LLA 2017-0001 Parcel ARECORDING REQUESTED BY
John A, MacDonald and Linda M. MacDonald
WHEN RECORDED MAIL TO
AND MAIL TAX STATEMENTS TO
John A. MacDonald and Linda M. MacDonald
917 Whann Avenue
McLean, VA 22101
DOC # 2017-0460583
11/03/2017 08:00 AM Fees: $55.00
Page 1 of 11
Recorded in Official Records
County of Riverside
Peter Aldana
Assessor -County Clerk -Recorder
**This document was electronically submitted
to the County of Riverside for recording**
Receipted by: LISA #580
AND FURNISH A COPY TO
. City of La Quinta
78495 Calle Tampico
La Quints, CA 92253
GRANT DEED
'� ��::�'��'��'�- �j'� �' LLA 20'� 7-000'[
TITLE ORDER NO. � � � ��_• ESCROW NO.�� � APN NO. 777-070-05'I, 777-140-Q23 777-140-027
�t ,
THE UNDERSIGNED GRANTOR(s) DECLAR (}
DO � UMENTARY TRANSFER TAX is $ t
CITY TAX $ ,�
computed on full value of property conveyed, or ❑ computed on full value less value of liens orencumbrances remaining at time
of sale,
❑ Unincorporated area: �I City of y � �� ,and
FOR A VALUABLE CQNSIDERATION, receipt of which is hereby acknowledged,
John A. MacDonald, Trustee and Linda 1111. MacDonald, Trustee ofi the MacDonald 2000 Family Trust
and
ND La Quinta Partners, LLC a Delaware Limited Liability Company
hereby GRANT(s} to
John A. MacDonald, Trustee and Linda M. MacDonald, Trustee of the MacDonald 2000 Family Trust
the following described real property in the City of La Quints, County of Riverside, State of California:
Parcel `A' of Lot Line Adjustment 2017-000'[ approved by the City of La Quinta, as depicted on
Exhibits "A" and "B", attached hereto and by this reference made a part hereof.
� ;' NOTE:. This Grant Deed perfects the intent of Lot Line Adjustment 20'17-0001 as approved by the
City of La Quinta. /,�
MacDonald 2000 Family Trust
n A. MacDona
, Trustee
ry��
G�L'� �/--�'�
Linda M. MacDonald, Trustee
��.f r �
Date
This Quitclaim Deed reflects Lot Line Adjustment
2017-0001 as Approved by the City of La Quints.
Bryan McKinney, P.E.; Date
Interim City Engineer, RCE No. 49418
ND La Quinta Partners, LLC, A Delaware Limited Liability Compan
By: Nationwide Realty Investors, LTD, an Ohio
Limited Liability Company, its Managing Member
Signature: t ��'`'�'' r
L � �. ��
Print Name; ��`�� z� e�'�"''� � '' � �
Pant Title: �4 ��..� ���. ���_�__���:`�: �' � ` �� �
:,
�• �
ti� � 4���
Date: 111YYY � UL� 4
--. -y.._
RECORDING REQUESTED BY
John A. MacDonald I" M. MacDonald
WHEN RECORDED MAIL TO
AND MAIL TAX STATEMENTS TO
John A. MacDonald and Linda M. MacDonald
917 Whann Avenue
McLean, VA 22101
AND FURNISH A COPY TO
City of La Quinta
78495 Calle Tampico
La Quinta, CA 92253
TITLE ORDER NO.� � �p� C�1 CMZ ESCROW NO.V�UL+� � ��APN NO. 777-070-051, 777-140-023, 777-140-027
THE UNDERSIGNED GRANTOR(s) DECLAR (s) G
DO UMENTARY TRANSFER TAX is $ CITY TAX $
computed on full value of property conveyed, or ❑ computed on full value less value of liens or encumbrances remaining at time
of sale,
❑ Unincorporated area: City of
FOR , receipt of which is hereby acknowledged,
A VALUABLE CONSIDERATION
and
John A. MacDonald, Trustee and Linda M. MacDonald, Trustee of the MacDonald 2000 Family Trust
and
ND La Quinta Partners, LLC a Delaware Limited Liability Company
hereby GRANT(s) to
John A. MacDonald, Trustee and Linda M. MacDonald, Trustee of the MacDonald 2000 Family Trust
the following described real property in the City of La Quinta, County of Riverside, State of California:
Parcel `A' of Lot Line Adjustment 2017-0001 approved by the City of La Quinta, as depicted on
Exhibits "A" and "B", attached hereto and by this reference made a part hereof.
