LLA 2018-0005 Andalusia Parcel B (Lot 98)Document-6879880-Page-1
Page 1 of 1
Order No.
Escrow No.
Loan No.
WHEN RECORDED MAIL TO:
City of La Qulnta
78-495 Calle Tampico
La Quinta, California, 92253
DOCUMENTARY TRANSFER TAX $ ............
USE
Computed on the consideration or value of property conveyed; OR
Computed on the consideration or value less liens or encumbrances
remaining at time of sale.
determining tax - Firm Name
APN'S: 764-680-014, 764-680-015
DOC # 2019-0086840
03/14/2019 03:47 PM Fees: $192.00
Page 1 of 7
Recorded in Official Records
County of Riverside
Peter Aldana
Assessor-Counfy Clerk -Recorder
"This document was electronically submitted
to the County of Riverside for recording"
Receipted by: TERESA #134
GRANT DEED
LLA 2018-0005
SPACE ABOVE THIS LINE FOR RECORDER'S
Signature of Declarant or Agent
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, SUNRISE LQ, LLC, a Delaware
limited liability Company
hereby GRANT(S) to T.D. DESERT DEVELOPMENT LIMITED PARTNERSHIP, a California limited partnership
the real property in the City of La Quinta, County of Riverside, State of California, described as
that portion of land in Parcel "A" which is overlaid by the reconfigured shape of Parcel "B" pursuant to
LLA 2018-0005 approved by the City of La Quinta. The reconfigured parcels are described in 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 2018-0005 as approved by the City of
La Quinta.
STATE OF CALIFORNIA } SUNRISE LQ, LLC, a Delaware limited liability
COUNTY OF. ] corrpKy ,
On before me,
personally appoared By:
Its: ��/ - e S cs�-�.✓�
Who proved to me on the bass ory evidence to be the person(s)
qp pVED BY CITY OF LA QUINTA
whose namets] Is sub. a within Instrument and acknowledged to
me that helshelthey exec t me in his/her/their authorized
capacity(ies),and tttat by h heir aIgnature(s) on the instrument the
person(s), or the er�t upo ehalf of which the person(s) acted, executed the
-
i3rya OKnney, P.E„ City Engineer
instrument
I certify under OF PERJURY under the laws of the State of
RCE 49418, Exp, 9-30-2020
California that the regoing paragraph Is true and correct.
WITNESS radhand and official seal.
SloAture
MAIL TAX STATEMENTS TO:
Place Notary Seal Above
about:blank 3/14/2019
Document-68798 80-Page-2
Page 1 of 1
DOC #2019-0086840 Page 2 of 7
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document, to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document
,State of California
County of Riverside
On March 14, 2019 before me, MONIKA RADEVA , Notary Public,
personally appeared BRYAN MCKINNEY 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
the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under' the laws. of the State of
California that the foregoing paragraph is true and correct.
MONiKA RADEVA
WITNESS my hand and official seal. Notaty Public - Calitornle
'l
Riverside County.
x Commission # 2t88979
M Comm. ExpiFes Oct 22. 2020~
Signature
(seal)
DOCUMENT:'
GRANT DEED LLA 2018-0005 re:'APN 764-680-014, and 764-680-015 —
owner(s): SUNRISE LQ, LLC
about:blank 3/14/2019
Document-6879880-Page-3
Page 1 of 1
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
DOC #2019-0086840 Page 3 of 7
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Riverside
On March 1, 2019
Date
before me, Juanita M.A. Gama, Notary Public ,
Here Insert Name and Title ofthe Officer
personally appeared Phillip K. Smith, Jr.
Name(s) of Slgner(s)
who proved to me on the basis of satisfactory
evidence to be the person(4 whose name(g) is/
ajA subscribed to the within instrument and
acknowledged to me that he/sW/thy executed
the same in his/Vr/thdir authorized capacity
(ilgj, and that by hls/kbgr/tVir signatureW on the
Instrument the personj4, or the entity upon
behalf of which the personA acted, executed
the instrument
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
JUANITAM. A. LAMA paragraph is true and correct.
Notary Public - California
Riverside County
Commission 112274alu WITNESS my hand and official seal.
My Comm. Expires Feb 7, 2023
Signature: —r12
Place Notary Seal Above Signature of Notary Public
OPTIONAL
Though the Information belowls not required bylaw, ltmay prove valuable to persons relying on the
document and could prevent fraudulent removal and reattachment of this form to another document.
