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PM 2017-0001Document -3085656 -Page -1 RECORDING REQUESTED BY CITY OF LA QUINTA When recorded, return to: CITY OF LA QUINTA CITY CLERK 78-495 CALLE TAMPICO LA QUINTA, CA. 92253 Page 1 of 1 THIS AREA FOR RECORDER'S USE ONLY DOC # 2017-0144285 04/11/2017 12:34 PM Fees: $0.00 Page 1 of 5 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: SONIA #751 CERTIFICATE OF PARCEL MERGER NO. 2017-0001 RECORD OWNERS EXISTING PARCELS (Assessor Parcel Numbers) Hicks Family Trust dated APN 777-390-001 November 3, 2004 Hicks Family Trust dated APN 777-390-002 November 3, 2004 LEGAL DESCRIPTION OF MERGED PARCELS See attached - Exhibit "A" and Exhibit "B" SIGNATURE(S) OF RECORDED 4 •y f (Must be Notarized) Print Nemo/7711e; Brent S. Hicks, Trustee sjpna, r'I —" n , Print Name/Pie: Jorja D. Hicks, Trustee ,r° rV' r s ,pg��/� Brent S. Hicks, Trustee Print Name?Ile: Sf fra' i !_ _ �� �f T C. snalure- "i, a CQ ice/ `- � PrintNam,fl5 Jorja D. Hicks, Trustee This ertiflcate of Parcel erger reflects Parcel Merger N. 0 -0001 as approved by the City of La Quinta. Date: 4/5-)17 by R. Jonas on, .E Public Works Director/ City Engineer, R.C.E. No. 45843 NOTARY ACKNOWLEDGEMENT 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 j1 ) COUNTY OF CIt'U t.R`c 1 oke, ) On R F<tt 5i L011- before me, 14Ots7 A \...th ►V -II .Q,i� � yy 10' u 1 u.N b (are) T, V\ 0 +�k R , O�Q.5GO� (Name and Tfle of officer) personally appeared 1 who proved to me on the basis within instrument and acknowledged and that by his/her/their signature(s) acted, executed the instrument. I certify under PENALTY OF correct. WITNESS myhan• and offldi-1 y _ * r !iv /peN. (Name(s) ofsigner(s)) of satisfactory evidence to be the person(s) to me that he/she/they executed the same on the instrument the person(s), or the PERJURY under the laws of the Sate of Calif seal {SEAL} z i_ whose name(s) is/are subscribed in his/her/their authorized capacity(ies), entity upon behalf of which the �. aris.icrtrue N{% AREA a Notary Public - California Riverside County ►lr Commission *2168979 ! F T _ My Comm.Eaptrus Oct 22202o to the person(s) and i[[[ ar Public about:blank 4/11/2017 RECORDING REQUESTED BY CITY OF LA QUINTA When recorded, return to: CITY OF LA QUINTA CITY CLERK 78-495 CALLE TAMPICO LA QUINTA, CA. 92253 THIS AREA FOR RECORDER'S USE ONLY CERTIFICATE OF PARCEL MERGER NO. 2017-0001 RECORD OWNERS EXISTING PARCELS (Assessor Parcel Numbers) Hicks Family Trust dated APN 777-390-001 November 3, 2004 Hicks Family Trust dated APN 777-390-002 November 3, 2004 LEGAL DESCRIPTION OF MERGED PARCELS See attached - Exhibit "A" and Exhibit "B" SIGNATURE(S) OF RECORDED. ¢, , ) (Must be Notarized) PrintName%fije: Brent S. Hicks, Trustee Si�j.na .r��, . . , _ Jorja D. Hicks,Trustee Print Name�tle: � sig � t r ri ��- c PrintName/Title: Brent S. Hicks, Trustee .1401/ 0-1,—,-41. , Print Name/Title: Jorja D. Hicks, Trustee • ,;F v `/� Signature: This Gertifigate of Parcel g erger reflects Parcel Merger No20 -0001 as approved by the City of La Quinta. r Date: 4 rsl 1 r ii ►.hy R. Jonas on, .I 1, Public Works Director/ City Engineer, R.C.E. No. 45843 STATE COUNTY On personally who within and acted, I correct.'.,� WITNESS NOTARY ACKNOWLEDGEMENT 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 OF CALIFORNIA ) OF \V E'.'�.$ l AL ) f � � RA, 5 I 2..011- before me, \"I Ot�i t \LR 4aQX � O \-at 11 U e (Date) ` (Name and Tilie of officer) l appeared 1 o'rl o sc 9S010, , proved to me on the basis instrument and acknowledged that by his/her/their signature(s) executed the instrument. certify under PENALTY OF my hanr and offici-1 f of satisfactory evidence to me that he/she/they on the instrument PERJURY under the laws seal _ (Name(s) of signer(s)) to be the person(s) whose name(s) is/are subscribed executed the same in his/her/their authorized capacity(ies), the person(s), or the entity upon behalf of which the person(s) of the Sate of Calif i■wlWlw NIK�ADEI�A '�. Notary Public - California fi Riverside Countyz 2 "r'► Commission 0 2168979 "''' M Comm. Expires Oct 22, 2020 to the true and n No ar! Public CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT ice• ¢: 't:vi�a- ,,15ac, t.rt CIVIL CODE § 1189 - P.�. +: n•. y 4/sCZr1LYc": 5�.'