OTE:. This Grant Deed perfects the intent of Lot Line Adjustment 2017-0001 as approved by the
N
City %J La Quinta.
l
MacDonald 2000 Family Trust
This Quitclaim Deed reflects Lot Line Adjustment
n A. MacDonald,
Trustee
Date
Linda M. MacDonald, Trustee Date
ND La Quinta Partners, LLC, A Delaware Limited Liabili
By:
Nationwide Realty Investors, LTD, an Ohio
Limited Liability Company, its Managing Member
Signature:
Print Name:
Print Title:
roveA by the City of La Quinta
Bryan McKinney, P.E., Date
Interim City Engineer, RCE No. 49418
Compan
EXHIBIT "A"
LEGAL DESCRIPTION
LOT LI N E ADJ USTM E NT 2017-0001
PARCEL `A'
That certain parcel of land located in the City of La C�uinta, County of Riverside, State of California, being
Lot 151 and Lot 152 of Amended Tract No. 29894-2, as shown by a map on file in Book 327, Pages 56
through 88 inclusive of Maps, Records of said County of Riverside;
EXCEPTING THEREFROM that portion of said Lot 151 which is described as Parcel "A" in "GRANT DEED,
LOT LINE ADJUSTMENT 2013-532, Robert D. Goodrich II and Virginia D. Goodrich", recorded January 30,
2014 as Doc. #2014-0041316, Official Records of said County of Riverside, more particularly described as
follows:
BEGINNING at the northwest corner of Lot 150 of said Amended Tract No. 29894-2;
Thence along the north line of said Lot 150 South 87°05'43" East a distance of 111.06 feet to the
beginning of a tangent curve, concave southerly, having a radius of 427.50 feet;
thence continuing along said northerly line of said Lot 150 and Lot 151 easterly along said curve
through a central angle of 03°41'04" an arc distance of 27.49 feet to a line parallel with and
20.00 feet southeasterly, measured at right angles, of the easterly line of said Lot 150;
thence along said parallel line South 23°28'50" West a distance of 151.28 feet to the Southerly
line of said Lot 151;
Thence along said southerly lines of Lot 151 and Lot 150 South 76°29'14" West a distance of
162.76 feet to the southwest corner of said Lot 150;
Thence along the westerly line of said Lot 150 North 23°28'50" East a distance of 201.36 feet to
the POINT OF BEGINNING.
TOGETHER WITH that portion of Lot "J" Of Tract No. 29894-3 as shown by a map on file in Book 351,
Pages 35 through 48 inclusive of Maps, Records of said County of Riverside, lying northeasterly of the
following described line:
BEGINNING at the northwest corner of Lot 153 of said Amended Tract No. 29894-2;
Thence North 54°05'56" West a distance of 97.90 feet to a point in the northerly line of said Lot
"J" of Tract No. 29894-3 and the POINT OF TERMINATION.
CONTAINING: 36,049 Square Feets more or less.
SUBJECT TO all Covenants, Rights, Rights -of -Way and Easements of record.
Graphically depicted on 'EXHIBIT "B" —PLAT', attached hereto and by this reference made a part
hereof.
Page 1 of 2
PARCEL `B'
That certain parcel of land located in the City of La Quints, County of Riverside, State of California, being
Lot "J" of Amended Tract No. 29894-3 as shown by a map on file in Book 351, Pages 35 through 48
inclusive of Maps, Records of said County;
EXCEPTING THEREFROM that portion of said Lot "J" of Amended Tract No. 29894-3 lying northeasterly
of the following described line:
BEGINNING at the northwest corner of Lot 153 of Amended Tract No. 29894-2 as shown by a
map on file in Book 327, Pages 56 through 88 inclusive of Maps, Records of said County of
Riverside;
Thence North 54°05'56" West a distance of 97.90 feet to a point in the northerly line of said Lot
"J" of Amended Tract No. 29894-3 and the POINT OF TERMINATION.
CONTAINING: 37.42 Acres, more or less.
SUBJECT TO all Covenants, Rights, Rights-of—Way and Easements of record.
Graphically depicted on 'EXHIBIT "B" —PLAT', attached hereto and by this reference made a part
hereof.
PARCEL `C'
That certain parcel of land located in the City of La Quints, County of Riverside, State of California, being
Lot 153 of Amended Tract No. 29894-2, as shown by a map on We in Book 327, Pages 56 through 88
inclusive of Maps, Records of said County of Riverside.
