LLA 2020-0002 Parcel A - AndalusiaOrder No.
Escrow No.
Loan No.
WHEN RECORDED IMAIL TO:
City of La Quinta
78-495 Calle Tampico
La Quinta, California, '92253
DOC # 2020-0190210
05/01/2020 04:24 PM Fees: $140.00
Page 1 of 8
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: TERESA #134
DOCUMENTARY TRANSFER TAX $ ................................................... SPACE ABOVE THIS LINE FOR RECORDER'S
USE
Computed on the: consideration or value of property conveyed; OR
Computed on the consideration or value less liens or encumbrances
remaining at time of sale. Signature of Declarant or Agent
determining tax - Finn Name
APN'S: 764-200-091, 764-660-051
GRANT DEED
LLA 2020-0002
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ANDALUSIA COUNTRY
CLUB, LLC, a Delaware limited liability company,
hereby GRANT(S) to Kevin N. Kowalkowski. A dingle Man
the real property in the City of La Quinta, County, of Riverside, State of California, described as
that portion of land in Parcel "D" which is overlaid by the reconfigured shape: of Parcel "A" pursuant to
LLA 2020-0002 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 2020-0002 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 CA IFORNIIA��
COUNTY OFS
On 1qQ,_1,o, 0 Lbefor
me, i II- a,/fnI-/�v10��\Ci
personally appeared�l W l i• s M 1 J h_��
Who proved to me on the basis of satisfactory evidence to be the person(0)
whose name(s) is/aye subscribed to the within instrument and acknowledged
to me that he/slktitbEy executed the same in hish)6r/th6ir authorized
capacity(ice,$),and that by his/hit/tl}eir signature(aj on the instrument the
person(, or the entity upon behalf of which the person(g) 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.
Signature "�Q, e C?wi G�
MAIL T STATEMENTS TO:
ANDALUSIA COUNTRY CLUB, LLC,
a-BEe aware limited liability comi3any
By: orz>Li
It's: �r-e Sr'o�ea, t
AP fOVED BY CITY OF LA QUINTA
Bry8in McKinney, P.E., Ci Engineer
RCE:49418, Exp. 9-30-2020
JUANITAM, A. GAMA
Notary Public • Callfornla
Riverside County
Commission k 2274810
My Comm. Expires Feb 7, 2023
Place Notary Seal Above
DOC #2020-0190210 Page 2 of 8
NOTARY ACKNOWLEDGMENT
A notary public or other .officer completing this certificate
verifies only the identity of the individual who signed the
docunrient, to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
State of California )
County of Riverside )
On Ahril 30, 2020 before me, MONIKA IRADEVA, Notary. Public,
personally appeared BRYAN McKINNEY who proved to me on the basis
of satisfactory evidence to be the personoi whose nameW isfafe
subscribed to the within instrument, and acknowledged to me that
he/spa-eye executed the same in his/#eir authorized
capacity{te�, and that by his/#e~ signatures} on the instrument
the person{s-y,- or the entity upon behalf of which the persons} 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.
Signature:
MONIKA RADEVA
Notary Public - California
Riverside County i
' Commission # 21168979 D
My Comm. Expires Oct 22, 2020
(notary seal)
DOCUMENT:
Grant Deed; Lot Line Adjustment (LLA 2020-0002)
APNs: 764-200-091 and 764-660-051
DOC #2020-0190210 Page 3 of 8
EXHIBIT "A"
LOT LINE ADJUSTMENT NO.2020-0002
PARCEL "A"
LOT 23 OF AMENDMENT NO.4 TRACT NO.31681-3, AS SHOWN BY MAP ON FILE IN BOOK
469 OF MAPS, AT PAGES 18 THROUGH 32, INCLUSIVE, RECORDS OF RIVERSIDE COUNTY,
IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA.
TOGETHER WITH THAT PORTION OF LOT "B" OF SAID AMENDMENT NO.4 TRACT NO.
