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LLA 2017-0003 Parcels B & CDocument -4167354 -Page -1 Page 1 of 1 78-49.6 Celle Tampico• La Quinta, CA 92253 SPACE ABOVE FOR RECORDER'S USE ONLY GRANT DEED LLA 2017-0003 APN 767-690-043 THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $ CITY TAX IS $ 0 ecomputed on full value of property conveyed, or computed.on full value less value of liens or encumbrances remaining at time of sale, QUnincorporated. area:� X ICity of La Quinta THIS AREA FOR RECORDERS USE. ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION about:blank 10/18/2017 DOC # 2017-0433717 10/18/2017 03:56 PM Fees: $55.00 Page 1 of 11 Recorded in Official Records ^.. County of Riverside PLEASE COMPLETE THIS INFORMATION Peter Aldana RECORDING REQUESTED BY Assessor -County Clerk -Recorder 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 78-49.6 Celle Tampico• La Quinta, CA 92253 SPACE ABOVE FOR RECORDER'S USE ONLY GRANT DEED LLA 2017-0003 APN 767-690-043 THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $ CITY TAX IS $ 0 ecomputed on full value of property conveyed, or computed.on full value less value of liens or encumbrances remaining at time of sale, QUnincorporated. area:� X ICity 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: SPACE ABOVE FOR RECORDER'S USE ONLY 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 the time of sale determining tax— Firm Name APN 767-690-043 GRANT DEED LLA 2017 -0003 signature o declarant or Agent FOR VALUABLE CONSIDERATION, receipt of which is g OVLD BY CITY OF LA QUINTA hereby acknowledged, The Madison Club Owners Association, a California Non-profit Mutual Benefit Corp. Brij. n McKinney, P.E. Interim City Engineer RCE 49418 Hereby GRANT(S) to The Madison Club Owners Association, a California Non-profit Mutual Benefit Corp. The real property in the City of LA QUINTA, County of RIVERSIDE, State of CALIFORNIA, described as Parcel B and Parcel C 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 On October 16, 2017 before me, 1Ao\A\ " 4aNOk, ; 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. —Aa;t&* Signature I U DOCUMENT: MONIKA RADEVA Notary Public . Calllornia ��►__ Riverside County z Commission # 2168979 n My Comm. Ex ares Oct 22. 2020 (seal) GRANT DEED LLA 2017-0003 re: APN 767-690-043 - 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 OF1� J On 0(�u\_ �' 1 beforeNota Public P rsonally -ear�� k 1� _ �. Who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) 0/are subscribed to the within instrument a d acknowledged to me thatW/she/they executed the same in O( her/their authorized capacity(ies), and that by IgIher/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. MAIL TAX STATEMENTS TO: The Madison Club Owners Association, A California non-profit mutual b it Corp. _---% eq By: It's: Pr ) j— MI-7� S AMANDATESSANDDRE Notary Public • Cafifo►nir RlWrids County Ila fi0rT11r118614A #F 2063337 111045 D*c 2612017 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 0 767-900-020 a California Nonprofit Mutual Benefit Corp. PARCEL A ADJUSTED LOT 36, TRACT NO. 33076-2 SHEET 1 OF 4 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 NO. 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°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. 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, 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°5923" EAST 11.60 FEET TO A PARALLEL LINE 10.00 FEET SOUTHEASTERLY OF SAID EASTERLY I (CONTINUED ON SHEET 2) EXHIBIT "A " LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS LOT/PARCEL NO. ASSESOR PARCEL NUMBER MARK L. WAGNER & DEBRA E. WAGNER, LOT 36 Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, LOT K a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 a California Nonprofit Mutual Benefit Corp. ADJUSTED LOT 36, TRACT NO. 33076-2 (CONTINUED) PARCEL A (CONTINUED) 767-690-028 767-690-043 767-900-020 SHEET 2 OF 4 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 7727'31" 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. 