2018 Sunridge Properties, Inc - Escrow Docs MiscYEAR
CALIFORNIA FORM
2018 Real Estate Withholding Certificate
Part I — Seller/Transferor Informations
Name
City of La Quinta, a California Municipal Corporation
Spouse's/RDP's name (if jointly owned)
Address aptJ te., room, PO Box, or FMB no.)
I �� CID W, n r� o
City (If you have a foreign address, see instructio s`.) State
AD Oic* CA
593-C
Return this form to your escrow company
SSNNo—or ITIN
SS�
�)— ?i-1%__0 �1
Spouse's/RDP's SSN or ITIN�ointly owned)
Zip Code
! FEIN _� CA Corp. no. E CA SOS file. no.
Ownership Percentage
% IM
Property address if no street a dress, provide parcel number and county)
A portion of 79523-79567 Highway III , La Quinta, CA 92253
To certify that you qualify for a fall or partial withholding exemption, check all boxes that apply to tho property being sold or transferred. (See Instructions)
Part II - Certifications which fully exempt the sale from withholding:
1 The property qualifies as the seller's/ transferor's (or decedent's, if sold by the decedent's estate or trust) principal residence within the
meaning of Internal Revenue Code (IRC) Section 121
The seller/transferor (or decedent, if sold by the decedent's estate or trust) last used the property as the sellers/ transferor's
2. _I (decedent's) principal residence within the meaning of IRC Section 121 without regard to the two-year time period.
The seller/transferor has a loss or zero gain for California income tax purposes on this sale. To check this box you must complete Form
3. ^ I 593-E, Real Estate Withholding -Computation of Estimated Gain or Loss, and have a loss or zero gain on line 16.
The property is being compulsorily or involuntarily converted and the seller/transferor intends to acquire property that is similar or related
4. in service or use to qualify for nonrecognition of gain for California income tax purposes under IRC Section 1033.
The transfer qualifies for nonrecognition treatment under IRC Section 351 (transfer to a corporation controlled by the transferor) or IRC
5. ❑ Section 721 (contribution to a partnership in exchange for a partnership interest).
The seller/transferor is a corporation (or a limited liability company (LLC) classified as a corporation for federal and California income tax
6. t-I purposes) that is either qualified through the California Secretary of State (SOS) or has a permanent place of business in California.
7 The seller/transferor is a California partnership or a partnership qualified to do business in California (or an LLC that is classified as a
partnership for federal and California income tax purposes and is not a single member LLC that is disregarded for federal and California
income tax purposes).
8. The seller/transferor is a tax-exempt entity under California or federal law.
The seller/transferor is an insurance company, individual retirement account, qualified pension/profit sharing plan, or charitable
9. i remainder trust.
Part III - Certifications that may partially or fully exempt the sale from withholding:
Real Estate Escrow Person (REEP): See instructions for amounts to withhold
10. F1 The transfer qualifies as a simultaneous like -kind exchange within the meaning of IRC Section 1031.
11. p The transfer qualifies as a deferred like -kind exchange within the meaning of IRC Section 1031.
The transfer of this property is an installment sale where the buyeritransferee is required to withhold on the principal portion of each
12. El installment payment. Copies of Form 593-I, Real Estate Withholding installment Sale Acknowledgement, and the promissory note are
attached.
Seller/Transferor Signature
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 and search for 1131 To request this notice by mail, call 800.852.5711
Under penalties of perjury, I declare that I have examined the information on this form, including accompanying schedules and statements, and to
the best of my knowledge and belief, it is true, correct and complete. I further declare under penalties of perjury that if the facts upon which this
form are based change, I will promptly notify the REEP. 11 �'--��,�,
Seller's/Transferor's Name and Title, ee s 1 1 • C. , +roeller's/Transferor's Signal Datei�4 I
L +''I . - F rV; 6
Spouse's/RDP's Name Spouse's/RDP's Signature Date
Seller/ If you checked any box in Part II, you are exempt from real estate withholding.
Transferor If you checked any box in Part III, you may qualify for a partial or complete withholding exemption.