. ra(VV..:-.4 h< '4+a •©{ i 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 8 loatsi On halm-( .2, 2011 1 Date personally appeared ) before me, f.?,,1 rr''Ltalc Here Insert Name and Title of the Officer ajdq Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the -son' whose nameijlare- sub oribed to the within instrument and acknowled s . d to me that h sileLthey executed the same in their authorized capacity(iJ s), and that b hie 4r''i%.'/their signature on the instrument the person(, or the entity upon behalf of whictr the person( j acted, executed the i strument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. D. JANE LOPEZ Commission # 2099617 z '• a Notary Public - California § 'Ir Riverside County › Signature N - ,da v T.M Comm. Expires Mar 5, 2019 Signature of No !ny Pus/ic WITNESS my hand and official seal. Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document _ Title or Type of Document: :went Date: Number of Pages: Signer(s) Other Than NAbove: Capacity(ies) Claimed by Signer(s) Signer's Name: _ ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ Gen ❑ Individual ❑ Attorne ❑ Trustee ❑ Gua ❑ Other: Signer Is Representin Fact an or Conservator 'La irLr�G 'sn,iti7.4' .V 3WS Pri-L,.•rl.+°u5•41, °rr,'n, Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 wt.. l • IN. wi✓iie�YciW'ktits4N.VT,., t\ s.• sem` 2 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 Ii1014 On h f1 before me, hi..teMiipo.. 14 't .i 44 BU - Date p r_ Here Insert Name and Title of the Officer personally appeared D L t -r-11 �i 1•'T?L.i'5 Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person whose nameiXa+ee• - bscribed to the within instrument and ackno dged to me that Ys�p executed the same bi /heI authorized capacityi s), and that b /her - ,eir signature( on the instrument the person , or the entity upon behalf of which the person( acted, executed the i strument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. O. JANE LOPEZ ramik.samiwws."46+-1.4.-+A-ima Commission # 2099617 z ;-., ..,;S Notary Public - California v 7 - Riverside County My Cwr•'n rx;,Gi s Mar 5, 2019 Place Notary Seal Above WITNESS my hand and official seal. Signature OPTIONAL Signature Lc� Though this section is optional, completing this information can deter alteration of the docu or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Doenr t Date: Number of Pages: Signer(s) Other Than Named Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in d-ct ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representin ve: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited E General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: .v,41✓V.•{. ae 4:h - h:.0 rs4 uq f �!4'ff •nli. 2541U •%: FY4 4Ld4it!:`LP515'iiIJA ..`, N.`_.� :.S A' ?4., ayM..'s`✓:''moi '.h+f-'J4•t..9C ©2014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 EXHIBIT "A" LEGAL DESCRIPTION CERTIFICATE OF PARCEL MERGER 2017-0001 PARCEL "A" That certain parcel of land located in the City of La Quinta, County of Riverside, State of California, being Lots 39 and 40 of Tract No. 29494-3 as shown by a map on file in Book 351, Pages 35 through 48, inclusive, of Maps, Records of said County, more particularly described as a whole as follows: BEGINNING at the northwest corner of said Lot 39; Thence along the northerly line of said Lot 39 and Lot 40 North 73°41'37" East a distance of 151.73 feet to the beginning of a tangent curve, concave northwesterly, having a radius of 607.50 feet; Thence continuing along the northerly line of said Lot 40 and northeasterly along said curve through a central angle of 07°33'49" an arc distance of 80.20 feet to the northeast corner of said Lot 40; Thence non -tangent from said curve along the easterly line of said Lot 40 South 10°38'28" West a distance of 225.11 feet to the southeast corner of said Lot 40; Thence along the southerly line of said Lot 40 North 80°03'08" West a distance of 69.91 feet to the southerly corner common to said Lots 39 and 40; Thence along the southerly line of said Lot 39 South 83°18'41" West a distance of 70.12 feet to the southwest corner of said Lot 39; Thence along the westerly line of said Lot 39 North 15°29'56" West a distance of 152.76 feet to the POINT OF BEGINNING. CONTAINING: 