HomeMy WebLinkAboutContracts & Agreements_79-2020First( American
Tyle Insurance Company
NATIONAL CQ 11,1 F?CIAL cFRVICFS
City of Redlands, a municipal corporation
P 0 Box 3005
Redlands, CA 92373
Kelly Simoneau
Escrow Officer
ksimoneau@firstam com
3281 E Guests Road, Suite 440
Ontario, CA 91761
Phone Number (909)510 6206
FAX (877)461 2088
March 30, 2020
Re Property Vacant Land Redlands, CA
File No NCS-1005171-ONT1 ( KS)
Dear City Clerk
Regarding the sale of your property referenced above, First American Title Insurance Company National
Commercial Services will be handling your transaction In connection with the above referenced transaction
COMPLETE IN FULL and/or SIGN AND RETURN the enclosed items
California Withholding Package Information
Loan Information Sheet
• Exchange Information Worksheet
• Owner's Affidavit
• Proceeds Disbursement Information
• Commission Information Worksheet
• Certification for Information Reporting on the Sale of Property (IRS 1099-S Reporting Form)
• Rent Statement
ENCLOSED please find the following for your records.
• Entity Document Request List (please provide applicable documentation)
Preliminary Title Report/Commitment for Title Insurance
Escrow Acceptance Letter
Please note that all original recordable documents must be sent directly to escrow
Should you have any questions or need further assistance, please contact the undersigned We appreciate the
opportunity to serve you
Sincerely,
Kelly Simoneau
Escrow Officer
First American Title Insurance Company
KS/mv
Via Email
TAXABLE YEAR
2020 Real Estate Withholding Statement
CALIFORNIA FORM
593
AMENDED • n
Part I Remitter Information • n REEP
Qualified Intermediary ET Buyer/Transferee
Other
Business name
First American Title Insurance Company National Commercial Services
LK] FEIN n CA Corp no 1 1 CA 505 file no
95 2566122
First name
Initial
Last name
SSN or ITIN
Address (apt./ste , room, PO box, or PMB no )
3281 E Guasti Road, Suite 440
City (If you have a foreign address, see instructions)
Ontario
State
CA
ZIP code
91761
Telephone number
(909)510 6200
Part II Seller/Transferor Information If a grantor or nongrantor trust, check the box that applies
Grantor U Nongrantor Trust
First name (Grantor)
Initial
Last name (Grantor)
SSN or ITIN
Spouse's/RDP's first name (if jointly owned)
Initial
Last name
Spouse's/RDP's SSN or ITIN (if jointly owned)
Business/Nongrantor Trust name (if applicable)
City of Redlands, a municipal corporation
FEIN CA Corp no L..... _ICA SOS file no
95 6000766
Address (apt/ste , room, PO box, or PMB no )
P 0 Box 3005
City (If you have a foreign address, see instructions)
Redlands
State
CA
ZIP code
92373
Telephone number
(909)798 7531
Property address (provide street address parcel number and county)
Vacant Land Redlands CA
Ownership percentage
100 0/0
Part III Certifications which fully exempt the sale from withholding (See instructions)
Determine whether you qualify for a full withholding exemption Check all boxes that apply to the property being sold or transferred
1
2
3
1�y
!I
The property qualifies as the seller's principal residence under Internal Revenue Code (IRC) Section 121
n The seller last used the property as the seller's principal residence under IRC 121 without regard to the two year time period
❑ The seller has a loss or zero gain for California (CA) income tax purposes on this sale Complete Part VI, Computation
4 ® n The property is compulsorily or involuntarily converted, and the seller intends to acquire property that will qualify for nonrecognition
of gain under IRC Section 1033
5 The transfer qualifies for nonrecognition treatment under IRC Section 351 or IRC Section 721
6 n T• he seller is a corporation (or a limited liability company (LLC) classified as a corporation), qualified through the CA Secretary of State
or has a permanent place of business in CA
7 1 1 The seller is a CA partnership or a partnership qualified to do business in CA (or an LLC classified as a partnership for income tax
purposes that is not a single member LLC disregarded for income tax purposes)
8 n T• he seller is a tax exempt entity under California or federal law
9 E The seller is an insurance company individual retirement account, qualified pension/profit sharing plan, or charitable remainder trust
Part IV Certifications that may partially or fully exempt the sale from withholding or if no exemptions apply (See instructions)