Further Description of Any Attached Document
Title or Type of Document: Grant Deed LLA 2018-0005 ; APN's: 764-680-014, 764-680-015
Document Date:
Signer(s) Other Than Named Above:
Number of Pages:
about:blank 3/14/2019
Document-6879880-Page-4 Page 1 of 1
DOC #2019-0086840 Page 4 of 7
EXHIBIT "A"
LOT LINE ADJUSTMENT NO.2018-0005
PARCEL "A"
LOT 97 OF AMENDMENT NO.3, TRACT NO.31681-3, AS SHOWN BYiMAP ON FILE IN
BOOK 452 OF MAPS, AT PAGES 39 THROUGH 53, INCLUSIVE,'RECORDS OF
RIVERSIDE COUNTY, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE
OF CALIFORNIA.
EXCEPTING THEREFROM THAT PORTION OF SAID LOT 97, MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE MOST EASTERLY CORNER OF LOT 98 OF SAID TRACT, SAID
CORNER ALSO BEING THE MOST NORTHERLY CORNER OF LOT "Z" OF SAID
TRACT;
THENCE N480 43' 19"W ALONG THE NORTHEASTERLY LINE OF SAID LOT 98 AND
THE SOUTHWESTERLY LINE OF LOT 97 OF SAID TRACT, A DISTANCE OF 72.05
FEET TO A POINT ON ANON -TANGENT CURVE CONCAVE SOUTHEASTERLY,
HAVING A RADIUS -OF 195.00 FEET; WITH A BEGINNING RADIAL OF N19° 16' 38"W;
THENCE NORTHEASTERLY ALONG SAID CURVE THROUGH A CENTRAL ANGLE OF
01 ° 42' 05", AN ARC -LENGTH OF 5.79 FEET;
THENCE S48° 43' 19"E, PARALLEL WITH AND 5.00 FEET DISTANT THEREFROM,
MEASURED AT RIGHT ANGLES, THE NORTHEASTERLY LINE OF SAID LOT 98, A
DISTANCE OF 70.48 FEET;
THENCE S56°25' 16"W, A DISTANCE OF 5.18 FEET TO THE POINT OF BEGINNING.
AS SHOWN ON EXHIBIT "B" ATTACHED HERETO AND BY THIS REFERENCE MADE
A PART HEREOF.
SAID PARCEL "A" CONTAINS 18,981 SQUARE FEET MORE OR LESS.
THIS DOCUMENT WAS PREPARED
BY ME OR UNDER MY DIRECTION
BASED ON RECORD INFORMATION
LO D W. _WA T5ON, RCE 26662
z.. 2alg
DATE
PAGE 1 OF 2
about:blank 3/14/2019
Document-6879880-Page-5 Page 1 of 1
DOC #2019-0086840 Page 5 of 7
ElXIIIBIT "A"
LOT LINE ADJUSTMENT NO.2018-0005
PARCEL `B"
LOT 98 OF AMENDMENT NO.3, TRACT NO.31681-3, AS SHOWN BY MAP ON FILE IN
BOOK 452 OF MAPS, AT PAGES 39 THROUGH 53, INCLUSIVE, RECORDS OF
RIVERSIDE COUNTY, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE
OF CALIFORNIA, AND ADJUSTED BY LOT LINE ADJUSTMENT NO.2017-0002,
RECORDED SEPTEMBER 21, 2017, AS DOCUMENT NO.2017-0392729, OFFICIAL
RECORDS OF RIVERSIDE COUNTY.
TOGETHER WITH THAT PORTION OF LOT 97 OF SAID TRACT NO.31681-3, MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE MOST EASTERLY CORNER OF SAID LOT 98, SAID CORNER
ALSO BEING THE MOST NORTHERLY CORNER OF LOT "Z" OF SAID TRACT;
THENCE N480 43' 19"W ALONG THE NORTHEASTERLY LINE OF SAID LOT 98 AND
THE' SOUTHWESTERLY LINE OF LOT 97 OF SAID TRACT, A DISTANCE OF 72.05
FEET TO A POINT ON A NON -TANGENT CURVE CONCAVE SOUTHEASTERLY,
HAVING A RADIUS OF 195.00 FEET, WITH A BEGINNING RADIAL OF N19° 16' 38"W;
THENCE NORTHEASTERLY ALONG SAID CURVE THROUGH A CENTRAL ANGLE OF
01° 42' 05", AN ARC'LENGTH OF 5.79 FEET;
THENCE S48° 43' 19"E, PARALLEL WITH AND 5.00 FEET DISTANT THEREFROM,
MEASURED AT RIGHT ANGLES, THE NORTHEASTERLY LINE OF SAID LOT 98, A
DISTANCE OF 70.48 FEET;
THENCE S56°25' 16"W, A DISTANCE OF 5.18 FEET TO THE POINT OF BEGINNING.