31,918 Square Feet (0.73 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. This Certificate of Parcel Merger reflects Parcel Merger No. 2017-0001, as approved by the City of La Quinta. This legal description was prepared by me or under my direction. Benjamin Daniel Egan, PLS 8756 Prepared: March 23, 2017 _1741/0/(7 Page 1 of 1 1A QUINTA EXHIBIT "B" LA AIENUE 52 PLAT AVENUE 54 VICINITY MAP Vkkti 20 0 40 80 rn LEGEND: () EXISTING LOT LINE DELETED LOT LINE BOUNDARY OF PARCEL DENOTES RECORD DATA PER MB 351/35-48 P.O.B. NW CORNER LOT 39 SCALE: 1"=40' PARCEL "A" 31,918± SQUARE FEET 0.73± ACRES (LOT 39) (TRACT 29494-3) (MB 351/35-48) 583.18'41 W 70.12 O'd.L' �/ig' (LOT 40) (TRACT 29494-3) (MB 351/35-48) N80 °19,3'O8" W 69.9 1 esj CO PO 0 w J U SHEET 1 OF 1 CERTIFICATE OF PARCEL MERGER 2017-0001 PREPARED BY: BENJAMIN DANIEL EGAN, PLS LS 8756 DATE: 3/23/2017 PETER ALDANA COUNTY OF RIVERSIDE ASSESSOR -COUNTY CLERK -RECORDER DOCUMENTARY TRANSFER TAX AFFIDAVIT Recorder P.O. Box 751 Riverside, CA 92502-0751 (951)486-7000 Website: www.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. ASSESSOR'S PARCEL NO. 777 —390 --002 Property Address: 80957 Via Pessaro La Quirtta, CA 92253 I declare that the documentary transfer tax for this transaction is: $ 0 . 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. 11921. The conveyance was given to secure a debt. 4. 11922. The conveyance is to a governmental entity or political subdivision. 5. 11925. The transfer is between individuals and a legal entity or partnership, or between legal entities and does not change the proportional interests held. 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. 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.) 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 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. 9. The easement is natperpetual, permanent, or for life. 10. The document is a lease for a term of Athan (35) years (including written options.) 11. (Include explanation and legal authority) Section Section ✓ Section 6. Section 7. Section 8. Section Section 8. Section 9. Other I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. N/A day of March , 2017 at La CJ Name of Firm (if applicable) Brent S Hicks Printed Name of AITan Address of Affiant (inch (503)417-6677 1 e!ephone Number of A This form is subject to the California Public Records Act (( u1(01l1 tate uue 0250 et. seq.) For Recorder's Use: Affix PCOR Label Here ACR 521 (Rev. 11/2014) Available in Alternate Formats BOE-502-A(P1) REV. 12 (05-13) PRELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the 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 MAILING ADDRESS OF BUYER/TRANSFEREE (Make necessary corrections to the printed name and mailing address) ✓ L PETER ALDANA, COUNTY OF RIVERSIDE ASSESSOR - COUNTY CLERK - RECORDER PO BOX 751, RIVERSIDE, CA 92502-0751 (951) 955-0400 www riversideacr com • ASSESSOR'S PARCEL NUMBER 777-390-001 SELLER/TRANSFEROR Hicks Family Trust BUYER'S DAYTIME TELEPHONE NUMBER ( 503) 407-6677 J BUYER'S EMAIL ADDRESS STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY 80925 Via Pessaro, La Quinta, CA 92253 MAIL PROPERTY TAX INFORMATION TO (NAME) Brent Hicks ADDRESS 80209 Via Capri brent@focuspointsolutions.com CITY La Quinta STATE ZIP CODE CA 92253 YES ✓ NO This property is intended as my principal residence. If YES, p ease indicate the date of occupancy or intended occupancy. MO DAY YEAR PART 1. TRANSFER INFORMATION Please complete all statements. This section contains possible exclusions from reassessment for certain types of transfers. YES NO ✓ A. This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.). I✓I 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: LI between parent(s) and child(ren) from grandparent(s) to grandchild(ren). * D. This transfer is the result of a cotenant's death. Date of death I� I trJ * E. This transaction is to replace a principal residence by a person 55 years of age or older. Within the same county? YES NO ✓I �✓ * 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 name(s) of the person(s) 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. ✓❑ 1. 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: ElJ. 