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, LOT 36 Trustees of The Wag Irrev Trust THE MADISON CLUB OWNERS ASSOCIATION, LOT K a California Nonprofit Mutual Benefit Corp. THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 a California Nonprofit Mutual Benefit Corp. ADJUSTED LOT 0, TRACT NO. 33076-1 PARCEL C ASSESOR PARCEL NUMBEI rl•�II•�'I�II�%•T:� 767-690-043 767-900-020 SHEET 3 OF 4 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, EXCEPTING THEREFROM THOSE PORTIONS DESCRIBED IN THE GRANT DEEDS RECORDED, AUGUST 13, 2009, AS INSTRUMENT NO. 2009-07422834 AND MAY 18, 2015, AS INSTRUMENT NO. 2015-0206137, BOTH OF OFFICIAL RECORDS. ALSO EXCEPTING THEREFROM THAT PORTION DESCRIBED IN LOT LINE ADJUSTMENT 2010-507 RECORDED JANUARY 14, 2011, AS INSTRUMENT NO. 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°5923" 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 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 Corgi THE MADISON CLUB OWNERS ASSOCIATION, LOT 0 767-900-020 a California Nonprofit Mutual Benefit Corp. 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. LA/Vo �,�L S ST EVEN SPG No. 7627 cn �r Ar 8'� f 4 9TH \�o¢� �F I-! ALD STEVEN LANTIS DATE CAS 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. LEGEND SHEET I 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 REMAW C2 �� (4=28'29'43" �j R=236.00' L=117.37) TRACT NO. 33076 - 2 ,el // 'A' PARCEL � 32,242 SQ. FT. �'� /• (0.740 ACRES) 2\ LOT 35 A.P.N. 767-690-028 LLA 12015-0001 LOT 36 ;�� ry M. B. 393 / 61 - 80 PARCEL A h O.R. 2015-0206137 ECRE'SON ` ELY BOUNDARY /Pmc��a O86 LOT 36/` E r '09, 7r 1 O' o, P 0.B A.P.N. 767-690-043 � PARCEL 8 & c LOTK o �vo. yv L L4 ND �6 X65 Ly 5O �+oARV LOT , / " ' `i 5� s� �� g1 EVEN 'iaG 5, W � 1 9 E �S goo} O �� 10172'7 -r — r N ' No. 7627 U' `� 29.92' 18.22 ' COURSE DATA c! p E 11o.71 Cl A=2'26'37" (R=236.00') L=10.07' 7727 31 N C2 A=30'56'20" (R=236.00') L=127.4 Q PARCEL 'C' PREPARE BY. LOT 0 A.P.N. 767-900-020 r TRACT NO. 33076-1ERALO 'STE0 LANTIS DATE M. B. 388 / 57 - 79 L.S. 7627 EXPIRES 12/31/18 EXHIBIT "B" 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 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 2 _ — a TRACT NO. 33076 - 2 J \ U � \ 1 /LOT 35 \ LLA12015-0001 PARCEL 'a" M.B. 393 / 61 - 80 (VACANT SITE) PARCEL 19' \ 1 (LANDSCAPE LOT) 'A/Vo s $1 EVEN No. 7627 0 4 ATF 0 �Fa��• PARCEL "C" F cAO LOT 0 (GOLF COURSE) PREPARED Y. TRACT NO. 33076-1 M. B. 388 / 57 - 79 O-.5K17 ERALD S*VE9 LANTIS DATE L.S. 7627 EXPIRES 12/31/1 @ EXHIBIT "B" LOT LINE ADJUSTMENT NO. 2017-0003 RECORD OWNERS I LOT/PARCEL N0. I ASSESOR PARCEL NUMBER 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. EASEMENT / ENCUMBRANCE DETAIL LOT 36 LOT K LOT 0 767-690-028 767-690-043 767-900-020 SHEET 3 OF 3 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. �i 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) Document -41673 54 -Page -1 sy or•8lVq.� PETER ALDANA COUNTY OF RIVERSIDE ASSESSOR -COUNTY CLERK -RECORDER `r.•� DOCUMENTARY TRANSFER TAX AFFIDAVIT Recorder P.O. Box 751 Riverside, CA 92502-0751 (951)486-7000 .aa. rl,* Page 1 of 1 WARNIl!LG 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 Me 028 ASSESSOR'S PARCEL NO. 767 -- floe -- 3 1 declare that the documentary transfer tax for this Property Address: }�jgrlwethr?r lay La_D.Wnta CH�— transaction is: $ �'' If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below. I CLAIM THAT THIS TRANSACTIONISEXEMPT FROMDOCUMENTARYTRANSFER TAX BECAUSE: (The Sections listed below are taken from the Revenue and Taxation Code with the exception of hems 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. Sectionl.1911. 