Determine whether you qualify for a full, partial, or no withholding exemption Check all boxes that apply to the property being sold or transferred
10 ® n The transfer qualifies as either a simultaneous or deferred like kind exchange under IRC Section 1031
11 ` n The transfer of this property is an installment sale where the buyer must withhold on the principal portion of each installment
payment Copy of the promissory note is attached Complete Part V Buyer/Transferee Information on Side 2
12 (i) n N• o exemptions apply Go to Part VII, Line 31
If you checked one or more boxes in 1 9, go to Side 3, complete the perjury statement and sign Provide Sides 1 3 to the remitter before the close of
escrow or exchange transaction to submit to the Franchise Tax Board STOP here Withholding is not required
If you checked box 10, go to specific line instructions on Page 4, Part IV
If you checked box 11, go to Part V on Side 2 Withholding may be required
If you checked box 12, go to Part VII on Side 3 for amounts to withhold Withholding is required
8601203
Form 593 2020 Side 1 III
Remitter Name
First American Title Insurance Company National Commercial Services
Part V Buyer/Transferee Information
SSN, ITIN, FEIN CA corp no , or CA S05 file no
95 2566122
Complete if you checked box 11 in Part IV for an installment agreement
First name (Grantor)
Donn
Initial
Last name (Grantor)
Grenda
SSN or ITIN
Spouse's/RDP's first name (if jointly purchased)
Initial
Last name
Spouse's/RDP's SSN or ITIN
Business/Nongrantor Trust name (if applicable)
n FEIN FICA Corp no 1 ICA SOS file no
Address (apt,/ste room PO box, or PMB no )
PO Box 390
City (If you have a foreign address see instructions)
Redlands
State
CA
ZIP code
92373 0123
Telephone number
Principal Amount of Promissory Note
Installment Amount
Interest Rate
Repayment Period
Number of months
Buyer's/Transferee's Acknowledgment to Withhold
Read the "Buyer/Transferee" Information below Go to Side 3, complete the perjury statement and sign.
I acknowledge that I am required to withhold on the principal portion of each installment payment to the seller/transferor fo r the above shown
California real property ether at the rate of 3 1/3% ( 0333) of the total sales price or the Alternative Withholding Calculation, as specifed by the
seller/transferor an Form 593, Real Estate Withholding Statement, of the principal portion of each installment payment I will complete Form 593 for
the principal portion of each installment payment and send one copy of each to the Franchise Tax Board along with Form 593 V Payment Voucher
for Real Estate Withholding the withholding payment, and give one copy of Form 593 to the seller/transferor I will send each withholding payment
to the Franchise Tax Board by the 20th day of the month following the month of the installment payment If the terms of the installment sale,
promissory note, or payment schedule change, I will promptly inform the Franchise Tax Board I understand that the Franchise Tax Board may
review relevant escrow documents to ensure withholding compliance I also understand that I am subject to withholding penalties if I do not
withhold on the principal portion of each installment payment and do not send the withholding along with Form 593 to the Franchise Tax Board by
the due date, or if I do not send one copy of Form 593 to the seller/transferor by the due date
Part VI Computation
Complete this part if you checked and certified box 3 in Part III, or to calculate an alternative withholding calculation amount
13 Selling price
14 Selling expenses
15 Amount realized Subtract line 14 from line 13
® 13
14
15
16 Enter the price you paid to purchase the property (see instructions How to Figure Your Basis) 16
17 Seller/Transferor paid points 17
18
19
18 Depreciation
19 Other decreases to basis
20. Total decreases to basis Add line 17 through line 19
21 Subtract line 20 from line 16
22. Cost of additions and improvements
23 Other increases to basis
24 Total increases to basis Add line 22 and line 23
25 Adjusted basis Add line 21 and line 24
26 Enter any suspended passive activity losses from this property
27 Add line 25 and line 26
22
® 23
20
21
24
26
® 25
27
28. Estimated gain or loss on sale Subtract line 27 from line 15 and enter the amount here If you have a loss or zero gain,
certify on Side 3 No withholding is required If you have a gain, go to line 29 and 30 to calculate your withholding 28