31681-3, MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHWESTERY CORNER OF SAID LOT 23;
THENCE N270 42' 12"W ALONG THE NORTHERLY PROLONGATION OF THE WESTERLY LINE
OF SAID LOT 23, A DISTANCE OF 16.59 FEET;
THENCE N670 28' 11"E A DISTANCE OF 56.55 FEET TO A POINT ON THE NORTHERLY LINE
OF SAID LOT 23 AND THE BEGINNING OF A CURVE CONCAVE SOUTHEASTERLY, HAVING
A RADIUS OF 100.00 FEET, WITH A BEGINNING RADIAL BEARING OF N22° 31' 49"W;
THENCE SOUTHWESTERLY ALONG SAID CURVE AND THE NORTHERLY LINE OF SAID
LOT 23, THROUGH A CENTRAL ANGLE OF 33° 24' 19", AN ARC LENGTH OF 58.30 FEET, TO
THE NORTHWESTERLY CORNER OF SAID LOT 23 AND THE POINT OF BEGINNING;
AS SHOWN ON EXHIBIT `B" ATTACHED HERETO AND BY THIS REFERENCE MADE A PART
HEREOF. SAID "PARCEL "A" CONTAINS 12,655 SQUARE FEET MORE OR LESS.
THIS DOCUMENT WAS PREPARED BY ME OR UNDER
MY DIRECTION BASED ON RECORD INFORMATION
6 20
L W. WATSON, RCE 26662 A -
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No. 26662
EXP.3-3120 (}
Civil-
Page1 of 4 Pages
DOC #2020-0190210 Page 4 of 8
EXHIBIT "A"
LOT LINE ADJUSTMENT NO.21,020-0002
PARCEL "B"
LOT 24'OF AMENDMENT NO.4 TRACT NO.31681-3, AS SHOWN BY MAP ON FILE IN BOOK
469 OF MAPS, AT PAGES 18 THROUGH 32, INCLUSIVE, RECORDS OF RIVERSIDE COUNTY,
IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA.
TOGETHER WITH THAT PORTION OF LOT "B" OF SAID AMENDMENT NO.4 TRACT NO.
31681-3, MORE PARTICULARLY DESCRIBED AS FOLLOWS„
BEGINNING AT THE NORTHWESTERY CORNER OF SAID LOT 24;
THENCE N22° 50' 47"W ALONG THE NORTHERLY PROLONGATION OF THE WESTERLY LINE
OF SAID LOT 24, A DISTANCE OF .19.53 FEET;
THENCE N670 28` 11"E A DISTANCE OF 63.61 FEET TO A POINT ON THE NORTHERLY
PROLONGATION OF THE EASTERLY LINE OF SAID LOT 24;
THENCE S27" 42' 12"E ALONG SAID LINE, A DISTANCE OF 116.59 FEET TO THE
NORTHEASTERLY CORNER OF SAID LOT 24 AND A POINT ON A NON -TANGENT CURVE
CONCAVE SOUTHEASTERY, HAVING A RADIUS OF 100.00 FEET, WITH A BEGINNING
RADIAL BEARING OF S550 56' 08"E;
THENCE SOUTHWESTERLY ALONG SAID CURVE AND THE NORTHERLY LINE OF SAID
LOT 24, THROUGH A CENTRAL ANGLE OF 00 07' 41 ", AN A ',C LENGTH OF 0.22 FEET TO THE
BEGINNING OF A REVERSE CURVE CONCAVE NORTHWESTERLY, HAVING A RADIUS OF
63.00 FEET;
THENCE SOUTHWESTERLY AND NORTHWESTERLY ALONG SAID CURVE AND THE
NORTHERLY LINE OF SAID LOT 24, THROUGH A CENTRAL. ANGLE OF 61 ° 5 8' 31 ", AN ARC
LENGTH OI, 68.14 FEET, TO THE NORTHWESTERLY CORNER OF SAID LOT 24 AND THE
POINT OF BEGINNING;
AS SHOWN ON EXIIIBIT `B" ATTACHED HERETO AND BY THIS REFERENCE MADE A PART
HEREOF.SA.ID "PARCEL `B" CONTAINS 14,142 SQUARE FEET MORE OR LESS.
THIS DOCUMENT WAS PREPARED BY ME OR UNDER
MY DIRECTION BASED ON RECORD INFORMATION
v�) G 41we-6z.
L YDWATSON, RCE 26662 DATE
to
PAGE 2 OF 4 PAGES
No.26662 �I
EXP. 331-20 Jet )
DOC #2020-0190210 Page 5 of 8
EXHIBIT "A"
LOT LINE ADJUSTMENT NO.2.020-0002
PARCEL "C"
LOT 25 OF ,AMENDMENT NO.4 TRACT NO.31681-3, AS SHOWN BY MAP ON FILE IN BOOK
469 OF MAPS, AT PAGES 18 THROUGH 32, INCLUSIVE, RECORDS OF RIVERSIDE COUNTY,
IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA. .
