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LLA 2017-0003 Lot KDocument -4160170 -Page -1 Page 1 of 1 THIS AREA FOR. RECORDERS. USE. -ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION about:blank 10/18/2017 DOC # 2017-0432101 1.0/18/2017 09:08 AM Fees: $55.00 Page 1 of 11 Recorded in Official Records County of Riverside PLEASE COMPLETE THIS INFORMATION Peter 'Aidana Assessor -County Clerk -Recorder RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: "This document was electronically submitted CITY OF LA QUINTA to the County of Riverside for recording" Attn: CITY CLERK DEPT Receipted by: MARY #880 78-495 Calle Tampico La Quinta, CA 92253 SPACE ABOVE FOR RECORDER'S USE ONLY GRANT DEED LLA 2017-0003 APN 767-900-0.20 THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS- $ CITY TAX IS $ 0 8corriputed on full value of property conveyed, or computed on full value less value of liens or encum4rances remaining at time of sale, —]Unincorporated area:[ 5�Cfty of La Quinta THIS AREA FOR. RECORDERS. USE. -ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION about:blank 10/18/2017 Order No. Escrow No. Loan No. WHEN RECORDED MAIL TO: DOCUMENTARY TRANSFER TAX $ USE SPACE ABOVE FOR RECORDER'S USE ONLY Computed on the consideration or value of property conveyed; OR Computed on the consideration or value less liens or encumbrances remaining at the time of sale determining tax—Firm Name APN 767-900-020 GRANT DEED LLA 2017 - 0003 signature o declarant or Agent FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, The Madison Club Owners AI?I�ROVED BY CITY OF LA QUINTA Association, a California Non-profit Mutual Benefit Corp. Br n McKinney, P.E. Interim City Engineer RCE 49418 Hereby GRANT(S) to Mark L. Wagner and Debra E. Wagner, Trustees of the Wag Irrev Trust dated 01/01/2015. The real property in the City of LA QUINTA, County of RIVERSIDE, State of CALIFORNIA, described as That portion of Lot K per Tract No. 33076-2, otherwise known as Parcel B TOGETHER WITH that portion of Lot 0 per Tract No. 33076-1, being overlaid by the reconfigured shape of Parcel A pursuant to LLA 2017-0003 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 2017-0003 as approved by the City of La Quinta. 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 V OVA � WaU,On October 16, 2017 before me,, 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. WITNESS my hand and official seal. mo A RADEVA public - California Riverside County /)A 1 14 o fission # 21.68979 Signature �'' Comm. ices Oat 22, 2020 (seal) MONIKA RADEVA Notary Public - California Riverside County F Commission # 2168979 n DOCUMENT: GRANT DEED LLA 2017-0003 re: APN 767-900-020 - owner(s): THE MADISON CLUB OWNERS ASSOCIATION 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 On before me, Notary Public Pea ! pp�ar Who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) ogre subscribed to the within instrument and acknowledged to me that lie''/she/they executed the same in iisber/their authorized capacity(ies), and that by&?/her their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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. WITNESS my hand and official seal. SigrNWOVA, Aw�I� MAIL TAX STATEMENTS TO: The Madison Club Owners Association, A California Non-profit M.utua Benefit Corp. AMANDA TESSANDORE Notary Pupk - California RIYMIido Cournfy ComtrN W" 0 2063337 AI Comm. Ex ROS Dec 26, 201 7 Place Notary Seal Above EXHIBIT "A LOT LINE ADJUSTMENT NO. 2017-0003 _ RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER MARK L. WAGNER & DEBRA E. WAGNER, LOT 36 767-690-028 Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, LOT K 767-690-043 a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, LOT O 767-900-020. a California Nonprofit Mutual Benefit Corp. ADJUSTED LOT 36, TRACT NO. 33076-2 SHEET 1 OF 4 PARCEL A LOT 36 OF TRACT NO. 33076-2, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA AS SHOWN ON MAP FILED IN BOOK 393, PAGES 61 THROUGH 80, OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY, TOGETHER WITH THAT PORTION OF LOT K OF SAID TRACT N0, 33076-2, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHWESTERLY TERMINUS OF THE EASTERLY BOUNDARY LINE OF SAID LOT 36 BEING N 26'34'41"E 262.83 FEET PER TRACT NO. 33076-2; THENCE SOUTH 32°5923" EAST 11.60 FEET TO A PARALLEL LINE LYING 10.00 FEET SOUTHEASTERLY OF SAID EASTERLY BOUNDARY LINE, THENCE ALONG SAID PARALLEL LINE NORTH 26'J4'41" EAST 288.07 FEET TO THE NORTHERLY BOUNDARY LINE OF SAID LOT K AND THE BEGINNING OF A NON—TANGENT CURVE WITH A RADIUS OF 236.00 FEET AND A RADIAL LINE BEARING NORTH 21°17'17" EAST; THENCE WESTERLY ALONG SAID CURVE 10.07 FEET THROUGH A CENTRAL ANGLE OF 02°2637';• THENCE ALONG THE EASTERLY BOUNDARY OF SAID LOT 36 SOUTH 26°34'41 " WEST 262.83 FEET TO THE POINT OF BEGINNING. TOGETHER WITH THAT PORTION OF LOT 0 OF TRACT NO. 33076-1,,. IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA AS SHOWN ON MAP FILED IN BOOK 388, PAGES 57 THROUGH 79, OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHWESTERLY TERMINUS OF THE EASTERLY BOUNDARY LINE OF SAID LOT 36 BEING N 26°34'41 "E 262.83 FEET PER TRACT 33076-2, 1N THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN ON MAP FILED IN BOOK 393, PAGES 61 THROUGH 80, OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY; THENCE SOUTH 32°5923" EAST 11.60 FEET TO A PARALLEL LINE 10.00 FEET SOUTHEASTERLY OF SAID EASTERLY i (CONTINUED ON SHEET 2) EXHI BI T "A " LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER - _ .. .... MARK L. WAGNER & DEBRA E. WAGNER, LOT 36 767-690-028 Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, LOT K 767-690-043 a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 767-900-020 a California Nonprofit Mutual Benefit Corp. ........ -- -- - ADJUSTED LOT 36, TRACT NO. 33076-2 (CONTINUED) SHEET 2 OF 4 PARCEL A (CONTINUED) BOUNDARY LINE; THENCE ALONG THE SOUTHWESTERLY PROLONGATION OF SAID PARALLEL LINE SOUTH 26°34'41 " WEST 18.22 FEET TO A PARALLEL LINE 25.00 FEET SOUTHERLY OF THE SOUTHERLY BOUNDARY LINE OF SAID LOT 36; THENCE ALONG SAID PARALLEL LINE SOUTH 77°27'31 " WEST 110.71 FEET TO THE SOUTHWESTERLY PROLONGATION OF THE WESTERLY BOUNDARY LINE OF SAID LOT 36; THENCE ALONG SAID PROLONGATION NORTH 20°4639" EAST 29.92 FEET TO SAID SOUTHERLY BOUNDARY LINE; THENCE ALONG SAID SOUTHERLY LINE NORTH 77°27'31 " EAST 101.72 FEET TO THE POINT OF BE.CINNINC. THE ABOVE DESCRIBED PARCEL A CONTAINS 32,242 SQUARE FEET OR 0.740, MORE OR LESS ADJUSTED LOT K, TRACT NO. 33076-2 PARCEL B LOT K OF TRACT NO. 33076-2, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA AS SHOWN ON MAP FILED IN BOOK 393, PAGES 61 THROUGH 80, OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY; - EXCEPTING THEREFROM THAT PORTION BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS; BEGINNING AT THE SOUTHWESTERLY TERMINUS OF THE EASTERLY BOUNDARY LINE OF LOT 36 BEING N 26°34'41 "E 262.83 FEET ON SAID TRACT NO. 33076-2; THENCE SOUTH 32°59'23" EAST 11.60 FEET TO A PARALLEL LINE LYING 10.00 FEET SOUTHEASTERLY OF SAID EASTERLY BOUNDARY LINE; THENCE ALONG SAID PARALLEL LINE NORTH 26°34'41 " EAST 288.07 FEET TO THE NORTHERLY BOUNDARY LINE OF SAID LOT K AND THE BEGINNING OF A NON—TANGENT CURVE WITH A RADIUS OF 236.00 FEET AND A RADIAL LINE BEARING NORTH 21°17'17" EAST; THENCE WESTERLY ALONG SAID CURVE 10.07 FEET THROUGH A CENTRAL ANGLE OF 02°26'37'; THENCE ALONG THE EASTERLY BOUNDARY OF SAID LOT 36 SOUTH 26°34'41 " WEST 262.83 FEET TO THE POINT OF BEGINNING. THE ABOVE DESCRIBED PARCEL CONTAINS 0.86 ACRES, MORE OR LESS. EXHIBIT "A" LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ... _...... — MARK L. WAGNER & DEBRA E. WAGNER, Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, a California Nonprofit Mutual Benefit Corp. ADJUSTED LOT 0, PARCEL C LOT 36 LOT K LOT 0 TRACT NO. 33076-1 ASSESOR PARCEL NUMBER 767-690-028 767-690-043 767-900-020 SHEET 3 OF 4 LOT 0 OF TRACT N0, 33076-1, IN THE CITY OF LA QUINTA, COUNTY .OF RIVERSIDE, STATE OF CALIFORNIA AS SHOWN ON MAP FILED IN BOOK 388, PAGES 57 THROUGH 79, OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY; EXCEPTING THEREFROM THOSE PORTIONS DESCRIBED IN THE GRANT DEEDS RECORDED, AUGUST 13, 2009, AS INSTRUMENT NO. 2009-07422834 AND MAY 18, 2015, AS INSTRUMENT N0. 