CONTAINING: 18,030 Square Feet, more or less.
SUBJECT TO all Covenants, Rights, Rights -of -Way and Easements of record.
Graphically depicted on 'EXHIBIT "B" —PLAT', attached hereto and by this reference made a part
hereof.
This legal description and accompanying plat
were prepared by me or under my direction.
Benjamin Daniel Egan, PLS 8756
Prepared: June 7, 2017
Page 2 of 2
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ORIGINAL LOT
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PARCEL " A � /�N31 R1 i1P��
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()R1 DENOTES RECORD DATA
PER AMENDED TRACT N0.
29894-2 (MB 327/56-88)
()R2 DENOTES RECORD DATA PER
PARCEL "A" OF GRANT DEED
REC. 1/30/2014 AS DOC.
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LINE BETWEENwt
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SCALE. 1"=50'
LOT LINE ADJ.
PREPARED BY:
BE'NJAMI
LS 8756
DATE:
�„
6/7/2017
1
SHEET 1 OF 1
2017-0001
S
A notary pub/ic or other officer comp/eting this certificate verifies on/y the
identity of the individual who signed the document, to which this certificate
is attached, and not the truthfu/Hess, accuracy, or validity of that document
State of California )
)
County of Riverside )
On July 18, 217 before me,
personally appeared BRYAN MCKINNEY who proved
_, y Notary Public,
to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the within
instrument, and acknowledged to me that he executed the same in his
authorized capacity, and that by his signature on the instrument the person, or
the entity upon behalf of which the person acted, executed the instrument.
I certify
California
under PENALTY OF PERJURY under the
that the foregoing paragraph is true and co
WITNESS my hand and official seal .
Signature
DOCUMENT:
laws of the State of
rrect.
Riverside County
Commission � 2 � fi8979
(seal)
GRANT DEED LLA 2017-0001 re: APN 777-070-051, 777-140-023, and
777-140-027 — owner(s): JOHN A. MACDONALD, TRUSTEE AND LINDA M.
MACDONALD, TRUSTEE OF THE MACDONALD 2000 FAMILY TRUST and
N D LA QU I NTA PARTNERS, LLC
n
I certify under
1 I I III Ill III11 �
penalty of perjury that the Notary Seal on the document to
which this statement is attached reads as follows:
NAME OF NOTARY:
COUNTY WHERE BOND IS FILED (if applicable): RIVERSIDE
STATE WHERE BOND IS FILED: CALIFORNIA
COMMISSION NUMBER (if applicable): 21c
DATE:
Septe
11111 1 1111111111
J
(CITY &STATE)
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document, to which the certificate is
attached, and not the truthfulness, accuracy, or validity of that document.
Commonwealth of Virginia )
County of Fairfax )
On August 21, 2017 before me, �YIC��. �fN�S�►'L ,Notary Public,
personally appeared JOHN MACDONALD who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the within
instrument, and acknowledged to me that he executed the same in his authorized
capacity, and that by his signature on the instrument the person, or entity upon
behalf of which the person acted, executed the instrument.
certify UNDER PENALTY OF PERJURY under the laws of the Commonwealth of
Virginia that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
signature _ U""��l ��1��-
�•
ANA ZELJKA CARLSON
N®TARP PUBLIC 7fi91Q53
GflMMdN1NEALTH OF VIRGINIA
(seal)
'' � � � 1 111 - �' 1 1 1 �i 1 • �1 1
' • � �• � � Ili � • � � • �
r � •
'_
r
r
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document, to which the certificate is
attached, and not the truthfulness, accuracy, or validity of that document.
Commonwealth of Virginia �
County of Fairfax )
capacity, and that by he
behalf of which the pers
Notary Public,
to me on tlhe basis of
is subscribed to the within
that he executed the same in his authorized
r signature on the instrument the p
son acted, executed the instrument.