TOGETHER WITH THAT PORTION OF LOT `B" OF SAID AMENDMENT NO.4 TRACT NO.
31681-3, MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHWESTERY CORNER OF SAID LOT 25;
THENCE N670 28' 11"E A DISTANCE OF 57.32 FEET TO A POINT ON THE NORTHERLY
PROLONGATION OF THE EASTERLY LINE OF SAID LOT 25;
THENCE S220 50' 47"E A DISTANCE OF 19.53 FEET TO THE NORTHEASTERLY CORNER OF
SAID LOT 2,5 AND A POINT ON A NON -TANGENT CURVE CONCAVE NORTHWESTERLY,
HAVING A RADIUS OF 63.00 FEET, WITH A BEGINNING RADIAL BEARING OF N05° 54' 42"E;
THENCE NORTHWESTERLY ALONG SAID CURVE AND THE NORTHERLY LINE OF SAID
LOT 25, THROUGH A CENTRAL ANGLE OF 30 35' 26", AN ARC LENGTH OF 3.95 FEET TO THE
BEGINNING OF A REVERSE CURVE CONCAVE SOUTHWESTERLY, HAVING A RADIUS OF
117.00 FEET;
THENCE CONTINUING ALONG THE NORTHERLY LINE OF SAID LOT 25, NORTHWESTERLY
AND SOUTHWESTERLY ALONG SAID CURVE, THROUGH A CENTRAL ANGLE OF 280 05' 35",
AN ARC LENGTH OF 57.37 FEET TO THE NORTHWESTERLY CORNER OF SAID LOT 25 AND
THE POINT OF BEGINNING;
AS SHOWN ON EXHIBIT "B" ATTACHED HERETO AND BY 'THIS REFERENCE MADE A PART
HEREOF.
SAID"PARCEL "C" CONTAINS 13,663 SQUARE FEET MORE OR LESS.
THIS DOCUMENT WAS PREPARED BY ME OR UNDER
MY DIRECTION BASED ON. RECORD INFORMATION
�iiG%U 4/l¢�,z,
LL YD W. WATSON, RCE 26— 66� ATE
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No.26662
E �Vll.0
PAGE 3 OF 4 PAGES
DOC #2020-0190210 Page 6 of 8
EXHIBIT "A"
LOT LINE ADJUSTMENT NO.2020-0002
PARCEL "D"
LOT "D" OF AMENDMENT NO.4 TRACT NO.31681-3, AS SHOWN BY MAP ON FILE IN BOOK
469 OF MAPS; AT PAGES 18 THROUGH 32, INCLUSIVE, RECORDS OF RIVERSIDE COUNTY,
IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA.
EXCEPTING THEREFROM THAT PORTION OF LOT "D" OF SAID AMENDMENT NO.4
TRACT NO.31681-3, MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHWESTERY CORNER OF LOT 25 OF SAID TRACT;
THENCE N670 28' 1 VE A DISTANCE OF 177.48 FEET TO A POINT ON THE NORTHERLY LINE
OF LOT 23 OF SAID TRACT AND A CURVE CONCAVE SOUTHEASTERY, HAVING A RADIUS
OF 100.00 FEET, WITH A BEGINNING RADIAL BEARING OF N22° 31' 49"W;
THENCE SOUTHWESTERLY ALONG SAID CURVE AND THE NORTHERLY LINE OF LOT 23
AND LOT 24 OF SAID TRACT, THROUGH A CENTRAL ANGLE OF 330 32' 00", AN ARC
LENGTH OF 58.52 FEET TO THE BEGINNING OF A REVERSE CURVE CONCAVE
NORTHWESTERLY, HAVING A RADIUS OF 63.00 FEET;
THENCE SOUTHWESTERLY AND NORTHWESTERLY ALONG SAID CURVE AND THE
NORTHERLY LINE OF LOT 24 AND LOT 25 OF SAID TRACT, THROUGH A CENTRAL ANGLE
OF 65° 33' 57", AN ARC LENGTH OF 72.09 FEET TO THE BEGINNING OF A REVERSE CURVE
CONCAVE SOUTHWESTERLY, HAVING A RADIUS OF 117.00 FEET;
THENCE NORTHWESTERLY AND SOUTHWESTERLY ALONG SAID CURVE AND THE
NORTHERLY LINE OF LOT 25 OF SAID TRACT, THROUGH A CENTRAL ANGLE OF 28° 05' 35",
AN ARC LENGTH OF 57.37 FEET TO THE NORTHWESTERLY CORNER OF SAID LOT 25 AND
THE POINT OF BEGINNING;
AS SHOWN ON EXHIBIT "B" ATTACHED HERETO AND BY THIS REFERENCE MADE A PART
HEREOF. SAID "PARCEL "D" CONTAINS 26.90 ACRES MORE OR LESS.