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 may be revoked by the transferor and is for the benefit of Elthe transferor, and/or the transferor's spouse n registered domestic partner. 2. to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint tenant, and which names the other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies. 3. to/from an irrevocable trust for the benefit of the n creator/grantor/trustor and/or grantor's/trustor's spouse n 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 transferor(s) and transferee(s) in each and every parcel being transferred remain exactly the same after the transfer. 2 Ri N. This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions. �✓ ✓ *0 This transfer is to the first purchaser of a new building containing an active solar energy system. * Please refer to the instructions for Part 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 (05-13) 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 11 Merger, stock, or partnership acquisition (Form BOE -100-B) ✓ WI Contract of sale. Date of contract: ❑✓ Inheritance. Date of death: ❑✓ Sale/leaseback ✓ Creation of a lease ✓ Assignment of a lease n Termination of a lease. Date lease began: Ori final term in years (including written options): Remaining term in years (including written options): Other. Please explain: Marcel Merger C. Only a partial interest in the property was transferred. YES NO PART 3. PURCHASE PRICE AND TERMS OF SALE A. Total purchase price If YES, indicate the percentage transferred: Check and complete as applicable. B. Cash down payment or value of trade or exchange excluding closing costs $o Amount $ C. First deed of trust @ % interest for years. Monthly payment $ Amount $ n FHA (_Discount Points) 1 Cal -Vet VA (_Discount Points) Fixed rate Variable rate n Bank/Savings & Loan/Credit Union In Loan carried by seller Balloon payment $ Due date: D. Second deed of trust @ % interest foryears. Monthly payment $ Amount $ n Fixed rate 1 Variable rate n Bank/Savings & Loan/Credit Union n Loan carried by seller Balloon payment $ Due date: E. Was an Improvement Bond or other public financing assumed by the buyer? YES I I NO Outstanding balance $ F. Amount, if any, of real estate commission fees paid by the buyer which are not included in the purchase price $ G. The property was purchased: (Through real estate broker. Broker name: Phone number: ( n Direct from seller From a family member -Relationship n 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 T Co-op/Own-your-own n Manufactured home jMultiple-family residence. Number of units: ❑ Condominium I✓I Unimproved lot n Other. Description: (i.e., timber, mineral, water rights, etc.) 0 Timeshare Commercial/Industrial B. p YESI✓✓-I 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 of the personal/business property: $ Incentives $ C. nYES rsiI NO A manufactured home is included in the purchase price. If YES, enter the value attributed to the manufactured home: $ nYES n NO 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: n Lease/rent CI Contract I I Mineral rights n Other: E The condition of the property at the time of sale was: (Good nAverage nFair Please describe: n Poor 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 OF BUY 10. OR CORPORATE OFFICER NAME OF 0 - ANS ER E/LEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) DATE J-2-Zc, 7 TITLE Brent S. Hicks Trustee TELEPHONE ( 503) 407-6677 EMAIL ADDRESS rent@focuspointsolutions.coi The Assessor's office may contact you for additional information regarding this transaction. BOE -502-A (P1) REV. 12 (05-13) PRELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the 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 MAILING ADDRESS OF BUYER/TRANSFEREE (Make necessary corrections to the printed name and mailing address) r L PETER ALDANA, COUNTY OF RIVERSIDE ASSESSOR - COUNTY CLERK - RECORDER PO BOX 751, RIVERSIDE, CA 92502-0751 (951) 955-0400 www.riversideacr com • ASSESSOR'S PARCEL NUMBER 777-390-002 SELLER/TRANSFEROR Hicks Family Trust BUYER'S DAYTIME TELEPHONE NUMBER ( 503) 407-6677 ▪ BUYER'S EMAIL ADDRESS brent@focuspointsoIutions.com STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY 80957 Via Pessaro, La Quinta, CA 92253 MAIL PROPERTY TAX INFORMATION TO (NAME) Brent Hicks ADDRESS 