® Form 593 2020 Side 2
8602203
Remitter Name SSN, ITIN, FEIN, CA corp no , or CA SOS file no
First Amencan Title Insurance Company National Commercial Services 95 2566122
29 Alternative withholding calculation amount Check the applicable box for the filing type
El Individual 12 3%
n Corporation 8.84% n Bank and Financial Corporation 10.84% ] Trust 12 3%
❑ Non California Partnership 12 3% ❑ S Corporation 13 8% n Financial 5 Corporation 15 8%
Multiply the amount on line 28 by the tax rate for the filing type selected above and enter the amount here This is the
alternative withholding calculation amount If you elect the alternative withholding calculation amount, then check the
appropriate box on line 35, Boxes B H, and enter the amount on line 36
30 Total sales price withholding amount Multiply the selling price on line 13 by 3'/3% ( 0333)
This is the total sales price withholding amount If you select the total sales price withholding amount, check box A on
line 35 below and enter the amount on line 36 . 30
Part VII Escrow or Exchange Information
31 Escrow or Exchange Number .
29
• 31 NCS 1005171-ONT1
32 Date of Transfer, Exchange Completion Failed Exchange, or Installment Payment (mm/dd/yyyy) • 32
33 Total Sales Price, Failed Exchange, or Boot Amount $ 1 390 000 00 x Ownership Percentage % • 33
34 Type of Transaction (Check One Only) •
A ] Conventional Sale/Transfer C ]Boot
B n Installment Sale Payment D ]Failed Exchange
35 Withholding Calculation (Check One Only) •
Total Sales Price Method
A 0 3%3% ( 0333) x Total Sales Price, Boot, or Installment Sale Payment
Alternative Withholding Calculation Election
B n Individual 12 3% x Gain on Sale F EIS Corporabon 13 8% x Gain on Sale
C i l Non -California Partnership 12 3% x Gain on Sale G n Financial 5 Corporation 15 8% x Gain on Sale
D n Corporation 8 84% x Gain on Sale H ]Trust 12 3% x Gain on Sale
E n Bank and Financia[ Corp 10 84% x Gain on Sale
36 Amount Withheld from this Seller/Transferor .. 1E36
Title and escrow persons, and exchange accommodators are not authorized to provide legal or accounting advice for purposes of
determining withholding amounts Transferors are strongly encouraged to consult with a competent tax professional for this purpose
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to
ftb ca gov/forms and search for 1131 To request this notice by mail, call 800 852 5711
Under penalties of perjury, I hereby certify that the information provided above is, to the best of my knowledge true and correct I further certify that
Check the applicable box(s)
The sale is fully exempt from withholding as indicated by a check mark(s) in Part III
n The sale is fully or partially exempt from withholding as indicated by a check mark(s) in Part IV
The seller has elected the Alternative Withholding Calculation as indicated by a check mark in Part VII, line 35 (B-H)
n The Buyer/Transferee understands and accepts the withholding requirements as stated on the Buyer's/Transferee's Acknowledgment to
Withhold in Part V This box should only be checked by those who are involved in an installment sale
Sign
Here
It is unlawful to forge
a spouse`s/RDP's
signature
Seller'C� ror` i. . ure
X
Sellers/Transferor's spouse's /RRDP's signature
x
Buyers/Transferee's signature
X
Date
Date
20
Buyer's/Transferee's spouse's/ADP's signature
X
Preparer's name and Title/Escrow business name
X Kelly Simoneau, First American Title Insurance Company National
Commercial Services
•
8603203
Date
Date
Telephone Number
(909)510 6206
Form 593 2020 Side 3 Ill
First AF22cI'dCa1]
Tale Insurance Company
NATlCON,?L COMLtFCE&.L SrPV CF'
RE Escrow No NCS-1005171-ONT1
3281 E Guasti Road Suite 440
Ontario, CA 91761
Date 03/30/2020
Officer Kelly Srmoneau
Property Vacant Land
Redlands, CA
LOAN / OWNER'S ASSOCIATION INFORMATION REQUEST
In order for us to obtain statements of account from your existing lender(s) or Owner's association, please provide us with
the following information on your accounts We must have accurate and complete information on your accounts, as some take
up to 30 days to return our request Please fill out and return this form as soon as possible
Federal Regulation 545-132D requires authorization in writing from you before a lender can release any payoff
information to an escrow holder A delay in returning this signed and completed form could delay the close of this
escrow.