arson, or entity upon
I certify UNDER PENALTY OF PERJURY under the laws of the Corromonwealth of
Virginia that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature
'� •
ANA ZELJKA CARLSoN
NOTARY PUB�.IG 1fi97
GL�MM�NWEALT�i OF VIRGINIA
��Y �G�,III��iI�SI�N �XPI��� N�VLMB�R 30, �0�0
(seal)
'' � � � 1 111 - �' 1 i 1 �1 1 �� �1 1
' � � �� � � 111 �
� � � r
U
C(�✓
ANA ZELJKA CARLSoN
NOTARY PUB�.IG 1fi97
GL�MM�NWEALT�i OF VIRGINIA
��Y �G�,III��iI�SI�N �XPI��� N�VLMB�R 30, �0�0
(seal)
'' � � � 1 111 - �' 1 i 1 �1 1 �� �1 1
' � � �� � � 111 �
� � � r
I certify under
penalty of perjury that the Notary Seal on the document to
which this statement is attached reads as follows:
NAME OF NOTARY:
DATE COMMISSION EXPIRES: NOVEMBER 30, 2020
COUNTY WHERE BOND IS FILED (if applicable): FAIRFAX
STATE \4'HERE BOND IS FILED: COMMONWEALTH Of VIRGINIA
COMMISSION NUMBER (if applicable): NOT SET OUT
(CITY &STATE)
SIGNATURE:
SCOTT A. HOOG
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document, to which the certificate is
attached, and not the truthfulness, accuracy, or validity of that document.
State of
County of NILLI N )
On before me, Cl 11 L - �V`L�r'1� ,Notary Public,
personally appeared (�Yo t . rj)) S who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the within
instrument, and acknowledged to me that he executed the same in his authorized
capacity, and that by hos signature on the instrument the person, or entity upon
behalf of which the person acted, executed the instrument.
hat the foregoing paragraph is true and correct.
Signature
T
seal}
Shelley L. �teUens
r
r
lot
Notary Public, Stade of Ohio
My Commission Expires ?o-
312? 7
'� 1 � � 1 111 �' i • '1 �1 1 • 1 1
• %I vow
• • r 1
FRUSTEE OF !•2000 FAMILY TRUST and ND LA QUINTA
I certify under
penalty of perjury that the Notary Seal on the document to
wnicn anis statemen
tis attached
reads as follows:
NAME OF NOTARY: SHELLEYL. STEVENS
DATE COMMISSION EXPIRES: OCTOBER 31, 2017
COUNTY WHERE BOND IS FILED (if applicable): F�NKLIN
STATE WHERE BOND IS FILED: OHIO
COMMISSION NUMBER (if applicable):
(CITY &STATE)
• Sept��.�.�__ , � �,�,
��:��•��r_ ►� Y�riy�rr�;�izizna►;��a►;��
_ -
-1 -
_-------r_ - _
_ -=- -=
� -__ -
-
- -
-
-
penalty of perjury that the Notary Seal on the document to
wnicn anis statemen
tis attached
reads as follows:
NAME OF NOTARY: SHELLEYL. STEVENS
DATE COMMISSION EXPIRES: OCTOBER 31, 2017
COUNTY WHERE BOND IS FILED (if applicable): F�NKLIN
STATE WHERE BOND IS FILED: OHIO
COMMISSION NUMBER (if applicable):
(CITY &STATE)
• Sept��.�.�__ , � �,�,
��:��•��r_ ►� Y�riy�rr�;�izizna►;��a►;��
BOE -502-A (P1) REV. 12 (OS -13)
PRELIMINARY CHANGE OF OWNERSHIP REPORT
To be completed by transferee (buyer) prior to a transfer of subject
property. in accordance with Section 480.3 of the Revenue and
Taxation Code. A Preliminary Change of Ownership Report must
be filed with each conveyance in the County Recorder's office for
the county where the property is located.
NAME AND MAII.,ING ADDRESS OF BUYER/TRANSFEREE
(Make necessary corrections to the printed name and mailing address)
the MacDonald 2000 Family Trust
917 Whann Avenue
McLean, VA 22101
STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY
Lot Line / La Quinta, CA 92253
'1��-b"�o-�
ASSESSOR' S PARCEL
SELLER/TRANSFEROR
ND La Quinta Partners, LLC
Escrow No.: PDL15139-139-CM
Title No.: 617650102
BUYER' S DAYTIME TELEPHQNE NUMBER
I: I ��'
MAIL PROPERTY TAX INFORMATION TO (NAME)
the MacDonald 2000 Family Trust
ADDRESS
917 Whann Avenue -McLean, VA 22101
❑ YES �I�O This property is intended as my principal residence. If YES, please indicate the date of occupancy MO DAY YEAR
or intended occu anc .
PART I: TRANSFER INFORMATION Please complete all statements.
This section contains possible exclusions from reassessment for certain types of transfers.