2015-0206137, BOTH OF OFFICIAL RECORDS. ALSO EXCEPTING THEREFROM THAT PORTION DESCRIBED IN LOT LINE ADJUSTMENT 2010-507 RECORDED JANUARY 14, 2011, AS INSTRUMENT N0, 2011-0020159, OFFICIAL RECORDS. ALSO EXCEPTING THEREFROM THAT PORTION BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS; BEGINNING AT THE SOUTHWESTERLY TERMINUS OF THE EASTERLY BOUNDARY LINE OF SAID LOT 36 BEING N 26°34'41 "E 262.83 FEET PER TRACT 33076-2, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN ON MAP FILED IN BOOK 393, PAGES 61 THROUGH 80, OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY; THENCE SOUTH 32°59'23" EAST 11.60 FEET TO A PARALLEL LINE 10.00 FEET SOUTHEASTERLY OF SAID EASTERLY BOUNDARY LINE, THENCE ALONG THE SOUTHWESTERLY PROLONGATION OF SAID PARALLEL LINE SOUTH 26°34'41 " WEST 18.22 FEET TO A PARALLEL LINE 25.00 FEET SOUTHERLY OF THE SOUTHERLY BOUNDARY LINE OF SAID LOT 36; THENCE ALONG SAID PARALLEL LINE SOUTH 77°27'31 " WEST 110.71 FEET TO THE SOUTHWESTERLY PROLONGATION OF THE WESTERLY BOUNDARY LINE OF SAID LOT 36; THENCE ALONG SAID PROLONGATION NORTH 20°46'39" EAST 29.92 FEET TO SAID SOUTHERLY BOUNDARY LINE, THENCE ALONG SAID SOUTHERLY LINE NORTH 77'27'31" EAST 101.72 FEET TO THE POINT OF BEGINNING. EXHIBIT "A" LOT UNE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER MARK L. WAGNER & DEBRA E. WAGNER, LOT 36 767-690-028 Trustees of The Wag Irrev Trust LOT K 767-690-043 THE MADISON CLUB OWNERS ASSOCIATION, a California Nonprofit Mutual Benefit Corp. THE . MADISON CLUB OWNERS ASSOCIATION, LOT 0 767-900-020 a California Nonprofit Mutual Benefit Corp. LL ADJUSTED LOT 0, TRACT NO. 33076-1 SHEET 4 OF 4 PARCEL C (CONTINUED) ALL SHOWN ON EXHIBIT "B" ATTACHED HERETO AND MADE A PART HEREOF, THE REAL PROPERTY DESCRIBED HEREIN HAS BEEN PREPARED BY ME, OR UNDER MY DIRECTION, IN CONFORMANCE WITH THE PROFESSIONAL LAND SURVEYORS ACT. �- LAN6 s STEVEN 4P7, No. 7627 cn OF ALD STEVEN LANTIS DATE H- CA� L.S. 7627 EXPIRES Q/31/16 EXHIBIT "B" LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER 767-690-028 MARK L. WAGNER & DEBRA E. WAGNER, LOT 36 Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, LOT K 767-690-043 California Nonprofit Mutual Benefit Corgi _a THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 767-900-020 a California Nonprofit Mutual Benefit Corp. LEGEND SHEET 1 OF 3 NEW LOT LINE (XXX) INDICATES RECORD DATA PER TRACT SEE SHEETS 2 & 3 - - - LOT LINE TO BE REMOVED NO. 33076-2, MB 393/61-80 FOR EASEMENTS LOT LINE TO REMAIN �taRNA�E �E�) C2 l � (d=28'29 43" CE.,�� G I I R=236.00' L=117.37)LLJ TRACT NO. 33076 - 2 ��`°/ / ''�•:; / PARCEL "A*49 32,242 SQ. FF.. g (0.740 ACRES) LOT 35 1 A.P.N. 767-690-028 LLA 12015-0001 LOT 36 °� /�� ��M.B. 393 / 61 - 80 O.R. 2015-0206137 ,ate PARCEL "B" E'LY BOUNDARY �le" LOT 36 0.86 ACRES 3 E I r 7-r i 0 09-- o, P.O.B. A.P.N. 767-690-043 �y oPARCEL B do C /LOT ti,�o, o l� �N� 1 2F�'° X07 3s �� 5'LY 900NDAR . r�Np � -61 EVEN GP �S 7'21'34[J•i• CJD I r r �j � f S) 101.72' r \� N No. 7627 `. COURSE DATA .