AS SHOWN ON EXHIBIT `B" ATTACHED HERETO AND BY THIS REFERENCE MADE
A PART HEREOF.
SAID PARCEL `B" CONTAINS 16,351 SQUARE FEET MORE OR LESS.
THIS DOCUMENT WAS PREPARED
BY ME OR UNDER MY DIRECTION
BASED ON RECORD INFORMATION
W. WATSON, RCE 26662
J S
DAT
PAGE 2 OF 2
about:blank 3/14/2019
Document-6 879 8 8 0-P age-6
Page 1 of 1
DOC #2019-0086840 Page 6 of 7
EXHIBIT „B„ SHEET 1 OF 2 SHEETS
LOT LINE ADJUSTMENT NO.2018-0005
LOT 97 & LOT 98 OF AMENDMENT NO.3, TRACT NO.31681-3
K2iV'i
CENTER SECTION
LINE, SECTION 27
I
l
l
0 4i16' 6007 8-10' 1200' 160T
SCALE: 1" = 400'
(IN FEET)
aij it U �) 00 WCl E NI U U NI E g W U U11 U PREPARED UNDER THE SUPERVISION OF:
f CIVIL ENGINEERING • LAND PLANNING�r- 9
I 48-725 VERBENA ROAD r/Z 3IaPi
PALM DESERT, CA92280 LLO D W. WATSON DATP
ph: (m) 27daim P.E. 26662
EXP. 3/31/20
about:blank 3/14/2019
Document- 6879880-Page-7
Page 1 of 1
LEGEND
DOC #2019-0086840 Page 7 of 7
EXH 1 B IT "'Ell'
LOT LINE ADJUSTMENT NO.2018-0005
LOT 97 & LOT 95 OF AMENDMENT NO.3, TRACT NO.31681-3
N 19°L ff]nR3
L C2�
-----EXISTING LOT LINE TO BE ADJUSTED
EXISTING LOT LINE TO REMAIN
ADJUSTED LOT LINE
SEE DETAIL
IN 19°16'�'mll
i 1 ra_ /
�95 G �
. I
••l
� �,
10'PUBLIC
Nr st, EASEMENT
CENTER SECTION
777100
I
LA 217-0002 REC
9/21/2017 AS DOC #
217-0392729, O.R.
5 12°1.4:54"EL),
N 41 PRc IIW� i 1
C3 "% \
N 17°34'33"W1R1�
ti296. \
SHEET 2 OF 2 SHEETS
20' DRAINAGE,Y' ti '
EASEMENT DETAIL
SCALE: 1 "=20'
a �
96
'° TRACT 31681-3
L5 p2 MS 452/39-53
LOT 97
�'sy\ PARCEL "A"
APN 764-680-014
18,981 SF
UTILITYUBLIC
EASEMENT
C6
Q
III
l
a 50, 90' 120' 180' 240'
SCALE: 1" = 60'
(IN FEET)
CURVE TABLE
CURVE
DELTA
RADIUS
LENGTH
TANGENT
Cl
86°47'23"
30.00,
45.44'
28.36'
C2
1°14'47"
195.00'
4.24'
2.12'
C3
2°56'52"
195.00'
10.03'
5.02'
C4
19°05'21"
1*95.00,
64.97'
32.79'
C5
13°45'42"
141.00'
33.87'
17.02'
C6
71°13'51"
25.00'
31.08'
17.91'
C7
20°4726"
195.00'
70.76'
35.77'
C8
01 °42'05"
195.00'
5.79'
LINE DATA
COURSEI
BEARING
LENGTH
L1
N 48°43'19"W
72.05'
L2
N 69°28'35"E
20.00'
L3
S 48°43'19"E
70.48'
L4
S 60°02'50"W
76.22'
L5
S 56°25'16"W
1 5.18'
about:blank 3/14/2019
Recorder
PETER ALDANA P.O. Box 751
COUNTY OF RIVERSIDE Riverside, CA 92502-0751
ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000
Website: www.riversideaer.enm
DOCUMENTARY TRANSFER TAX AFFIDAVIT
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.