80209 Via Capri CITY La Quinta STATE ZIP CODE CA 92253 k YES Q NO This property is intended as my principal residence. If YES, please indicate the date of occupancy or intended occupancy. MO DAY YEAR PART 1. TRANSFER INFORMATION Please complete all statements. This section contains possible exclusions from reassessment for certain types of transfers. YES NO 1✓I n✓ 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.). I" 1 * C. This is a transfer: between parent(s) and child(ren) n from grandparent(s) 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 resirience by a person 55 years of age or older. Within the same county? n 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? n YES NO G 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: 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 may be revoked by the transferor and is for the benefit of nthe transferor, and/or n 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 tenant, and which names the other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies. 3. to/from an irrevocable trust for the benefit of the creatorlgrantorltrustor and/or _ ggrmr lor's/trustor's spouse n grantor'sltrustor'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 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. 1✓1 u El WIn✓ * O. This transfer is to the first purchaser of a new building containing an active solar energy system. * Please refer to the instructions for Part 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 (05-13) PART 2. OTHER TRANSFER INFORMATION A. Date of transfer, if other than recording date B. Type of transfer: ✓ Purchase Foreclosure 1,? -1 Gift ./ Trade or exchange Contract of sale. Date of contract: Check and complete as applicable. Merger, stock, or partnership acquisition (Form BOE -100-B) Inheritance. Date of death: Sale/leaseback n Creation of a lease ✓ Assignment of a lease n Termination of a lease. Date lease began: Original term in years (including written options): Remaining term in years (including written options): n✓ Other. Please explain: Parcel Mercier C. Only a partial interest in the property was transferred. I✓IYES ✓ NO If YES, indicate the percentage transferred: PART 3. PURCHASE PRICE AND TERMS OF SALE A. Total purchase price B. Cash down payment or value of trade or exchange excluding closing costs C. First deed of trust @ % interest for years. Monthly payment $ ❑ FHA ( Discount Points) Cal -Vet n VA ( Discount Points) I Fixed rate C n Loan carried by seller Balloon payment $ Due date: D. Second deed of trust @ % interest for years. Monthly payment $ Check and complete as applicable. n Bank/Savings & Loan/Credit Union Variable rate Ok $0 Amount $ Amount $ Amount $ I Fixed rate ❑ Variable rate I I Bank/Savings & Loan/Credit Union n Loan carried by seller nBalloon payment $ Due date: 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 $ G. The property was purchased: nThrough real estate broker. Broker name: Phone number: ( I I Direct from seller I 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 ❑ Single-family residence 7 Co-op/Own-your-own I I Manufactured home © Multiple -family residence. Number of units: n Condominium n Unimproved lot n Other. Description: (i.e., timber, mineral, water rights, etc.) I1 Timeshare Commercial/Industrial Check and complete as applicable. 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 of the personal/business property: $ Incentives $ C. nYES I I NO A manufactured home is included in the purchase price. If YES, enter the value attributed to the manufactured home: $ ✓ YES I✓I NO The manufactured home is subject to local property tax. If NO, enter decal number: D. ✓YES WINO The property produces rental or other income. If YES, the income is from: n Lease/rent n Contract n Mineral rights ❑ Other: E. The condition of the property at the time of sale was: n Good Average Il Fair Please describe: Poor 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 OF 'AfJ REE OR OFFICER DATE TELEPHONE /' - ZO / 503 407-6677 NAME OF •' ER(TRANSfEREEJLEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE EMAIL ADDRESS Trustee ,rent@focuspaintsolutions.col The Assessor's office may contact you for additional information regarding this transaction. Brent S. Hicks