THIS DOCUMENT WAS PREPARED BY ME OR UNDER MY
MY DIRECTION BASED ON RECORD INFORMATION
LLOYD W. WATSON, RCE 26662 ATE
i
pG No. 26662
�* EXP. 3-39 20 }} /
CI vv-��Q7/
PAGE 4 OF 4 PAGES
DOC #2020-0190210 Page 7 of 8
EXHIBIT „B„ PAGE 2 OF 2 PAGES
LOT LINE ADJUSTMENT NO.2020-0002
LOTS 23, 24, 25, AND "B" OF AMENDMENT NO.4, TRACT NO.31681-3
0 60, 90' 120' 180'
C101 N 17030'39"W(R1
N 22°31'49-
SCALE: 1" = 60' \ AMENDED NO.4 TRACT 31681-3
(IN FEET) PARCEL "D" / \ \ MB 469/18-32
LOT„B„ / \ ------
APN 764-200-091 / 55
30' WIDE WATER PIPELINE 26.90 AC / ,11 xz j j
EASEMENT OF USA REC.
AS INST. NO, 2005-0313110 6�°2$ 63b
4/21/05, O.R. PARCEL A
"" 21
,SID
/ PARCEL "C ' C5 C8 \m -y- < 22
P.O.B. / ,66 PARCEL
-oZ CI P.O.B. \\i�
26 v-a �' N- �o�. v
27 "0- _11�rnk(_%
�N \ \ � 2
\N� Go
tJcp.
10' PUBL.IC C4
UTILITY /
EASEMENT / / . J
Y OP - \v��
P �EQR c,
N 5 0 CB PARCEL „A„
10
C P TY IPRC 03 4
UTILITY 9 WAR N P.O.B.
EASEMENT �`rs PARCEL "A"
CURVE TABLE
CURVE
DELTA
RADIUS
LENGTH
TANGENT
C1
4040'33"
287.00'
23.42'
11.72'
C2
1 °40'26"
1426.00'
41.65'
20.83'
C3
3013'27"
1426.00'
80.25'
40.13'
C4
3018'45"
1426.00'
82.44'
41.23'
C5
28°05'35"'
117.00'
57.37'
29.27'
C6
3°35'26"
63.00'
3.95'
1.97'
C7
61 °58'31 "'
63.00'
68.14'
37.84'
C8
0007'41"
100.00,
0.22'
0.11,
C9
33024'19"
100.00,
58.30'
30.01'
C10
5°01'10"
100.00,
8.76'
4.38'
C11
33°32'00"'
100.00,
58.52'
1 30.13'
Cl2
65°33'57"'
63.00,
72.09' 1
40.57'
PARCEL "D" \So. LOT 23
LOT „B" / o \od,
PARCEL "A"
LOT 23. �C&
DETAIL �\
SCALE: 1"=2'
LINE DATA
COURSE
BEARING
LENGTH
L1
N 22°50'47"W
19.53'
L2
N 27042'12"W
16.59'
I r7e%rlklr%
-----EXISTING LOT LINE TO BE ADJUSTED
EXISTING LOT LINE TO REMAIN
ADJUSTED LOT LINE
DOC #2020-0190210 Page 8 of 8
EXHIBIT "B„ PAGE 1 OF 2 PAGES
LOT LINE ADJUSTMENT NO.2CI20-0002
LOTS 23, 24, 25, AND "B" OF AMENDMENT NO.4, TIRACT NO.31681-3
38
I
37
�4039r'3e , 211
21
33 TRACT 31681-2
MB 397/34-44 32 / >
/i I
31 30J,. ?%
45 d 29
<. 27 194
Z N 48 26 25 24 Z3 I 1
OT "
hZ I ` 1 I 2
00 3 4 5 6 7 8 g
LLJ� r osti
0_ W✓, 10
53
LuU 4 53 I 11
Z W es 1
U I " 'LOT', 0 12
43 I PARICEL "D" 13
`h 42LOT "B"
41 14
5 6 7 4039 I PARCEL "A" 15 0
859 ' 38 37 SEE SHEET 2 16
6061 36 PARCEL "B" 17
s26`I 5 SEE: SHEET 2.. 18
34 PARCEL C
'45 O� 33 SEE SHEET 2 19
3 6 31 20
67 30
— I — 68 29 23 22 21 195
—{I— 69 262 24
7 71 q'LO 21 27
72
73 `spy
74 16 16 19
16 16 LOT "H"
CENTER SECTION 75 15 -158160 61
LINE, SECTION 27 76 Q
77 tL� 166 W
78 167
79 168 �
80 a W
169 � 0 T LoT'r' TRACT 31681-3 o z
84 M B 469/18-32 170
85 148 1/1 O
87 86 147 :288 11 14(i 1172
90 89 ONpP 11 145 1173
no 91 11 144 174
400' 600' 800' 1200' 1600,
SCALE: 1" = 400' I
( IN FEET)
p O N K 2� A N� ill I NR PREPARED UNDER THE SUPERVISION OF:
%Q OFESSION\
�-4 2c
L7 m
No.26662
EXP.3-31-22 �{
CIVIC -
CIVIL ENGINEERING • LAND PLANNING
46-725 VERBENA ROAD 7'
PALM DESERT, CA92260 LOYD W. WATSON DATE,
PH: (760) 275-1553 P.E. 26662
EXP. 3/31 /22
± OF RI V e,6
. PETER ALDANA Recorder
P.O. Box 751
COUNTY OF RIVERSIDE Riverside, CA92502-0751
♦• o a ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000
