village Manager or any
other duly authorized official of the village of
Elk Grove Village certifging that any portion of
the site improvements has not been satisfactorily
maintained.
The improvements in the above described project consist of: (Z appropriate boxes).
17_�I
I I Watermain and Appurtenances
7_V_1
I I Sanitary Sewer and Appurtenances
Storm Sewer and Appurtenances
Roadway (Curb 9 Gutter, pavement)
ARLINGTON HEIGHTS FEDERAL SAVINGS AND LOAN ASSOCIATION
Sidewalk
Street Lights
Parkway (Trees, etc.)
Traffic Control (Signals, Signs, Markings)
Ponds (DetentionlRetantion)
Excavation (Soil Erosion Control, Stockpile)
Other (Retaining walls, etc.)
Partial drawings are permitted under this Irrevocable Letter of
Credit. Said drafts may be submitted for payment for a ninety (90) day
period following the completion date of this Irrevocable Letter of Credit
and said draft shall be duly honored upon presentation during the ninety
day (90) days in accordance with the terms and provisions herein contained.
if, within thirty (30) days of the date of any demand (made in
conformity with this Irrevocable Letter of Credit) presented, we fail
to honor same, we agree to pay all attorney fees, court costs and other
reasonable expenses incurred by the Village of Elk Grove Village in enforcing
the terms of this Irrevocable Letter of Credit. The amount of each draft
must be endorsed on the reverse side of the original Irrevocable Letter
of Credit by the Village Engineer and attested by the Clerk. This Irrevocable
Letter of Credit shall be utilized to secure the maintenance of all improvements
required under the Municipal Code of the village of Elk Grove village
and specified on the engineering drawings and in the specifications and
agreements. This Irrevocable Letter of Credit shall not operate as a
limitation upon the obligation of the Better Living Company, Inc.
to properly maintain all improvements required by the Village of Elk Grove
village.
It is a condition of this Irrevocable Letter of Credit that it
shall be automatically extended for one year from the present expiration
date hereof unless thirty (30) days prior to such expiration date the
Village manager shall notify the undersigned in writing, certified mail,
return receipt requested that he or she� based upon the advice and supporting
documentation from the village Engineer that he or she does elect not
to arbitrarily request renewal of this Irrevocable Letter of Credit for
such additional one (1) year period without due cause.
The undersigned shall notify the Village Manager, by certified
mail, return receipt requested, at least ninety (90) days prior to said
expiration date that said Irrevocable Letter of Credit is about to expire.
It is expressly agreed by the undersigned that the expiration date shall
be automatically extended as shall be required to comply with this notice
provision and the requirements stated previously.
This Irrevocable Letter of Credit is subject to the "Uniform Customs
and Practice for Document Credit" the international Chamber of Commerce
Publication #290, most recent revision" except as herein above modified.
We hereby agree with the drawers, indorsers, and
bona fide holders of drafts drawn in compliance
with the terms of this credit that they shall be
honored on presentation.
Dated: Setpember 2, 1988
Issuing Financial institution: ARLINGTON HEIGHTS FEDERAL SAVINGS & LOAN ASSN.
By:_ F 9�i/ilj
(Name) (Title)
Robert T. Kowall, Vice President
Developerlowner
"The undersigned hereby acknowledges the absolute
right of the village of Elk Grove Village to draw
on this Irrevocable Letter of Credit subject to
the conditions herein set forth and waives any
right to enjoin the Village from so proceeding."
Date:
Developerlowner: (1 (2 Z/
Name and Title-
Name 4(n d? Ti tl e
Don C. Gearhart, Preside�q t Nancy 9. Gearhart, Secretary
Note: if property is in a trust, attach a copy of the trust agreement
as Exhibit.