� s3 „ E 110.71 C1 6=2'26'37" (R=236.00') L=10.07' N 77.27F C2 A=30'56'20" (R=236.00') L=127.4 0 PARCEL "C" PREPARE BY: LOT 0 A.P.N. 767-900-020 TRACT NO. 33076-1DA ERALD ST[o LANTIS DATE A4. B. 388 / 57 - 79 L.S. 7627 EXPIRES 12/31/16 EXHIBIT "B" LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER MARK L. WAGNER & DEBRA E. WAGNER, LOT 36 767-690-028 Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, LOT K 767-690-043 a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 767-900-020 a California Nonprofit Mutual Benefit Corp. SHEET 2 OF 3 SEE SHEET 3 FOR EASEMENT & ENCUMBRANCE DETAIL _ _ A Ifo \ A TRACT NO. 33076 — 2 Q —�� � SLOT 35 \ LLA12015-0001 � PARCEL "a M.B. 393 / 61 — 80 (VACANT SITE) PARCEL 'B" \ (LANDSCAPE LOT) LA&D S $1 EVEN Goy x No. 7627 70 Q- F PARCEL 'C' CAS LOT 0 (GOLF COURSE) PREPARED Y: TRACT NO. 33076-1 M. B. 388 / 57 — 79 ERALD S E LANTIS DATE L.S. 7627 EXPIRES 12/31/18 EXHIBIT "B" LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER MARK L. WAGNER & DEBRA E. WAGNER, Trustees of The Wag Irrev Trust LOT 36 767-690-028 THE MADISON CLUB OWNERS ASSOCIATION, LOT K 767-690-043 a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 767-900-020 a California Nonprofit Mutual Benefit Corp. SHEET 3 OF 3 M EASEMENT / ENCUMBRANCE DETAIL INDICATES AN EASEMENT FOR PUBLIC UTILITY PURPOSES IN FAVOR OF THE CITY OF LA QUINTA DEDICATED ON TRACT MAP NO. 33076-2, M.B. 393/61-80. 2� INDICATES AN EASEMENT • FOR UTILITY PURPOSES IN FAVOR OF THE IMPERIAL IRRIGATION DISTRICT DEDICATED ON TRACT MAP NO. 33076-2, M.B. 393/61-80. INDICATES AN EASEMENT FOR LANDSCAPE AND DRAINAGE PURPOSES RESERVED ON TRACT MAP NO. 33076-2, M.B. 393/61-80. (VARIABLE WIDTH) 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. 767 650 026 ASSESSOR'S PARCEL NO. 77677 -- W o -- a o _ I declare that the dockmentary transfer tax for this Property Address: Meriwpther 1Nay I a Q, ilnta Ca transaction is: $ ,�' 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 BECA USE. (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 1191 1. The consideration or value of the property, exclusive of any liens and encumbrances is PETER ALDANA Recorder The conveyance transfers to a revocable living trust by the grantor or from a revocable living trust to a beneficiary. P,O. Box 751 The conveyance was given to secure a debt. 4. Section 11922. COUNTY OF RIVERSIDE Riverside, CA 92502-0751 �lr ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000 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. w. Website: wwriversideacr_com wax DOCUMENTARY TRANSFER TAX AFFIDAVIT 8. Section 11930. 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. 767 650 026 ASSESSOR'S PARCEL NO. 77677 -- W o -- a o _ I declare that the dockmentary transfer tax for this Property Address: Meriwpther 1Nay I a Q, ilnta Ca transaction is: $ ,�' 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 BECA USE. (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 1191 1. The consideration or value of the property, exclusive of any liens and encumbrances is For Recorder's Use: This form is subject to the California Public Records Act (Government Code 6250 et. seq.) Affix PCOR Label Here ACR 521 (Rev. 11/2014) Available in Alternate Formats $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 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. Section 8. The easement is perpetual, permanent, or for life. 10. Section 9. The document is a lease for a term of jg&than (35) years (including written options.) 11. Other (Include explanation and legal authority) A I_ of Line A& iSItmentsiihmitted to the eity -""rota-depict ng, -L0"6 and podions of I of K and 1 --of Cl DPNc iaheie i ahmm I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TR UE AND CORRECT. NV ` , Q '3 6 W /VV L'cu� ted this• 9 [1 .day of 220_a__ at 1 � IJ ({its GIJQ .Iry . r. cityte �iusfe� In 41 A 1r- szr_as�re-s Part,1 aya Sipnature of Affiant rint ame of Affiant !r n❑ n -M1� dr of Cant (in&tduig City. State, and 7_ip Co c) O Name of Firm (if applicable) -22J.o--�g) Telephone Number ofAftiant (including area eodt-.) For Recorder's Use: This form is subject to the California Public Records Act (Government Code 6250 et. seq.) 