Website: www.riversideacr.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. 764 --200 -- 091 I declare that the documentary transfer tax for this
Property Address: Tract
311681-3 1 nt R 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 FROMDOCUMENTARY TRANSFER TAXBECAUSE: (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. x 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 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 ntperpetual, permanent, or for life.
10. Section 9.
The document is a lease for a term of Ethan (35) years (including written options.)
11. Other
(Include explanation and legal authority)
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT:
Executed this_14th day of April 20�� at La CJuinta CA
/
/ _ _ + City State
�1�+L, Phillip K Smith
Signature of Affiant V Printed Name of Affiant
Andalusia Country C h tb, I I C _81570 Carboneras La nitinta, CA 92253
Name of Firm (if applicable) Address of Affiant (including City, State, and Zip Code)
760 772 7227
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 Alternate Formats
BOE-502-A (P1) REV. 13 (06-17)
PRELIMINARY CHANGE OF OWNERSHIP REPORT PETER ALDANA, COUNTY OF RIVERSIDE
ASSESSOR -COUNTY CLERK -RECORDER
To be completed by the transferee (buyer) prior to a transfer of subject PO BOX 751, RIVERSIDE, CA 92502-0751
property, in accordance with section 480.3 of the Revenue and Taxation (951) 955-0400 www.riversidea(•r.com
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.
FOR ASSESSOR'S USE ONLY
(-
ASSESSOR'S PARCEL NUMBER
764 660 051
SELLERn;RANSFEROR
Andalusia Country Club, LLC
BUYER'S DAYTIME TELEPHONE NUMBER
831 ) 840 6456
L J BUYER'S EMAILADDRESS
STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY knkowalkowski@gmail.com
81900 Andalusia La Quinta, CA 92253
❑ YES 0 NO This property is intended as my principal residence. If YES, please indicate the date of occupancy Mo DAY YEAR
or intended occupancy.
❑ YES 0 NO Are you a disabled veteran or a unmarried surviving spouse of a disabled veteran who was
compensated at 100% by the Department of Veterans Affairs?
MAIL PROPERTY TAX INFORMATION TO (NAME)
Kevin N. Kowalkowski
MAIL PROPERTY TAX INFORMATION TO (ADDRESS) CITY STATE ZIP CODE
1 Mesa Way Watsonville CA 195076
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 (addition orremoval of
a partner, death of a partner, termination settlement, etc.).
❑ ❑✓ C. This is a transfer: ❑ between parent(s) and child(ren) ❑ from grandparent(s) to grandchild(ren).
❑ [Y(] * D. This transfer is the result of a cotenant's death. Date of death
❑ a * E. This transaction is to replace a principal residence owned by a person 55 years of age or older.
Within the same county? ❑ 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.
❑ 0 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: _
❑ a J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document.
K. This is a transfer of property:
❑ 0 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.