Except as to an installment sale, if the seller/transferor did not check any box in Part II or Part III of Form 593-C, the withholding will be
3 1/3% (.0333) of the total sales price or the optional gain on sale withholding amount from line 5 of Form 593, Real Estate
Withholding Tax Statement. If the seller/transferor does not return the completed Form 593 and Form 593-C by the close of the real
estate transaction, the withholding will be 3 1/3% (.0333) of the total sales price, unless the type of transaction is an installment sale.
If the transaction is an installment sale, the withholding will be 3 1/3% (.0333) of the down payment
If you are withheld upon, the REEP should give you one copy of Form 593. Attach a copy to the lower front of your California income
tax return and make a copy for your records.
7131183 I — Form 593-C 2017
YEAR Real Estate Withholding CALIFORNIA FORM
2018 Computation of Estimated Gain or Loss 593-E
(You are required to complete this form if you claim an exemption due to a loss or zero gain or if you elect an optional gain on sale
withholding amount.)
Part I — Seller/Transferor Information
Name S or IT IN
City of La Quinta, a California Municipal Corporation — � L�LL� J �
Spouse's/RDP's name (if jointly owned) Spouse's/RDF3's SSN or rf IN (it jointly owned)
Address (apt./ste., room, PO Box, or PMB no.) D FEIN ' CA Corp. no. a CA SOS file no.
City (If you have a foreign address, see instructions.) State I Zip Code
CA
Property address (if no street address, provide parcel number and county)
A portion of 79523-79567 Highway 111 , La Quinta, CA 92253
Part II - Computation
1 Selling price ......_................. ................ ................................_... ....1 $1.389,564.00
2 Selling expenses ...................... :................................... ................... ........... ................................................................ ..2
3 Amount realized. Subtract line 2 from line 1................................................................................................................3
4 Enter the price you paid to purchase the property (If you acquired the property other than by purchase,
see instructions, How to Figure Your Basis).................................................................................................. 4
5 Seller/Transferor-Paid points .................—.....................................................................5 ........................
6 Depreciation ............... ..................................... ......................... .......... ............................ 6
7 Other decreases to basis................................................................................................7
8 Total decreases to basis. Add line 5 through line 7................................................ ................ .......................
8
9 Subtract line 8 from line 4................ .......................... ........... ---- .... --- ....................... ........................... 9
10 Cost of additions and improvements...............................................................................10
11 Other increases to basis................................................................_................................11
12 Total increases to basis. Add line 10 and line 11..............................................................................................12
13 Adjusted basis. Add line 9 and line 12..._........................................................................................_...............13
14 Enter any suspended passive activity losses from this property ------------ ........ :.......... .......................................... 14
15 Add line 13 and line 14...........................................................................................................................................................15
16 Estimated gain or loss on sale. Subtract line 15 from line 3 and enter the amount here. If you have a loss or zero gain,
skip lines 17 and 18. Complete the Seller/Transferor Signature area below and check the box on Form 593-C, Real
Estate Withholding Certificate, Part II line 3. If you have a gain, go to line 17...........................................................................16
17 Optional gain on sale withholding amount Check the applicable box for the filing type.
[ ] Individual 12.3% [ ] Corporation 8.84% [ ] Bank and Financial Corporation 10.84%
[ ] Non -California Partnership 12.3% [ ] S Corporation 13.8% [ ] Financial S Corporation 15.8%
Multiply the amount on line 16 by the tax rate for the filing type selected above and enter the result on line 17. This is the optional gain on sale
withholding amount. If you elect the optional gain on sale withholding amount on line 17, get Form 593, Real Estate Withholding Tax Statement,
and check the appropriate box on line 4 (Boxes B-G) for the Optional Gain on Sale Election, and transfer the amount on line 17 to Form 593, line
5. Sign Form 593 to certify the election ................ ............... —......... —....... --- ..... —..... ............ -- ....... — ... — ....... ....... ..... . 17
18 Total sales price withholding amount. Multiply the selling price on line 1 by 3 1/3% (.0333) and enter the amount on line 18.
This is the total sales price withholding amount.