Village officials ApproallAcceptance Resolution:
(Title) (Date)
EXHIBIT A
Legal Description wlPhase Plan indicated (if applicable)
Village Officials Release Resolution:
(Title) (Date)
RIDER "A"
LEGAL DESCRIPTION
THE SOUTH 290 FEET (MEASURED ALONG THE EAST LINE) OF THE E4ST 450.65
FEET (MEASURED ON THE SOUTH LINE) OF THAT PART OF THE SOUTHEAST 1/4
OF SECTION 29, TOWNSHIP 41, NORTH, RANGE 11, EAST OF THE THIRD
PRINCIPAL MERIDIAN, DESCRIBED BY BEGINNING AT A POINT IN THE WEST LINE
OF SAID QUARTER 21.44 CHAINS (1415.04 FEET) NORTH OF THE SOUTHWEST
CORNER OF SAID SOUTHEAST 1/4; THENCE SOUTH 87PEGREES EAST 1479 FEET
TO AN IRON STAKE IN THE CENTER OF ROAD: THENCE NORTHERLY IN THE
CENTER OF SAID ROAD 450.89 FEET TO AN ANGLE IN SAID ROAD: THENCE
NORTH IN THE CENTER OF SAID ROAD 84.11 FEET TO AN IRON STAKE: THENCE
NORTH 89 AND THREE FOURTHS DEGREES WEST 1499.4 FEET TO A POINT IN THE
WEST LINE OF SAID QUARTER 535 FEET NORTH OF PLACE OF BEGINNING:
THENCE SOUTH ALONG THE WEST LINE OF SAID QUARTER 535 FEET TO THE
PLACE OF BEGINNING, IN COOK COUNTY, ILLINOIS.
PERMANENT TAX ID NUMBER: 08-29-400-048
COMMONLY KNOWN AS: THE BETTER LIVING SUBDIVISION
ELK GROVE VILLAGE, ILLINOIS
IDEED OF CONVEYANCE/BILL OF SALE
KNOW ALL MEN BY THESE PRESENTS, that BETTER LIVING COMPANY,
INC. (the "Developer") , located at 71 SYLVAN COURT
ELK GROVE, ILLINOIS , I
a CORPORATION (corporation, partnership, individual)
authorized to do business in the State of Illinois, for and in consideration of
the sum of One Dollar ($1.00) and other good and valuable consideration in hand
paid, the receipt and sufficiency of which are hereby acknowledged, does hereby
Grant, Sell, Transfer Over, Convey and Deliver unto the Village of Elk Grove
Village (the "Village") , Cook and DuPage Counties, Illinois, a municipal corpor-
ation, to and for its own use forever the following:
UNDERGROUND IMPROVEMENTS
rv-T
I" Watermain and Appurtenances
rv-T
RECEIVED L11-1 Sanitary Sewer and Appurtenances
1771
Li-1 Storm Sewer and Appurtenances
MAY 11988 J_N�A Lift Station and Force Main
ELK GROVE VILLAGE
ENGINEERING DEPARTMENT F-1 Other AS-BUILT
SURFACE IMPROVEMENTS
rv-7
JAI Roadways (Curb & Gutter/Pavement) (Street Names)
rv-1
LILA Sidewalks
71 Parkway Trees
rV_T
ImLl Traffic Control/Street Signs
EJA Storm Water Retention/Detention Basins
F-1 Other AS-BUILT
cont'd. . .
-2-
located in the Project known as BETTER T.TVTNC SUBDIVISION
(the "Project") as described on the "as-built" engineering. plans prepared by
NORMAN J. TOBERMAN located at 615 W. ROCKWELL
AVENUE, ARLINGTON HEIGHTS, ILLINOIS
and dated MARCH 18, 1986 —, which plans with "Bill of materials"
are incorporated by reference and made a part hereof.
WHEREAS, the Developer does hereby warrant to the Village, it is the lawful
owner of and has good and marketable title to the aforedescribed improvements, that
the same are free from all encumberances; that the Developer has the right to Sell
the same; and that the Developer warrants and will defend and hold harmless the
Village against the lawful claims and demands of all persons with respect to the
title hereby conveyed; and that the execution of this Bill of SalelDeed of Con-
veyance is an authorized Act of Said Corporation, individual or Partnership.
IN WITNESS WHEREOF, the Developer has caused this instrument to be signed and
delivered this TENTH day of MAY 19 88.
CORPORATE
BE�IER LIVINGCOMPANY, INC. , MAY 10, 1986. "SXAL
Ze (DATE)
G
El&ART.,W9I9EKT.e
PRESIDENT; BETTER LIVING CO. , INC
(TITLE)
ATTEST: OFF71CIAL-:SEAL
DOLOgiE,4J. KNOEBEL
NOTAR STATE OF ILLINOIS
%1Y COMM&W EXPIRES 6/10/90
I(DATE)
BETTER LIVING COMPANY INC.