ASSESSOR'S PARCEL NO. 764 --680 --014 I declare that the documentary transfer tax for this
Property Address: 81552..jRnnda la n4 4Pnta C'A 9}7753 transaction is: $
If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below.
I CLAIM THAT THIS TRANSACTIONIS EXEMPT FROMDOCUMENTARY TRANSFER TAX BECAUSE. (The
Sections listed below are taken from the Revenue and Taxation Code with the exception of items 9 and IO which are taken
from Riverside County Ordinance 5I6). Please check one or explain in "Other'.
1. Section 11911.
2. Section 11911.
3. Section 11921.
4. Section 11922.
5. Section 11925.
6. Section 11926.
7. _Section 11927
8. Section 11930
9. Section 8.
10. Section 9.
11. _Other
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.
The conveyance transfers to a revocable living trust by the grantor or from a revocable living
trust to a beneficiary.
The conveyance was given to secure a debt.
The conveyance is to a governmental entity or political subdivision.
The transfer is between individuals and a legal entity or partnership, or between
legal entities and does not change the proportional interests held.
The conveyance is to a grantee who is the foreclosing beneficiary and the consideration paid by
the foreclosing beneficiary does not exceed the unpaid debt.
The conveyance relates to a dissolution of marriage or legal separation.
(A spouse must sign a written recital in order to claim this exemption. This form may be used for that purpose.)
The 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) may be required to
file Form 709 (Federal Gift Tax Return) with the Internal Revenue Service.
The easement is =Lperpetual, permanent, or for life.
The document is a lease for a term of jgiLthan (35) years (including written options.)
(Include explanation and legal authority) Ftnih land n ner�grRR_ that hnfh_f0 S 2r�
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
I uted this
Dhil Cmi4h
dayof ��` �' L'—�"` 41— , 20I_
U City State
���
Signature or Af t Printed Name of Affiant
,IMC SP 1 C]
Name of Finn (if ;fpplicable) Address of iant (including City, State, and Zip Cade)
For Recorder's Use:
7607977997
Telephone Number of Affiaut (including area code)
This form is subject to the California Public Records Act (Government Code 6250 et. seq.)
Affix PCOR Label Here
if
ACR S21 (Rev. 11/2014) Available in Alternate Formats
BOE-502-A(P1) REV 13 (06-17)
PRELIMINARY CHANGE OF OWNERSHIP REPORT PETER ALDANA, COUNTY OF RIVERSIDE
ASSESSOR -COUNTY CLERK -RECORDER
To be completed by the transferee (buyer) prior to a transfer of subject PO BOX 751, RIVERSIDE, CA 92502-0751
property, in accordance with section 480.3 of the Revenue and Taxation (951) 955-0400 www.riversideacr.com
Cade. 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.
FOR ASSESSOR'S USE ONLY
AStESSOITS PARCEL NUMBER
+mrI jr e, L-,9U-G
SELLERrrRANSFEROR
7%O 77-7 /77
BUYER'S DAYTIME TELEPHONE NUMBER
A 51) Lrk5Q_ fin c�0 ha*'r✓1ai4,Lo.y
L I BUYER'S EMAIL AD RESS
STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY A
l S 5
This property is intended as my principal residence. If YES, lease indicate the date of occupancyMo DAY IYEAR
❑ YES �J�10 P P Y P P
I/ or intended occupancy.
❑ YES NO Are you a disabled veteran or a unmarried surviving spouse of a disabled veteran who was
`f compensated at 100% by the Department of Veterans Affairs?
MAIL PROPERTY TAX INFORMATION TO (NAME)
f. �. Df''�
STATE ZIP CODE
MAIL PROPERTY TAX INFORMATION TO (ADDRESS) CITY
C"r �oe
,I r.0 5 L� ��QK '�� ZL,;- 3
PART 1. TRANSFER INFORMATION Please complete all statements.
This section contains possible exclusions from reassessment for certain types of transfers.
YES NO
❑ . This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.).
❑ L 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 parent(s) and child(ren) ❑ from grandparent(s) to grandchild(ren).