FIRST TRUST DEED
Lender Name
Address
Not Applicable
Loan Number
Phone Number Fax Number SS#/TIN
SECOND TRUST DEED
Lender name
Address
Loan Number
Phone Number Fax Number SS#/TIN
OWNER'S ASSOCIATION (if applicable)
Association Name
Management Co
Address
Account Number
Phone Number Fax Number SS#/TIN
Our signatures below are to be considered instructions for obtaining statements, to comply with the instructions of the above
named companies, and our authorization to pay from Funds due us at the close of escrow said companies' fees, including, but not
limited to Statement Fees, Transfer Fees, Late Fees, Prepayment Penalties, Impound Account Shortages without our further
approval
Please Provide Your Forwarding Address below, so funds or documents may be sent to you after close of escrow
PO Box 3005, Redlands, CA 92373
Effective Date
First American Title Insurance Company National Commercial
Services
3281 E Guasti Road, Suite 440
Ontario, CA 91761
SELLER(S)•
City of Redlands, a municipal corporation
P.O Box 3005
Redlands, CA 92373
City of Redlands,
a municipal corporation
ems. Pv�alif;
Paul W Foster, Mayor
File No NCS-1005171-ONT1 (KS)
Date 03/30/2020
First American
Title Insurance Company
l4, T CJ ".I CDMMF9C`A.L SERVICES
3281 E Guasti Road, Suite 440
Ontario, CA 91761
Ph (909)510-6206
FAX - (877)461 2088
DATE March 30, 2020 Escrow # NCS-1005171-ONT1
TO Escrow Officer Kelly Sfmoneau
EXCHANGE INFORMATION
We need the following information to process your escrow. Please complete this form and return to our office
❑ I/We request that First American Exchange Company contact us to discuss a 1031
Exchange Or, I/we may also contact First American Exchange directly at (877) 317-1031 to discuss
a Tax -Deferred Exchange
❑ I/We will contact My Exchange Company listed below regarding a Tax Deferred Exchange
I/We will ask them to contact you
Accommodator
Exchange Officer
Exchange Number
Phone and Fax Number
E -Mail Address
Final Date to Exchange
I/We are certain that we will NOT be doing a 1031 Exchange Transaction for this property
I/We hereby authorize you as Escrow Holder to discuss this file with my Exchange Company in order to process
this escrow
rez_t_J
Name QAUL VJ Fa5IE11� ti MDR.