If you select the total sales price withholding amount on line 18, check Box A "3 1/3% (.0333) x Total Sales Price" on line 4 of
Form 593, and transfer the amount on line 18 to Form 593, line 5.................. ....—................................................................ -..18
Seller/Transferor Signature
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 and search for 1131. To request this notice by mail, call 800.852.5711
Under penalties of perjury, I declare that I have examined the information on this form, including accompanying schedules and statements, and to
the best of my knowledge and belief, it is true, correct, and complete. I further declare under penaltie of ry that if the facts upon which this
form are based change, I will promptly notify the Real Estate Escrow Person (REEP).
Seller's/Transferor's Name . iA--A CYYn: r. Seller's/Transferor's Sign DatUAA AV
It is unlawful to forge Spouse's/RDP's Name (if jointly owned) U el
a spouse's/RDP's
signature. Spouse's/RDP's Signature (if jointly owned) Date:
7151183 r— Form 593-E 2017
51351 Avenida Bermudas, La Quinta, CA 92253
Phone (760) 564-4044 Fax (760) 771-2999
AUTHORIZATION TO EXPEDITE ESCROW
RE: A portion of 79523-79567 Highway 111, La Quinta, CA 92253 ESCROW NO: FS2566
In order to proceed with the above referenced escrow, we need the following information about your property. PLEASE COMPLETE.
SIGN, AND RETURN this form to our office as soon as possible.
FIRST LOAN: Name of Lender 11�1cAr
Loan Number: Approximate unpaid balance
Phone Number: Is your loan impounded? Yes No (circle one)
SSN:
SECOND LOAN: Name of Lender
Loan Number: Approximate unpaid balance
Is this a line of credit? Yes No (circle one)_ Phone Number
If your property is affected located within a Homeowner's Association please complete the following:
Name of Association
Name of Management Company
Account No
Phone No.
Amount of Dues $
We, the undersigned, certify that the above information is true and correct to the best of our knowledge and
hereby for the purpose of expediting the escrow process, hereby authorize Four Seasons Escrow, Inc. to obtain
pertinent information regarding any liens and encumbrances and HOA information on the subject property.
• Request(s) for the demand for the payment of any encumbrance in connection with the above referenced escrow.
• Request(s)/Instruction to close, freeze or terminate a Home Equity Line of Credit.
• HOA Authorization for release of HOA documents.
• I/we give our permission to Four Seasons Escrow, Inc. to speak on my/our behalf and obtain any pertinent
information in connection with this escrow.
We are aware that we will be provided with copies of any payoff demands ordered/received on our behalf and that any
HOA documents ordered will be provided direct to the buyer.
A
a Q inta, ifornia Municipal Corporation
y: rank J. pevacek
Its: City Manager
TO EXPEDITE THE PROCESSING OF YOUR ESCROW, PLEASE COMPLETE, SIGN AND IF
POSSIBLE, FAX TO ESCROW AS SOON AS POSSIBLE. FAX NUMBER: (760) 771-2999
Recorder
PETER ALDANA P.O. Box 751
COUNTY OF RIVERSIDE Riverside, CA 92502-0751
ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000
Website: www.dversideacr.com
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. 600-020-053 1 declare that the documentary transfer tax for
Property Address: A portion of 79523-79567 Highway 111 , La Quinta, this transaction is: $
CA 92253
If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below.
I CLAIM THAT THIS TRANSACTION IS EXEMPT FROM DOCUMENTARY TRANSFER TAX BECAUSE: (The
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 partnership, or between legal entities, and
does not change the proportional interests held.
6. Section 11926.
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.
7. Section 11927.
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.)
8. Section 11930.
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
give 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.
9. Section 8.
The easement is not perpetual, permanent, or for life.
10. Section 9.
The document is a lease for a term of less than (35) years (including written options.)
11. Other
(Include explanation and legal authority)
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOR�E1GOIN IS TRUE AND CORRECT.
JExectedthis day of 20 -M at cam. � tCity State
of t Printed Name of Affiant
C � '"-1� � i 4 [�� "�'�D car. it.€7 (CL G L�, C )
Name of F it (if ap 'cable) Addre s of Affiant (including City, State, and Zip Code
—1 U0 — -I�'1— )C)30
Telephone Number of Affiant (including area code)
This form is subject to the California Public Records Act (Government Code 6250 et. seq.)