❑ Rr.$. This transfer is the result of a cotenant's death. Date of death
❑ �E. This transaction is to replace a principal residence owned by a person 55 years of age or older.
Within the same county? [—]YES I-11 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
❑ [�rG. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage).
If YES, please explain:
❑ Z`�H. The recorded document creates, terminates, or reconveys a lender's interest in the property.
❑ 2 ' 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: — --
❑ 2--J' The recorded document substitutes a trustee of a trust, mortgage, or other similar document.
K. This is a transfer of property:
❑ ?r— 1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of
❑ the transferor, and/or ❑ the transferor's spouse ❑ registered domestic partner.
❑ 2. to/from an irrevocable trust for the benefit of the
❑ 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.
❑ [?1'1M- This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) 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, or restrictions
imposed by specified nonprofit corporations.
❑ Ell. 0. This transfer is to the first purchaser of a new building containing an active solar energy system.
❑ ❑ P. Other. This transfer is to !v) v \1 r P (- I + r ^' " i- I q C -%- cc cc(SS J e
* Please refer to the instructions for Part 1. A o Af 04 + 1 a 1 e fje , h i e5c e 1.r t t3-c
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. 13 (06-17)
PART 2. OTHER TRANSFER INFORMATION Check and complete as applicable.
A. Date of transfer, if other than recording date:
B. Type of transfer:
❑ Purchase ❑ Foreclosure ❑ Gift ❑ Trade or exchange ❑ Merger, stock, or partnership acquisition (Form BOE-100-13)
L� 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 (i cluding written optio``7s] Remaining term in years (including written options).
Other. Please explain: La.k LNR a -ti- pa f
C. Only a partial interest in the property was transferred. ❑YES VNO If YES, indicate the percentage transferred %
PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable.
A. Total purchase price I $
B. Cash down payment or value of trade or exchange excluding closing costs Amount $
C. First deed of trust @ % interest for years. Monthly payment $ Amount $
❑ FHA (Discount Points) I . Cal -Vet ❑ VA (_Discount Points) ❑ Fixed rate ❑ Variable rate
❑ Bank/savings & Loan/Credit Union ❑ Loan carried by seller
❑ Balloon payment ,$ Due date:
D. Second deed of trust @ % interest for years. Monthly payment $ Amount $
❑ Fixed rate ❑ Variable rate ❑ Bank/Savings & Loan/Credit Union ❑ Loan carried by seller
❑ Balloon payment $ _ Due date:
E. Was an Improvement Bond or other public financing assumed by the buyer? YES f❑NO Outstanding balance $
F. Amount, if any, of real estate commission fees paid by the buyer which are not Includedlin the purchase price $
G. The property was purchased: ❑Through real estate broker. Broker name: Phone number: k
❑ Direct from seller ❑ From a family member -Relationship
❑ Other. Please 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
A. Type of property transferred
Check and complete as applicable.
Single-family residence �_ Co-op/Own-your-own L.I Manufactured home
Multiple -family residence. Number of units: Condominium C Unimproved lot
Otrr. Desc►Iption: (i.e., mtler, mineral, water rights, etc.) �_ Timeshare Commercial/Industrial
V�s
r�-'
B. [—]YES NO Personal/business property, or incentives, provided by seller to buyer are included! n 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 of the personal/business property: $ Incentives $
C. ❑YES �4NO A manufactured home is included in the purchase price.
If YES, enter the value attributed to the manufactured home: $
[]YES gNO The manufactured home is subject to local property tax. If NO, enter decal number:
D. ❑YES � NO The property produces rental or other income.
If YES, the income is from: ❑ Leaselrent ❑ Contract ❑ Mineral rights ❑ Other:
E. The condition of the property at the time of sale was: ZGood [—]Average [—]Fair [—]Poor
Please describe:
CERTIFICATION
I certify (or declare) that the foregoing and all information hereon, including any accompanying statements or documents, is true and correct to
the best of my knowledge and belief.
SIGNATURE 9UYER �RAOR CORPTpt OFFICER DATE TELEPHONE
NAM F RANSFERE PERSONAL REP RESENTAMVEMOR ORATE OFFICER (PLEASE PRINT) TILT D EMAILADDRESS
I1/d "� (13 Vref Ir�S �PP�C � ix a ,rkscr�.�cl,��
The Assessor's office may contact you for additional information regarding this transaction.
Gt a! fit•r� ;orv�P �otij