DEVELOPER(S)IOWNER(S) DPK C, GEAR Z qT —MAY 10, 1988,
,V (DATE)
VILLAGE INSPECTOR
(NAME) (DATE)
-3-
ASSISTANT VILLLAGE ENGINEER: CERTIFICATION
All work required for this development has been inspected and found to
be completed in a satisfactory manner. All documentation for acceptance has been
submitted and found to be acceptable.
dee
V VA�J
(DATE) V (NAME) (TITLEJf
APPROVAL AND ACCEPTANCE OF GOVERNING AUTHORITY
The VILLAGE OF ELK GROVE VILLAGE does hereby approve and accept for
maintenance and operation the above described improvement. It is understood that
the guarantee period of 24 months shall commence as of the date of Village Board
acceptance.
It is also understood that this approval and acceptance covers only the
specific work indicated above and is subject to a final punch list being made
concerning adjustment, alignment and necessary repairs of all structures, boxes,
hydrants, ect. Acceptance of maintenance by the Village does not relieve the
developer from the responsibility of keeping all dirt and debris due to cons-
truction operations out of both storm and sanitary sewer systems. Final accept-
ance of the subdivision or other general development is conditional upon com-
pleting all indicated items on the final punch list. It is the responsibility
of the owner or developer to request the final punch list to be made. No re-
fund of maintenance escrow monies will be made until all items in the final
punch list have been corrected.
VILLAGE OF ELK GROVE VILLAGE
BY:
(DATE)
4io 01 rust Agrejenunt clated this......2nd..........day of....jAaRRNy......................
19..86............... and known as Trust Number........!�q�............................ is to certify that the MOUNT PROSPECT STATE
BANK, a corporation of Illinois as trustee hereunder, is about to take title to the following described real esiate
Cook I
in.... -------------------................. .............. County, Illinois, to-witt.
THE SOUTH 290 FEET (MEASURED ALONG THE EAST LINE) OF THE EAST 450.65 FEET
(MEASURED ON THE SOUTH LINE) OF THAT PART OF THE SOUTHEAST 1/4 OF SECTION 29,
TOWNSHIP 41 NORTH, RANGE 11 , EAST OF THE THIRD PRINCIPAL MERIDIAN, DESCRIBED BY
BEGINNING AT A POINT IN THE WEST LINE OF SAID QUARTER 21 .44 CHAINS ( 1415.04 FEET)
NORTH OF THE SOUTHWEST CORNER OF SAID SOUTHEAST 1/4; THENCE SOUTH 87 DEGREES EAST
1479 FEET TO AN IRON STAKE IN THE CENTER OF ROAD; THENCE NORTHERLY IN THE CENTER
OF SAID ROAD 450.89 FEET TO AN ANGLE IN SAID ROAD; THENCE NORTH IN THE CENTER OF
SAID ROAD 84.11 FEET TO AN IRON STAKE; THENCE NORTH 89 AND THREE FOURTHS DEGREES
WEST 1499.4 FEET TO A POINT IN THE WEST LINE OF SAID QUARTER 535 FEET NORTH OF
PLACE OF BEGINNING; THENCE SOUTH ALONG THE WEST LINE OF SAID QUARTER 535 FEET TO
THE PLACE OF BEGINNING, IN COOK COUNTY, ILLINOIS.
otherwise known as No-.........�aR...S. Arlington Heights Rd. , Elk Grove Vill.ajp�j......111;LTIS?�.s
and that when it has taken the title thereto, or has accepted title, In whing, to any other real estate deeded to it as tisirsite
hereunder, it will hold it for the uses and purposes and upon the trusts herein set forth. The following named persons shall
be entitled to the earnings, avalls and promeds of said real estate according to the respective interests herein set forth, to-wit:
Better Living Co. , Inc. , an Illinois Corporation 4
IT IS UNDERSTOOD AND AGREED betwmn the T.agtles hereto, and by any person or persons who mav
become entitled to any interest under this trust. that the rest of any beneficiary hereunder shall] consist solely cilf
a power of direction to deal with the title to said propen and to manage and control said property as hereinafter
provided,' and the right to receive the proceeds from ren2s and from mortgages. mlet or other disposition of mid
P m ises and that such right in the avalls of said property shall be deemed to be personal property. and in& be asirig,ed
4ferred as such; that in ase of death of any beneficiary hereunder during the existence of Nis trust, his
and tra c
or he� right and interest hereunder shall, except as herein otherwise specifically provided, pass to his or her executor or
administrator, and not to his or her heirs at law; and that no beneficiary now has, and that no beneficiary hereunder at
any time shall have any right, title or interest in or to any portion of said real estate as such, either legal or equitable.
but only an interest in the earnings, avails and promeds as aforesaid. The death of any brieficiary hereunder shall not
terminate the trust nor in any manner affect the powers of the trustee hereunder. No assignment of any beneficial interest
hereunder shall be binding on the trustee until the original or a duplicate of the assignment is lodged with the truslee
and accepted by the trustee and every assignment of any beneficial interest hereunder, the original or duplicate of which
shall not have been lodged with and accepted by the trustee, shall be void as to all subsequent assignees or purchasers
without notice.