For Recorder's Use:
Affix PCOR Label Here
ACR 521 (Rev 11/2014) Available in Alternative Formats
FOUR SEASONS ESCROW, INC.
Information to assist Sellers in the completion of
the 1099-S Certification and 1099-S Input Form
To comply with IRS regulations, requiring reporting of the sale or exchange of Real Property, follow the instructions below:
Step 1
Each Seller must complete a 1099-S Certification form (Husband and Wife must each complete a separate form).
Step 2
A) If all questions are answered "True or Yes" on the 1099-S Certification, return the completed and signed form to your
Escrow officer. DO NOT complete the 1099-S Input Form. No additional steps are required.
B) If you answered "False or No" to any question on the 1099-S Certification, continue to Step 3.
Step 3
Each seller who does not answer "True/Yes" to all questions on the 1099-S Certification form, must complete and
sign the attached 1099-S Input form. Return the completed 1099-S Input Form to your escrow officer.
Husband and wife filing joint returns need only complete one 1099 Input Form (and one percentage allocation of 100%).
TRUSTS: Trusts are not automatically exempt from receiving 1099s. If the Trust has not been issued it's own Tax I.D.
number then each trustee must complete the form with the social security number to be used and the name, as it appears on
tax return, with the percentage allocation for each trustee. If the Trust has it's own TIN then enter the Trust Tax I.D. number
and the legal name as it appears on the tax return.
ESTATES: If using the decedent's social security to file tax return, then use the decedents name. If the Estate has been
issued it's own TIN, then use Estate of John Smith and the TIN assigned to that Estate name.
CONSERVATORSHIP& If a Minor, use the Name and social security number assigned to that minor. If an Elder, use
the Elder's name and social security number that the tax return will be filed under.
PARTNERSHIPS/LLC (Limited Liability Company): Are not automatically exempt. The name and tax I.D. number for the
partnership, one 1099 will be issued to one partner. (If volume transferor please provide documentation.)
Corporations, Non -profits, government entities, 1031 Exchanges, Refinance, Bankruptcy, Deed in Lieu of
Foreclosure, Bulk Sales and Volume Transferors (more than 25 transactions per year) are automatically
exempt.
The IRS wants the social security number that was assigned to the name (as it appears on IRS
IRS records) that will be filing the tax return reporting the sale of this property in this escrow
transaction.
(In some cases this may not be the same name as the Seller(s) on the Grant Deed. i.e. Decedents cannot convey property. Trusts cannot
convey property.)
ALL SELLERS - COMPLETE THE 1099-S CERTIFICATION
COMPLETE THE 1099-S INPUT FORM - ONLY IF APPLICABLE
1099-S CERTIFICATION
FOR 1099-S REPORTING ON THE SALE OF A PRINCIPAL RESIDENCE
This form may be completed by each seller of a principal residence to determine if no Form 1099-S information reporting
is required to be made to the Internal Revenue Service. In order to qualify for this exemption each seller. includina
husband and wife sellers. must sign a separate form answering "TRUE" to all the required questions. If all questions
are not answered "TRUE" on this form, this form is not needed and the seller(s) must fill out a 1099-S Input Form.
ESCROW NO. FS2566
Date Escrow Closed
SELLER ASSURANCES:
Check "TRUE" or "FALSE" for each of the following assurances set forth below:
During the 5-year period ending on the closing date of this escrow, I owned and used this property as my principal
residence for at least 2 years. TRUE 0 FALSE G
I have not sold or exchanged another principal residence during the 2 year period ending o the closing date of
this escrow (not taking into account any sale or exchange prior to May, 7, 1997. TRUE UF FALSE 0
No portion of the propertypas been used for business or rental purposes by me (or my spouse, if married) since
May 6, 1997. TRUE 0 FALSE ❑
Is at least one statement below True??
1. The sale or exchange of the property includes the entire residence, and the sales price or valuation is
$250,000 or less.
2. 1 am married and the sale or exchange of the property includes the entire residence and the sales price or
valuation is $500,000 or less, and (A) I intend to file a separate tax return for the year of the sale or
exchange, (B) The gain on the sale or exchange of the entire residence is $250,000 or less.