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) F -� Mark L. Wagner & Debra E. Wagner, Trustees of the Wag Irrev. Trust 1609 Milano Villa Avenue Henderson, NV 89052 L J STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY 52577 Meriwether Way, La Quinta CA 92253 MAIL PROPERTY TAX INFORMATION TO (NAME) Mark Wagner 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 767-690-028, 767-690-043, 767-900-020 SELLERITRANSFEROR The Madison Club Owners Association BUYER'S DAYTIME TELEPHONE NUMBER ( 516 ) 526-7807 BUYER'S EMAILADDRESS mwagner@exitllc.com DORE§ CITY STATE I ZIP CODE 1609 Milano Villa Avenue Henderson NV 89052 ❑YES 7 N ............................... This property is intended as my principal residence. If YES, please indicate the date of occupancy MO DAY YEAR or intended occupancy. 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.). ❑ ❑✓ B. This transfer is solely between domestic partners currently registered with the California Secretary of State (arlriilion or removal of a partner, death of a partner, termination settlement, etc.). ❑ 0 * C. This is a transfer., ❑ between parent(s) and child(ren) ❑ From grandparent(s) to grandchild(ren). ❑ I ✓I. * D. This transfer is the result of a cotenant's death. Date of death ❑ * E. This transaction is to re=place a principal residence by a person 55 years of age or older Within the same county? [—I 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 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: ❑ ✓y J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. K. This is a transfer of property: ❑ F 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. ❑ P-1 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. ❑ L,J 3. 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. ❑ Q L. This property is subject to a lease with a remaining lease term of 35 years or more including written options. ❑ 0 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. ❑ 0 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. * 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: Check and complete as applicable. ❑ 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: Lot line adjustmentC. 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 A. Total purchase price Check and complete as applicable. $0 Amount $ 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 ❑ 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 $ ❑ Fixed rate ❑ Variable rate ❑ Bank/Savings & Loan/Credit Union ❑ Loan carried by seller Balloon payment $ Due date: Amount Amount E. Was an Improvement Bond or other public financing assumed by the buyer? LYES ❑ 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: ❑ 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 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 Fj(] Unimproved lot ❑ Other. Description: (i.e., timber, mineral, water rights, etc.)1. Timeshare [] Commercial/Industrial B. ❑YES❑ NO Personal/business property, or incentives, provi dcd by seller to buyer are included in the purchase price. Examples of personal property are furniture, farm equipment, machines y, etc. Examples of Incentives are club memberships, etc.Attach list if available. If YES, enter the value of the personal/business property: $ C. ❑YES ✓❑ NO A manufactured home is included in the purchase price. If YES, enter the value attributed to the manufactured home: $ E]YES E NO The manufactured home is subject to local property tax. If NO, enter decal number: D. ❑YES 0 NO The property produces rental or other income. If YES, the income is from: ❑ Lease/rent ❑ Contract ❑ Mineral rights ❑ Other: Incentives $ E. The condition of the property at the time of sale was: []Good ❑Average ❑ Fair ❑ Poor Please describe: n/a CERTIFICATION 1 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. SIGN F BUYE 8 EE OR COR }TATE OFFICER DAT TELEPHONE �„LA h - 516 ) 526-7807 NAME -OF BUYEWTRANSFEREEILE AL REPRESENTATIVErCORP ATE OFFICER (PLEASE PRINT) TITLE EMAILADDRESS — .. -.. W6 lateti I k U. 4n-js,kp S mwagner@exitllc.com The Assessor's office may contact you for additional information regarding this transaction.