❑ a 2. to/from an irrevocable trust for the benefit of the
❑ creator/grantor/trustor and/or ❑ grantor's/trustor's spouse ❑ grantor's/trustor's registered domestic partner.
❑ a L. This property is subject to a lease with a remaining lease term of 35 years or more including written options.
❑ a 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 aI transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions, or restrictions
imposed by specified nonprofit corporations.
❑ * 0. This transfer is to the first purchaser of a new building containing an active solar energy system.
❑ P. Other. This transfer is to straighten property line between golf course and residential lot.
* 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
130E-M-A(P2) REV. 13 (W17
PART 2. OTHER TRANSFER INFORMATION Check and complete as applicable.
A. Date of transfer, iifother than recordng date:
B. Type of transfer:
❑ Purchase ❑ Foreclosure o Gift ❑ Tnade or exchange ❑ Merger. stock, or partnershlp acquiradon (Form BOE-1oo-a)
❑ Contract of sate. Date of contract•. ^� � [_] Inheritance. Date of death:
❑ Salelleasebaek L J Creetion of a lease ❑ Assignment of a lease ❑ Termination of a tease. Date lease began:
Original term in years p%-itrd V wjj"n options):.._._,. Remain term in
Other. Please explain: t ins Adlu Rent.No-moniesyearo (lam wdtte,n —options);
C. Only a partial interest In the property was transferred.[]YES []NO If YES, indicate the percentage transferred: 9S
PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable.
A. Total purchase price C�
B. Cash down payment or value of trade or exchange excluding dosing costs Amount sue_
C. First dead of trust Interest for yeare. Monthly payment S Amount S
❑ FHA L—Diarxwnt Pwb) ❑ Cal -Vet ❑ VA ("_Diamurd Points) Fixes refs �' Variable rate
❑ BaWSavings & LoaWCredit Union ❑ Loan carried by seller '
❑ Balloon payment x Due dodo:
D. Second deed of trust C 95 interest for , years. Monthly payment S Amount
❑ Fued rate J Variable rate ❑ BankiSavings & Loan/Credd Union ❑ Loan carried by seller
❑ Balloon payment t3 Due date
E. Was an Improvement Bond or ottrer public financing assumed by buyer? UYES L]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.
t Direct from sealer ❑ ly _. _.
;.,.J From a farm membet�Relationahip . ., '.,r. .
P� Other. Piease explain;
H. Please explain artyspecdai terms, seller concessions, broker/agent fees walked. financing, and any otherinformation (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 ccvrtplete as applicable.
A. Type of property transferred
❑ single-family residence
❑ Mutliple-family residence. Number of units:E] Co-oplOwn-your-own ❑ Manufactured Fame
❑ Condominium ❑ Unimproved lot
Q Other. Dsscrlplon; (I.e., tknber, mineral, water rights, etc.) Timeshare
Goff Course isnd to ben ❑ ❑ �►�rcirrtnnduatrial
me ilsH� unimDkL
B. ❑ YES ❑ NO Pero onallbusiness property, or incentives, provided by seller to buyer are inducted in the purchase price. Examples of personal
property are furniture. farm equipment, machinery, eta Examples of Incentives are club memberships, etc,Attadh list iiavailable.
If YES, enter the value of the personaYbusiness property: $-- Incentives $
C.[]YES []NO A manufactured home Is Inctuded In the purchase price.
It YES, enter the value attributed to the manufactured home; $
EYES 0 NO The manufactured home is "ect to local property tax. If NO, enter decal number.
D-❑YES ❑ NO The property produces rental orother Intone.
If YES, the income is from: ❑ LeaWmnt ❑ Contract ❑ Mineral rights ❑ Other.
E. The condition of the property at the time of sate was; QGood []Average []Fair ❑ Poor
Please describe:
...�.. .... .,._.__-...CERTIFICATION --------------_.... ----_._._.
I certify (or dedam) that the fwe904V and aR frdbimatipn hereon, incfudrng any accompanying stalmnenfs or documents, is true and correct to
the best of my knowledge and belief.
- _ -.--.-.-- . _.. v."— OATS TELEPHONE
Mh OF eU RAH9 EE/PER$ RONAL� E ESENTATIVRORPORATE OFFICER (PEEME PRINT) nrLE a3 { A ll AO��
eriAORESESS ,,
Kevin N Kowalkowtakl knkowatkorivs;kiftmal
The Assessors office may contact you for additional information regarding this transaction.