YES
I■
CI
it
■I
:i
NO
�,�- �� oz
A. This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.).
B. This transfer is solely between domestic partners currently registered with the California Secretary of State (addition or removal of a partner,
death of a partner, termination settlement, etc.).
* C. This is a transfer: ❑ between parents) and children) ❑from grandparents) to grandchild ren).
* D. This transfer is the result of a cotenant's death. Date of death
* E. This transaction is to replace a principal residence by a person 55 years of age or older.
Within the same county? ❑YES ❑ NO
* F. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69.5.
Within the same county? ❑YES ❑ NO
G. This transaction is only a correction of the names) of the persons) holding title to the property (e.g., a name change upon marriage).
If YES, please explain:
H. The recorded document creates, terminates, or reconveys a lender's interest in the property.
I. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner).
If YES, please explain:
J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document.
K. This is a transfer of property:
1. to/from a revocable trust that maybe revoked by the transferor and is for the benefit of
❑the transferor, and/or ❑the transferor's spouse ❑registered domestic partner.
2. to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint ten
beneficiaries when the creator/grantor/trustor dies.
3. to/from an irrevocable trust for the benefit of the
ant, and which names the other joint tenants) as
❑ creator/grantor/trustor and/or ❑grantor's/trustor's spouse ❑grantor's/trustor's registered domestic partner.
L. This property is subject to a lease with a remaining lease term of 35 years or more including written options.
M. This is a transfer between parties in which proportional interests of the transferors) and transferees) in each and every parcel being transferred
remain exactly the same after the transfer.
N This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions.
* O. This transfer is to the first purchaser of a new building containing an active solar energy system.
I *Please refer to the instructions for Part 1.
1 Please provide any other information that will help the Assessor understand the nature of the transfer.
THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION
BOE -502-A (P2) REV. 12 (OS -13)
PART 2. OTHER TRANSFER INFORMATION
A. Date of transfer, if other than recording date:
B. Type of transfer:
Check and complete as applicable.
LAY Purchase ❑Foreclosure ❑Gift ❑Trade or exchange ❑Merger, stock, or partnership acquisition (Form BOE -100-B)
❑ Contract of sale. Date of contract: ❑ Inheritance. Date of death:
❑ Sale/leaseback ❑ Creation of a lease ❑ Assignment of a lease ❑ Termination of a lease. Date lease began:
Original term in years (including written options): Remaining term in years (including written options):
❑ Other. Please explain
Only a partial interest in the property was transferred.
❑ YES ❑ NO If YES, indicate the percentage transferred:
PART 3. PURCHASE PRICE AND TERMS OF SALE
Total purchase price.
Cash down payment or value of trade or exchange excluding closing costs
First deed of trust @ %interest for
years. Monthly payment $_
❑ FHA Discount Points) ❑Cal -Vet ❑ VA (.Discount Points)
❑ Bank/Savings & Loan/Credit Union
❑ Balloon payment $
D. Second deed of trust @ %interest for
❑ Fixed rate ❑ Variable rate
❑ Balloon payment $
❑ Loan carried by seller
Due date:
years. Monthly payment $
❑ Bank/Savings & Loan/Credit Union
Due date:
Check and complete as applicable.
❑ Fixed rate
❑ Variable rate
U Loan carried by seller
Amount
Amount
Amount $
E. Was an Improvement Bond or other public financing assumed by the buyer? ❑YES ❑ NO Outstanding Balance $
F. Amount, if any, of real estate commission fees paid by the buyer which are not included in the purchase price $
The property was purchased: 11 Through real estate broker. Broker name:
❑ Direct from seller ❑ From a family member -Relationship
❑ Other. Pleas
Phone number:_ ( )
e explain:
H. Please explain any special terms, seller concessions, broker/agent fees waived, financing, and any other information (e.g., buyer assumed the existing loan
balance) that would assist the Assessor in the valuation of your property.
PART 4. PROPERTY INFORMATION Check and complete as applicable.
A. Type of property transferred
❑ Single-family residence ❑ Co-op/Own-your-own ❑Manufactured
home
❑ Multiple -family residence. Number of units: ❑Condominium ❑Unimproved lot
❑ Other. Description: (i.e., timber, mineral, water rights, etc.) ❑ Timeshare ❑ Commercial/Industrial
i
B. ❑YES ❑ NO Personal/business property, or incentives, provided by seller to buyer are included in the purchase price. Examples of personal property
are furniture, farm equipment, machinery, etc. Examples of incentives are club memberships, etc. Attach list if available.