Ai7E-5T TEMIj DotitittAA
Name C i71 t Witk
VW*
Signature Phone Number
1.7)70-7531
• ature Phone Number
PLEASE COMPLETE AND RETURN
OWNER'S CERTIFICATION AND GAP INDEMNITY
A The undersigned, City of Redlands ("Owner") which owns title to the real
property located in the City of Redlands , County of san Bernard,n5, State of California (the
"Property") described in the Commitment for Title Insurance issued under NCS -
NCS 1005171-ONT1 (the "Commitment') and in consideration of First American Title Insurance
Company ( the "Company') issuing its policies of title insurance insunng an interest in the
Property under said order number, hereby represents and certifies as follows
1 That Owner is the owner of the Property and has not conveyed title to the Property to any
third party and is not aware of any third party disputing the Owner's ownership of the Property,
2 That there are no delinquent real estate taxes or unpaid current real estate taxes, nor any
pending or levied assessments on the Property including but not limited to those for trees,
sidewalks, streets, sewers and water lines,
3 That except as shown on the attached Exhibit A, within the last six (6) months (a) no
labor, service or materials have been furnished to improve the land, or to rehabilitate, repair,
refurbish, or remodel the building(s) situated on the land, (b) nor have any goods, chattels,
machinery, apparatus or equipment have attached to the building(s) thereon, as fixtures, (c) nor
have any contracts been let for the furnishing of labor, service materials, machinery, apparatus
or equipment which are to be completed subsequent to the date hereof, (d) nor have any notices
of lien been received, except as shown on said attached exhibit
4 That the Owner is in sole possession of the Property and that no other party has
possession, or has a right of possession under any tenancy, lease or other agreement, written or
oral, except as shown on the attached Exhibit B, and that in connection with any such possessory
nght, lease or other agreement, there are no rights of first refusal, rights or first offer, or options to
purchase all or any portion of the Property
5 That the covenants and restrictions, if any, shown in the Commitment have not been
violated by the erection of the improvements on the Property or the use of the Property, and there
are no known facts which would cause such violation, nor has Owner received any notices of any
violations thereof
6 That except as shown on the attached Exhibit C the Owner is not a "retailer,
"commission merchant,' "dealer," or "broker" of "perishable agricultural commodities" as defined
in 7 USC 449a(4)
7 In order to induce the Company to issue its policies of title insurance with full knowledge
that the Company will rely upon the accuracy of the statements made herein, Owner hereby
agrees to hold the Company harmless from and indemnify the Company against any and all Toss,
cost, damage or expense of every kind, including attorneys' fees, which the Company may suffer
or incur or become liable for under its said policies directly or indirectly, due to its reliance on the
accuracy of the foregoing representations or in connection with its enforcement of its rights under
this certificate and indemnity
6 The Owner acknowledges and agrees as follows
1 The Company is unwilling to issue sad policy or policies until the closing rnstrument(s)
under which the proposed insured acquires an interest in the Property is/are filed for record in the
appropriate recording office(s) (the "Recording Date"),
2 The parties in the transaction have requested the Company to provide a so-called New
York Style Closing' which provides for the unconditional delivery, upon the closing, of the title
policies concurrently with the delivery of the instrument(s) between the parties and the passing of
consideration therefor
3 In consideration of the Company issuing its policies without taking exception therein for
matters which may arise between the most recent effective date of the Commitment (the
"Effective Date") and the Recording Date, known as the "Gap Period", and which matters may
constitute an encumbrance, hen or objectionable matter to or may affect said title (collectively,
"Objections to Title"), the Owner agrees to promptly defend, remove, bond or otherwise dispose