Nothing contained in this agreement shall be construed as imposing any obligation on the trustee' to file any income.
profit or other tax reports or schedules, it being expressly understood that the beneficiaries from time to time will individually
make all such reports, and pay any and all taxes, required with respect to the earnings. avails and proceeds of said real estate
or growing out of their interest under this trust agreement.
In case said Trust" shall make any advances of money on account of this Trust or there is any dispute, controversy or litigation
on account of holding title to said real estate or in connection with this Trust, or In case said Trustee shall be compelled to pay
any sum of money on account of this Trust, whether on amount of breach of contract, injury to person or property, fine$
or penalties under any law or otherwise. the beneficiaries hereunder do hereby jointly and severally agree that they will on
demand pay to the said Trustee, with interest thereon at the rate of 7% per annum, all such disbursements or advances or
payments made by said Trustee, together with its expenses, including the reasonable fees of its attorneys. and that the said Trust" shall
not be called upon to convey or otherwise deal with said property at any time held hereunder until all of said disbursements.
ryments,advances and expenses made or incurred by said Trustee shall have been full paid,together with interest thereon as aforesaid.
owever, nothing herein contained shall be construed as requiring the !�rustee to advance or pay out any money
on account of this Trust or to prosecute or defend any legal promeding Involving this Trust or any property or interest
thereunder unless it shall be furnished with funds sufficient therefor or be satisfactorily indemnified in respect thereto. In the
"ent the Trustee is served with process or notice of legal promedings or any other matter concerning the Trust or the TruNt
property, the sole duty of the Trustee in connection therewith shall be to forward the Process or notice by first class mail to the
rrson designated herein as the person to whom inquiries or notices shall be sent or. in the absence of such designation. to the
1neficiaries. The last address appearing in the records of the Trustee shall be used for such mailing.
It shall not be the duty of the purchaser of said premises or of any part thereof to see to the application of the purchase
money paid therefoi; nor shall any one who may deal with said trustee be required or privileged to inquire into the necessity
or expediency of any act of said trustee, or of provisions of this instrument.
This trust agreement shall not be placed on record in the Recorder's Office of the county in which the land is situated,
or elsewhere, however the rwording of the same shall not be considered as notice of the rights of any person hereunder,
derogatory to the title or powers of mid trustee.
The Trustee may at any time resign by sending by registered mail a notice of its intention so to do to each of the
then beneficiaries hereunder at his or her address last known to the Trustee. Such resignation shall become effective
ten days after the mailing of such notices by the Trustee. In the event of such resignation, a successor or successors may
be appointed by the person or persons then entitled to direct the Trustee in the disposition of the trust property, and the
Trustee shall thereupon convey the trust properly to such successor or successors in trust. In the event that no successor
in trust is named as above provided within ten days after the mailing of such notices by the Trustee, then the Trustee may
convey the trust property to the beneficiaries in accordance with their respective interests hereunder, and the
deed of conveyance may be recorded or registered, as the case may be, by the Trustee. or the Trustee may. at its
option, file a bill for appropriate relief in any court of competent jurisdiction. The Trustee notwithstanding such
resignation shall continue to have a first lien on the trust property for its costs. expenses and attorneys' fices and for
its reasonable compensation.