3. 1 am married and the sale or exchange of the property includes the entire residence, and the sales price or
valuation is $500,000 or less, and (A) I intend to file a joint return for the year of the sale or exchange, (B) my
spouse also used the residence as his/her principal residence for at least 2 years during the 5 year period
ending on the closing date of this escrow, and (C) my spouse also has not sold or exchanged another
principal residence during the 2 year period ending on the closing date of this escrow (not taking into account
any sale or exchange prior to May 7, 1997).
4. During the 5 year period ending on the date of sale or exchange the Seller did not acquire the residence in a
1031 tax deferred exchange.
5. If the Seller's basis in the residence was passed on from a person who acquired the residence as a part of a
1031 tax deferred exchange, the exchange took place more than 5 years before the current sale of the
Seller's residence.
At least one of the above TRUE ❑ All of the above FALSE
NOTE TO SELLER; IF YOU ANSWERED "TRUE" TO EACH OF THE ABOVE QUESTIONS YOU DO NOT HAVE
TO COMPLETE THE 1099-S INPUT FORM.
Does this property involve a 1031 Tax Deferred Exchange: YES ❑ NO
If YES, please complete 1099-S Input Form.
"UNDER PENALTY OF PERJURY, 1 CERTIFY THAT ALL OF THE ABOVE INFORMATION IS TRUE AS OF THE END OF THE CLOSING DATE OF
THE SALE OR EXCHANGE." T tal Sale rice $ 1,389,564.00
SELLER SIGNAT;JR PRINT NAME HERE: JN-r -\V.
PROPERTY ADD SS: A po n of 9523-79567 Highway 111 , La Quinta, CA 92253
Note to SELLER:
This form does NOT need to be completed if all questions on the 1099-S CERTIFICATION FORM are answered
"True". If the property involves a 1031 Tax Deferred Exchange, PLEASE COMPLETE THIS FORM.
FOUR SEASONS ESCROW, INC.
1099-S INPUT FORM
Company Number Office Number Type Escrow Number Actual Closing Date
❑Add ❑Change ❑Delete FS2566
SUBJECT PROPERTY INFORMATION
STREET ADDRESS OR BRIEF FORM OF LEGAL DESCRIPTION (FOR VACANT LAND, USE APN, COUNTY AND STATE)
A portion of 79523-79567 Highway 111
CITY STATE ZIP CODE
La Quinta CA 92253
TRANSACTION DATA
CONTRACT SALES PRICE
No. OF 1099-S
2 OR MORE 1099
BUYERS PART OF
CONTINGENT
EXCHANGE
forms
FORMS - S
REAL ESTATE TAX
TRANSACTION
(Line 401 of HUD-1 form)
required for
If 2 or more 1099-s
Note: If this is an
the sale of
forms are required for
Show any real
Is this a
Was (or will
exchange, provide total
this property
this transaction,
estate tax, on a
contingent
there be) other
dollar value of cash, notes
record the dollar
residence, charged
transaction
property
and debt relief received by
amount for the seller
to the buyer at
wherein gross
services
this exchanger.
based on the seller's
settlement.
proceeds cannot
received?
declaration
be determined
with certainty at
time of closing?
$ I � {: �J LQ L
$
$
❑ Yes
❑ Yes
SELLER INFORMATION — PLEASE
PRINT CLEARLY
SFULER'S LAST NAME
FIRST NAME
M.I.
SELLER'S FORWARDING STREET ADDRESS
CITY STATE
SELLER'S SOCIAL SECURITY NUMBER
ZIP CODE (or country if not USA)
05)Rj3
SELLER'S TAX IDENTIFICATION NUMBER
OR V — l
You are required by law to provide your closing agent with your Under penalties of perjury, I certify that t e nuer shown above is my
correct Taxpayer Identification Number. If you do not provide your correct Taxpayer Identification Number
closing agent with your correct Taxpayer Identification Number; you
may be subject to civil or criminal penalties imposed by law under th
Tax Reform Act of 106, under Internal Revenue Code Sections
6D45(E), 6670. 672-2. 6723 and 7203. Salle�s Signature Date Signed
TO: Four Seasons Escrow, Inc.