of any Objections to Title which may arise or be filed, as the case may be, against the Property
during the Gap Period and to hold the Company harmless from and indemnify the Company
against all expenses, costs and reasonable attorneys' fees which may arise out of Owner's failure
to so remove, bond or otherwise dispose of any of said Objections to Title
Dated 4/(112
[Owner]
By6� (1)
Its Paul W Foster, Mayor
Attest
ne Donaldson, City Clerk
EXHIBIT A
WORK AT PROPERTY
{Describe work, or if none, state "NONE"}
NONE
EXHIBIT B
PARTIES IN POSSESSION AT PROPERTIES
RIGHTS OF FIRST REFUSAL, RIGHTS OF FIRST OFFER OR OPTIONS TO PURCHASE
{Attach Rent Roll or list of leases and confirm that there are no ROFRs or ROFOs or Options}
No ROFRs, ROFOs, or Options
EXHIBITC
PACA/PSA Act exceptions
First Arncr•rcan
Fire Insurance Company
f4rT o -'J 1 CD',WERC L SFRVl Ers
PROCEEDS DISBURSEMENT
Dated 03/30/2020
City of Redlands, a municipal corporation
P 0 Box 3005
Redlands, CA 92373
Order Number NCS-1005171-ONTI
Property Address Vacant Land, Redlands, CA
Buyer/Borrower(s) Donn Grenda
Seller(s). City of Redlands, a municipal corporation
32B1 E Guasti Road, Suite 440
Ontario, CA 91761
The undersigned seller(s) or borrower(s) request that the proceeds from the sale or refinance of the above
captioned property be sent in the following manner Please select one and complete if necessary
1 _ Pick-up at First American Title Insurance Company National Commercial Services, 3281 E Guasti Road, Suite 440,
Ontario, CA 91761
2 Mail to the following address
3 _ Overnight via express mail service to the following address
4 Wire proceeds to Union Bank, 400 California
Bank Name & Address
122000496
Bank ABA Routing Number
Street, San Francisco, CA 94101
2740026189
Bank Account Number
City of Redlands
Bank Account Name
5 Other
Page 1 of 2
Seller(s)
City of Redlands,
a municipal corporation
Paul W Foster, Mayor
Date 4 / /2020
Page 2of2
To
Re
Seller
• M
First American Title Insurance Company National Commercial
Services
Kelly Simoneau, Escrow Officer
Vacant Land, Redlands, CA
City of Redlands, a municipal corporation
INFORMATION REQUEST FORM — For IRS 1099-5 Reporting For Real Estate Transactions
("Property")
First American Title insurance Company
National Commercial Services
3281 E Guasti Road Suite 440
Ontario, CA 91761
(909)510 6206
Fax - (877)461-2088
File No NCS 1.005171 ONT1 (KS)
Date March 30 2020
Give form to
requestor Do not
send to the IRS
Print or type— follow all
instructions carefully
Name (as shown on your income tax return) City of Redlands
Business name/disregarded entity name if different from above
Check appropriate box. 0 individual / Sole proprietor B Corporation (exempt from 1099 S reporting) 0 Partnership
0 Limited liability company For LLC, enter the tax classification (D=disregarded entity C=corporation S=S Corporation,
❑ Other (ie Bankrupts, etc — see instructions) ►
0
0 Trust/estate
P=Partnership IP -
Forwarding Street Address (your address after closing)
35 Cajon Street, Suite 2
Percentage Owned
ti 100% 0 Other To
City State and Zip code Redlands, CA 92373
Number of sellers including you
Part I
Taxpayer Identification Number (TIN)
Enter your taxpayer identification number (TIN") in the appropriate box. The TIN provided must match the name
given on Line 1 to avoid the imposition under the Internal Revenue Code of civil or criminal penalties for failing to
furnish a correct TIN and to insure the TIN passes the IRS's NamerTlN matching software's TIN matching process
which we utilize For individuals this is your social security number (SSN) However for a resident alien sole
proprietor or disregarded entity see "Specific Instructions below For other entities it is your employer identification
number (EIN) Note If multiple sellers are involved see "General Instructions below
Part II
Certification of U.S Person **IMPORTANT** SIGN HERE IF YOU ARE A U S PERSON
ocial security
or
Employer identification number
95
600766
Under penalties of perjury I certify that
1 The number shown on this form is my correct taxpayer identification number (or I a waiting for a number to be issued to me) and
2 I am a U S citizen or other (definbelow)
Sign Here
U S person
Part III
Certification of Foreign Person
Date O. 4U ( I202 0
**IMPORTANT** SIGN HERE IF YOU ARE FOREIGN SIGN ABOVE IF YOU ARE SPERSON
Under penalties of perjury I certify that.