Every successor Trustee or Trustees appointed hereunder shall become fully vested with all the estate. Properties,
rights, powers. trusts. duties and obligations of its. his or their redecessor.
flover)
It is understood and agreed by the parties hereto and by any person who may hereafter become , party hereto. that
said Mount Prospect State Bank will deal with said Mal estate only when authorized to do so in writing. and
that (notwithstanding any change in the beneficiary or beneficiaries hereunder) it will, on the written direction of
The President and the Secretary/Treasurer as designated in writing to the Trustee
on a Certified Resolution of the Board of Directors of Better Living Co. , Inc .
or will on the written direction of such other person or persons as &hill be from time to time named In writing by the
bentenciary or beneficiaries, or on the written direction of such person or persona as may be berienciary or beneficiaries at
the time, make deeds for, or otherwise deal with the title to sold real astalao and may upon direction of the beneficiaries
or their legal representatives, convey the trust property directly to another trustee on behalf of said beneficiaries, or
others named by said beriefictstries, provided, however, that the trustee &hall not be required to enter into any personal
obligation or liability in dealing with sald land or to make Itself liable for any damages, costs. expenses. floes or penalties,
or to deal with the title so long as my money is due to It hereunder. Said po"r of direction shall Include the right to
direct the trustee In matters regarding recalpt, payment or dispositJon, of funds or proceeds to which the beneficiaries
ate, entitled. The trustee shag not be required to loquin into the propriety of say such direction. The beneficiaries by
written instrument delivered to Me trust" may revoke The foregoing power of direction and designate the person or
persons thereafter to exercise the pirwar of direction. Such Instrument #hall be signed by all beneficiaries at that time.
Mortgages or Trust Deeds made and executed 'by the Trustee may Include waiver of any and all rights of redemption
from sale under any order or decree of forisclosum of track Mortgage or Trust Dead.
Nothing contained in this agreement shall be construed w imposing any obligation an the trustee to file any income. profit
or other tax reports or schedules, it being expressly understood that the beneficiaries from time to time will individuall, make
all such reports. and pay any and all taxes. required with respect to the earnings, avails and proceeds of said rest eitate or
growing out of their interest under this trust agreement.
The beneficiary or beneficiaries hereunder, in his. her or their own right shall have the management of said property
and control of the selling, storing and handling thereof. and said trustee shall have no duty in respect to such management
or control, or the collection, handling or application of such rents, earnings, avail$ or proceeds. or in respect to the pay-
ment of taxes or assessments or in respect to insurance, litigation or otherwise, except on Witten direction as hercinabove
mvided, and after the payment to It of All money necessary to carry out said Instructions. No beneficiary hereunder shall
eve any authority to contract for or In the name of the trust" or to bind the trustee personally. If any property remains
In this trust twenty years from this date or any extension thereof. it shall be sold at public sale by the trust" on reasonable
notice, and the proceeds of the sale shall be divided among those who are entitled thereto under this trust agreement.
...........
The Trustee shall receive for its services In accepting this Trust and taking title hereunder the sum of $-Art.
and in addition each year in advance for holding title after one year from the date herecif an annual fee as determined by the Trustee's then
current rate schedule and also its regular scheduled fees for executing deeds, mortgages or other inittruments. It shall receive reasonable
compensation for any special services which may be rendered by it &to for taking and holding any other property which may hereafter be
conveyed to it hereunder,which fees,charges and other compensation the beneficiaries jointly and severally agree to pay. If the value of the
property Is Increased for any reason after the Trustee has accepted title thereto.the Trust"ithall be entitled to a reasonable additional annual
fee, in accordance with its scheduled fees for holding title to the property.
IN TESTIMONY WHEREOF, the Mount Prospect State Bank has caused these presents to be ed by its Trust Officer
Assistant See rind
and attested by its retary, and has caused its corporate seat to be hereto attached as I for the act and deed
of said corporation, the day and date &!:�t written.
M0LJNT-.FR0SFECr STATE BANK
.............
Attest:................................................................................
Assistant Secretary
And on said day the said bentfitiarits have signed this Declaration of Trust and Trust Agreement in order to
signify their assent to the terms hereof.
Be', ter L.i.v.i.ylg. Go Inc ALI
Address Social Security
�4.W_41 A 1 60005
froisident Address
.............. ISEAL) Address Social Security No. (or I.D.)
------------ ......*............. ...............
SVEret ary/*T'r*e"a'S*U*rer ..................................S.oc.i.ai..S.ec.u.rit.y..N.o. (o.r...I.D.
.......................................................................(SEALI -—-------..............................................................................
Address Social Security No. (or I.D.)
May the name of any beneficiary be disclosed to the public?...........i�R....................................4...........................................
Refer written inquiries, bills, legal notices and other matters by Arst class mail to....... .......................4............
May oral inquiries be referred directly?......!!��.................To whom?....................................................................................
1040 S. Arlington Heights Rd.
Attorney for bencliciaries...... ......W�4m...............Ar.14m.mll... ................................
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