RE: A portion of 79523-79567 Highway 111 , La Quinta, CA 92253 ESCROW NO: FS2566
PROCEEDS / REFUND INSTRUCTIONS
UPON THE CLOSE OF THE ABOVE REFERENCED ESCROW, YOU ARE INSTRUCTED TO DISBURSE ANY FUNDS
DUE THE UNDERSIGNED AS FOLLOWS:
Select One:
() Check for refund will be picked up at your office.
Contact me at the following number when funds are ready:
() Mail check to:
(Your bank may impose a holding period for check clearance)
() Overnight delivery to:
(Charge my account for the cost of overnight delivery)
(. ]� Wire transfer funds to the account of the undersigned:
Bank Name: t`6-Lcc�,�
Address:
Phone No.:
Account No.:����
ABA (routing) No.: c
(Please Note: Your Bank's Wiring ABA number maybedifferent from the routing number on your checks)
Credit to the Account of: a4 i-" Q� lGL Qunia,
(Enter name exactly as it appears on your checks)
() Other instructions (ie: split funds equally between each seller/buyer):
My/our address at close of escrow:
Date
❑ same as subject property
❑ other:
❑ Temporary/Vacation address currently on file
Sunridge Properties, Inc., an Arizona corporation
By: Paul Welker
Its: CEO
nicipal Corporation
SELLER'S AFFIDAVIT
OF NONFOREIGN STATUS
Section 1445 of the Internal Revenue Code provides that a transferee of a U.S. real property interest must
withhold tax if the transferor is a foreign person. To inform the transferee that withholding of tax is not required
upon the disposition of a U.S. real property interest located at A portion of 79523-79567 Highway 111 , La
Quinta, CA 92253 by City of La Quinta, a California Municipal Corporation, (name of transferor), I hereby
certify the following (if an entity transferor, on behalf of the transferor):
(CORPORATION, PARTNERSHIP, TRUST, OR ESTATE TRANSFEROR(S):
1. City of La Quinta, a California Municipal Corporation, is not a foreign corporation, foreign partnership,
foreign trust or foreign estate (as those terms are defined in the Internal Revenue Code and Income Tax
Regulations);
2. City of La Quinta, a California Municipal Corporation U.S. Employer identification number is
- 3-1 3 I
3. City of La Quinta, a California Municipal Corporation office address is
8 14q 5 C bl 1 o Y VN(?-T1MC-n t-0 (p i �-'R "G-6q
Under penalties of perjury, under the laws of the State of California, I declare that I have examined this
certification and to the best of my knowledge and belief, it is true, correct and complete; and, I/we further declare
that I/we have authority to sign this document on behalf of Seller if a corporation, partnership or trust are sales
entities.
CONSULT YOUR ATTORNEY AND/OR TAX ADVISOR — NO REPRESENTATION OR RECOMMENDATION IS
MADE CONCERNING THE LEGAL SUFFICIENCY AND/OR TAX CONSEQUENCES OF THIS DOCUMENT.
YOU MAY BE REQUIRED TO FILE A COPY OF THIS DOCUMENT WITH THE INTERNAL REVENUE SERVICE
OR THE STATE OF CALIFORNIA.
Date: July 2, 2018
City of La Quinta, a rnia Municipal Corporation
)MPLETE THIS FORM IN FULL, SIGN, DATE AND RETURN TO ESCROW
COMPLETE ONE FORM FOR EACH INDIVIDUAL OR ENTITY SELLER
(husband and wife each must complete separate forms)
THIRD PARTY AUTHORIZATION
Escrow No: FS2566
Property Address: A portion of 79523-79567 Highway 111
The undersigned authorizes escrow holder, Four Seasons Escrow, Inc. to releasing any and all
information pertinent to the above referenced transaction in both written and verbal form, as it is
requested or required by this/these additional, authorized parties without further instruction to release.
Company Name:
Contact Person:
Address:
Phone: ( ) Fax: ( y
Relationship to Party of Escrow:
Company Name:
Contact Person:
Address:
Phone: ( 1 Fax: { l
Relationship to Party of Escrow:
A facsimile copy of this document may be accepted as an original.
Date:
SELLERS:
BUYERS:
Municipal Corporation Sunridge Properties, Inc., an Arizona corporation
By: Paul Welker
Its: CEO