1 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me) and
2 I am a Foreign Person (defined below)
Sign Here
Foreign person ►
Date ►
GENERAL INSTRUCTIONS
Section references are to the Internal Revenue Code unless otherwise noted
Purpose of Form
A person who is required to file an information return on real estate with the IRS must obtain
your correct taxpayer identification number (TIN) which may be your social security number
(SSN) individual taxpayer number (ITIN} adoptive taxpayer identification number(AT1N) or
employer identification number (EN)
Definition ofa U.S Persorr. For federal tax purposes you are considered a U S. person if
you are
An individual who is a U S citizen or U.S resident alien
• A partnership corporation company or association created or organized in the United
States or under the laws of the United States
• An estate (other than a foreign estate) or
A domestic trust (as defined in Regulations section 301 7701 7)
Definition ofa Foreign Person.
A foreign person includes a nonresident alien individual, foreign corporation foreign
partnership foreign trust, foreign estate, and any other person that is not a U.S person It
also includes a foreign branch of a U S financial institution if the foreign branch is a qualified
intermediary In most cases the U 5 branch of a foreign corporation or partnership is
treated as a foreign person
Requirement to Furnish TIN 8 Penalties for Failure
You are required by law to provide us with your correct taxpayer identification number
("TIN") If you do not provide us with your correct taxpayer identification number ("TIN ) you
may be subject to civil or criminal penalties imposed by law If we disclose or use your TIN
in violation of federal law, we may be subject to civil or criminal penalties imposed by law
Multiple Sellers
Each seller must complete a separate form Spouses who hold title as
tenants in common joint tenants tenants by the entirety, or community property
will be treated as a single seller unless we are instructed otherwise
SPECIFIC INSTRUCTIONS
Please review chart "What Name and Number to Give" on page 2
Individuals You must generally enter the name shown on your income tax
return However if you have changed your last name, for instance, due to
marriage without informing the Social Security Administration of the name
change enter your first name the last name shown on your social secunty card
and your new last name
If more than one name is listed list first and then circle, the name of the
person or entity whose number you entered in Part I of the form
Note ITIN Applicant Enter your individual name as it was entered on your form
W-7 application line la This should also be the same as the name you entered
on the Form 104011040N1040EZ you filed with your application
Limited liability company (LLC). Check the Limited liability company' box
only and enter the appropriate code for the tax classification ("D" for disregarded
entity "0' for corporation P" for partnership) in the space provided and follow
the instructions on the next page
(SpecW,c Instructions Continued on Next Page)
For Escrow Use Only — Additional File Information
[ ] Change
j ) Void
Delete
For Escrow Use Only — Required for 1099-S Data Entry Only (No entry in FAST
[ ] Add
[ ] Change
No of 1099-S Forms required
for this file?
I1
Is NamelEntily Party a'Non-Record' Seller
Type is: [ ] HAV or Individual
[ I
] Trust/Business
Is Property pari of an Exchange?
I
YES [ 1NC
1 r)pletri
Contract Sales Price
Buyer's Part of Real estate Tax
Actual Settlement Date
Region National Commercial Services Division FAST Office 30 (1602) (MV)
First American
Title Insurance Company
h4A7:LJ JA'l- COMMERCIAL. SERVFCES
TO FIRST AMERICAN TITLE COMPANY
ESCROW NO NCS-1005171-ONT1
3281 E Guasti Road Suite 440
Ontario, CA 91761
In order that rents for the property I am conveying may be correctly prorated through escrow, I hereby state that
rentals as to amounts and dates to which they are paid, are as follows
Unit Tenant Rate per month Date paid Security deposit Option to Right of
to Purchase 1st
Y or N Refusal
YorN
Unless prior to date of recording I have notified you in writing of some change in tenancy, you are to assume I will
collect all rents which fall due according to the foregoing statement prior to close of escrow, and you will prorate the
rents accordingly You will also pay the grantee the above security deposit (if any), charging my account
DATED 4 4/20 SELL
PAUL u W
FoSTeltr iM�4YD�
SELLER
The above rent statement is hereby approved as a basis for rent prorations through this escrow
DATED BUYER
BUYER
Page 1 of 1
my /03/30/2020