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. _Section 4. 11922. The conveyance is to a governmental entity or political subdivision. _Section 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. 11926. The conveyance is to a grantee who is the foreclosing beneficiary and the consideration paid by _Section the foreclosing beneficiary does not exceed the unpaid debt. 7. 11927. 'Che conveyance relates to a dissolution of marriage or legal separatio n. _Section (A spouse must sign a written recital in ordor to claim this exemplion. 'Phis form a3. -.y be used for that purpose.) 8. _Section 11930. 'f he conveyance is an inter vivos gift* or a transfer by death. *Please be awn re that Information stated on this document may be given to and used by governmental agencies, Including the Internal Revanua5ervice. AEso, certain gifts In excess orthc annual Federal gift lax exemptlau may triggers FC d0rid Gift'r=- In such cases, the Transferor (do nodgrautor) may be required to file Form 709 (Federal Gift Tax Miura) 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 JuLthan (35) years (including written options.) 11. _Other (Include explanation and legal authority) A Int I inn Adie is mant �i ihmitFr�rf to the rito _", liAta deglGt�[It i Ot . 7 rJRd {]41 lO�Ut K anri I nt_fl _AP1Val8�LlBCi 2l]OYB IDECLAREUNDER PENAL77OFPER JURYTHA TTHE FORE GOING IS1TRUEAND �IC�ORRECT. /� E au c this daayy o00- 20� at r O " r + V r-0b1zV- city tv -fu v e part, ea Sigaure afAffiunt nocFR 7 amt of Affiant t,(i g trr Gj,.#l� i rrirfPKnn V 11 Name offirm (if applicable) . dr of iaat (including fey stow. inti :p adv) xybs-1�1— Telephone Numbar of Afrwnt (including arca Gado) This form is subject to the California Public Records Act (Government Code 6250 et. seq.) For Recorder's Use: ACR 521 (Rev. 11/2014) Affix PCOR label Here Available In Alternate Formats about:blank 10/18/2017 Document -4167354 -Page -2 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 properly, In accordance wilh secllon 480.3 of the Revenue nnrl Taxation Cade, A Preliminary Change of Ownership Report must be 06d wish each conveyance In the County Recorder's office for the county where the property is located. Page 1 of 1 PETER ALDANA, COUNTY OF RIVERSIDE ASSESSOR - COUNTY CLERK -RECORDER PO BOX 751, RIVERSIDE, CA 92502.0751 (951) 955.0400 www.rlversldeacr.com NAME AND MAILING ADDRESS OF BUYERTRANSFEREE (Make ns scary comedfons foThe pdnfed name and mcL ee;,l address) r , ASSESSORS PAtiCEl NUMBER Mark L. Wagner & Debra E. Wagner, Trustees of the Wag Irrev. Trust 767-690-028, 767-690-043, 767-900-020 1609 Milano Villa Avenue SELLER/TRANSFEROR Henderson, NV 89052 The Madison Club Owners Association BUYERT DAYTIME TELEPHONE NUMBER [ 516 ) 526-7807 L J Bt1YER'SEMAR-ADDRESS mwagner@exitllc.com STHFFTAODRFSS OR PHYSMAL LOCATION OF REAL PROPERTY 52577 Merjwether Way, La Quinta CA 92253 MAIL PROPERTY TAX INFORMATION TO (NAME) Mark Wagner _ ... ......... T ADDRESS CITY STATE 2iP GOD - 1609 Milano Villa Avenue 1 Henderson NV 89052 ❑YES Z NO This property Is Intended as my principal residence. If YES, please indicate the date of occupancy Mo onY rFn 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 domasticpartners currantly•registered with the California Secretary of State (atkiilkin or removal of apartner, death of partnar, termination sattlemen4 etc.). ❑ 0 * C. This Is a transfer. ❑ 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 ❑ ❑' E. This transaction Is to replace a principal residence by a person 55 years of age or older. Withlr( the same county? BYES ❑ NO ❑ ❑✓ • F. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue end Taxation Code asctlon 59.6. Within the some county? F]YES NO .i J] G. This transaction is only a correctlon of the name (a) of the persons) holding title to the property (e. g., a name change upon marriage). If YES, please explain: _ ❑ ❑✓ H. The recorded document creates, terminates, or reconveys a lender's interest In the property. ❑ O I. This transaction Is retarded only as a requirement for financing purposes or to create, termlriate, or recorvey a Security interest (e.g., cosignor). If YES, please explain,. ❑ 0 J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. K. This Is a transfer of property: ❑ O 1. to/from a revocable trust that may be revoked by the transferor and Is for the benefit of ❑ the transferor, and/or ❑ the transferDes spouse ❑ registered domestic partner. ❑ O 2, toifrom a trust that maybe revoked by the erestorigrsntorltrustorwho Is also ajoint tenant, and which names the other Joint tenant(s) as beneficiaries when the creatorfgrantorRrustor dies. ❑ ❑✓ 3, tolfrom an Irrevocable trust for the benefit of the El creator/grantorltrustor and/or ❑ gtantDeshrustor's spouse ❑ grantor's/trustor's registered domestic partner, ❑ ❑✓ L. This property Is subject to a lease with a remaining lease term of 35 years or more including written options. ❑ ✓❑ M. This is a transfer between parties in which proporticnai Interests of the transferor(s) and transferee(a) In each and every parcel being transferred remain exactly the some after the transfer. ❑ 0 N. This 13 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 infoinnatlon that will help the Assessor understand the nature of the transfer. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION about:blank 10/18/2017 Document -41673 54 -Page -3 BOE -602-A (P2) REV. 12 (05-13) PART 2. OTHER TRANSFER INFORMATION A. Date of transfer, if other then recording date: B. Type of transfer. Check and complete as applicable. Page 1 of 1 ❑ 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 litre adlUstment C. 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 Check and complete as applicable. A. Total purchase price $ 0 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 ❑ Fl in (_01sc0unt Paints) ❑ Cal -Vet ❑ VA L„ _ Dlawuizt Points) ❑ Fixed rete ❑ Variable rate ❑ Barik/Savings & LoanlCredit Union ❑ Loan carried by sella ❑ Balloon payment $, Due date: D. Second deed of trust Q % 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 ❑ 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. ) R ❑ 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 U Co-op/Own-your-own ❑ Manufactured home ❑ Multiple-famlly residence. Number of units: ❑ Condominium Q Unimproved lot ❑ Other. Description: (Le., timber, mineral, water rights, etc.) ❑ Timeshare ❑ Commercial/Industrial B. ❑YES Q NO Personallbuslnessproperty, or Incentives, provided by sellerto 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. ❑YES ✓❑ NO A manufactured home Is included In the purchase price. If YES, enter the value attributed to the manufactured home: —, []YES 0 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: ❑ Lease/rent ❑ Contract ❑ Mineral rights ❑ Other: E. The condition of the property at the time of sale was: []Good ❑Average ❑Fair []Poor Please describe: n/a CERTIFICATION I certify (or declarb) 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. 610r! - K BUYER S EE OR CO RATE 0rr]CPA ire 0-0 tr OAT' TEMOM LE ( 516 ) 526-7807 NAME OF aVYERrrRANSPUREERE L R£PRF.SENTATIVEICORP TE OFFICER IPLEASE PRINT) Wt.�6 ���� ^ ` >� Sf TITLE, r ..,g�� EMAILADDRESS irtwagner{g�sxitllc.com The Assessor s oftioe may contact you for additional Information regarding this transaction. about:blank 10/18/2017