If YES, enter the value if the personal/business property: $
❑ YES ❑ NO A manufactured home is included in the purchase price.
If YES, enter the value attributed to the manufactured home: $.
❑YES ❑ NO The manufactured home is subject to local propert
y tax. If NO, enter decal number:
D. ❑YES ❑ NO The property produces rental or other income.
If YES, the income is from: ❑Lease/rent ❑Contract ❑Mineral rights ❑Other:
E. The condition of the property at the time of sale was: El Good El Average 11 Fair
❑Poor
CERTIFICATION
I cert��r declare) that the foregoing and all information hereon, including any accompanying statements or documents, is true and correct to the best of myYVV41 zf I 4H 1//) '7
S GNA RANSFEREE OR CORPORATE OFFICER DATE TELEPHONE
N R/TRANSFEREE/LEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE EMAIL ADDRESS
The Assessor's office may contact you for additional information regarding this transaction.
r-:
i
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a ��.
��
�� �'�3
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��
PETER ALDANA
COUNTY OF RIVERSIDE
ASSESSOR -COUNTY CLERK -RECORDER
Recorder
P.O. Box 751
Riverside, CA 92502-0751
(951) 486-7000
Website: «��v�v.riversideacr.com
WARNING
ANY PERSON WHO MAKES ANY MATERIAL MISREPRESENTATION OF FACT FOR THE PURPOSE OF AVOIDING ALL OR ANY PART
OF THE DOCUMENTARY TRANSFER TAX IS GUILTY OF A MISDEMEANOR UNDER SECTION 5 OF ORDINANCE 516 OF THE COUNTY
OF RIVERSIDE AND IS SUBJECT TO PROSECUTION FOR SUCH OFFENSE.
AS SES SOR' S PARCEL NO. "�� -- � -- O I declare that the documentary transfer tax for this
Property Address: - - �" . I � transaction is: $ 47 �'��
O
If this transaction is exempt from Documentary Trans r Tax, the reason must be identified below.
I CLAIM THA T THIS TRANSA CTION IS EXEMPT FR OM D OCUMENTAR Y TRANSFER TAX BECA USE: (Th e
Sections listed below are taken from the Revenue and Taxation Code with the exception of items 9 and 10 which are taken
from Riverside County Ordinance 516). Please check one or explain in "Other':
1. Section 11911. The consideration or value of the property, exclusive of any liens and encumbrances is
$100.00 or less and there is no additional consideration received by the grantor.
2. Section 11911. The conveyance transfers to a revocable living trust by the grantor or from a revocable living
trust to a beneficiary.
3. Section 11921. The conveyance was given to secure a debt.
4. Section 11922. The conveyance is to a governmental entity or political subdivision.
5. Section 11925. The transfer is between individuals and a legal entity or nership, or between
legal entities and does not change the pro a interests held.
6. Section 11926. The conveyance is to a grantee 's the foreclosing beneficiary and the consideration paid by
the foreclosing benefic' oes not exceed the unpaid debt.
7. Section 11927. The conveyan ates to a dissolution of marriage or legal separation.
(A spouse st sign a written recital in order to claim this exemption. This form maybe used for that purpose.)
8. Section 11930. T conveyance is an inter vivos gift* or a transfer by death.
*Please be aware that information stated on this document may be given to and used by governmental
agencies, including the Internal Revenue Service. Also, certain gifts in excess of the annual Federal gift tax
exemption may trigger a Federal Gift Tax. In such cases, the Transferor (donor/grantor) maybe required to
file Form 709 (Federal Gift Tax Return) with the Internal Revenue Service.
9. Section 8. The easement is perpetual, permanent, or for life.
1 Section 9. The document is a lease for a term of jg��than (3 5) years (including written options.)
11. Other (Include explanation and legal authority)
I DECLARE UNDER PENAL TY OF PERJUR Y THA T THE FOREGOING IS TR UE AND CORRECT.
Name of Firm (if applicable)
For Recorder's Use:
20� at La �uinta_ Californi
City
Printed Name of Affiant
Address of Affiant (inc uding City, State, and Zip Code)
Telephone Number of Affiant (including area code)
This form is subject to the California Public Records Act (Government Code 6250 et. seq.)
Affix POOR Label Here
State
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ACR 521 Rev. 11%2014 Availab(� in Alternate Formats r-�
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