LLA 2020-0015 Parcel B - The QuarryOrder No.
Escrow No.
Loan No.
WHEN RECORDED MAIL TO:
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
DIOC # 2020-0657202
12/23/2020 05:00 PM Fees: $110.00
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: MARIA #309
DOCUMENTARY TRANSFER TAX $.......... 0.................. 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
Remainiag at time of sale Signature of Declarant or Agent
Determining tax —Firm Name
APN'S 766-044-003 and 766-050-017
GRANT DEED
LLA 2020-0015
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
The Quarry at La Quinta, Inc., a California Non Profit Mutual Benefit Corporation
Herby GRANT(S) to
The Quarry at La Quinta, Inc., a California Non Profit Mutual Benefit Corporation
The real property in the City of LA QUINTA, County of RIVERSIDE, State of CALIFORNIA, described as
Parcel `B" pursuant as LLA 2020-0015 approved by the City of La Quinta. The reconfigured parcel is described in Exhibits A .
and B attached hereto and by this reference hereof.
Note: This grant deed perfects the intent to Lot Line Adjustment 2020-00151 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.
LLA 2020-0015
2By:
ryhe City of La Quinta
an McR;.inney P.E., Ci�nginer
RCE 49418, Exp. 9-30-2022
MAIL TAX STATEMENTS TO: The Quarry at La Quinta, Inc.
The Quarry at La Quinta, Inc.; a California
Non Profit Mutual Benefit Corporation
A 4&L
tame:, /Nior-t
It's: keAl Manager
DOC #2020-0657202 Page 2 of 8
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 DE:CEMBER 23, 2020 before me, NICHOLE ROMANE , 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 underthe laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature
(seal)
*my
NICHOLE ROMANE
Notary Public - CaliforniaRiverside CountyCommission k 2312710
Comm. Expires Nov 16, 2023
DOCUMENT:
GRANT DEED LOT LINE ADJUSTMENT 2020-0015 re: APN 766-044-003 and
766-050-017 — owner(s): THE QUARRY AT LA QUINTA, INC
DOC #2020-0657202 Page 3 of 8
CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189
A notary pub4c 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�,,p ,.I n
County of _',i V �Si G(L
On Pk V >-eX 11 �, Z)20 before me, SW )1j. , A YIA
Date �/ Here Insert Name and Title of the Officer
personally appeared AAM r T -�' V\DMas Sr � P. baCA/1
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/'their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
ALLISON P. ROWE
Notary Public • California
Riverside County =_
Commission # 2315964
My Comm. Expires Dec 16, 2023 1
Place Notary Seal and/or Stamp Above
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 APIxYO
Signature of Notary Public
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:
Document: Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:
02018 National Notary Association
Number of Pages:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other: _
Signer is Representing:
DOC #2020-0657202 Page 4 of 8
EXHIBIT "A"
LEGAL DESCRIPTION
LOT LINE ADJUSTMENT NO. 2020-0015
PARCEL "A"
IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA,
LOT 3 AS SHOWN ON TRACT MAP NO. 27728 ON FILE ON BOOK 249 OF MAPS,
PAGES 1 THROUGH 13, INCLUSIVE, RECORDS OF THE RIVERSIDE COUNTY
RECORDER, LOCATED IN THE NORTH HALF OF SECTION 29, TOWNSHIP 6
SOUTH, RANGE 7 EAST, SAN 13ERNARDINO MERIDIAN:
TOGETHER WITH THAT PORTION OF PARCEL "B" AS, DESCRIBED IN GRANT DEED
FOR LOT LINE ADJUSTMENT NO. 08-491 RECORDED DECEMBER 19, 2008 AS
DOCUMENT NO. 2008-06635411, OFFICIAL RECORDS OF SAID COUNTY, BEING A
PORTION OF LOT 68 OF SAID TRACT MAP NO. 27728 DEPICTED ON EXHIBIT "B"
AS "LOT 68 AREA 1", MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST CORNER OF SAID LOT 3;
THENCE ALONG THE NORTHERLY LINES OF SAID LOT 3, THE FOLLOWING THREE
(3) COURSES:
THENCE NORTH 89015-02" WEST, A DISTANCE OF 79.48 FEET;
THENCE SOUTH 43010'57" WEST, A DISTANCE OF 166.38 FEET;
THENCE NORTH 89047'25" WEST, A DISTANCE OF 27.33 FEET;
THENCE LEAVING SAID NORTHERLY LINES, NORTH 43°10'57" EAST, A DISTANCE
OF 182.45 FEET;
THENCE SOUTH 8901502" EAST, A DISTANCE OF 95.86 FEET TO A POINT ON THE
WESTERLY LINE OF LOT 2 OF SAID TRACT MAP NO. 27728;
THENCE SOUTH 00012'35" WEST, ALONG SAID WESTERLY LINE, A DISTANCE OF
11.60 FEET, TO THE POINT OF BEGINNING;
LOT 68 AREA 1 CONTAINING 4,505 SQUARE FEET OR 0.103 ACRES MORE OR
LESS.
1 OF 2
DOC #2020-0657202 Page 5 of 8
EXHIBIT "A"
LEGAL DESCRIPTION
LOT LINE ADJUSTMENT NO. 2020-0015.
ALSO TOGETHER WITH THAT PORTION OF PARCEL "B" AS DESCRIBED IN GRANT
DEED FOR LOT LINE ADJUSTMENT NO: 08-491 RECORDED DECEMBER 19, 2008
AS DOCUMENT NO.2008-066354.1, OFFICIAL RECORDS OF SAID COUNTY, BEING
A PORTION OF LOT 68 OF SAID TRACT MAP NO. 27728 DEPICTED ON EXHIBIT "B"
AS "LOT' 68 AREA 2", MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE SOUTHWEST CORNER OF SAID LOT 3;
THENCE NORTH 8904725" WEST, ALONG THE SOUTHERLY LINE OF SAID LOT 68,
A DISTANCE OF 54:00 FEET;
THENCE NORTH 00012'35" EAST, A DISTANCE OF 30.00 FEET;
THENCE SOUTH. 89-47'25"EAST, A DISTANCE OF: 54.00 FEET TO THE MOST
WESTERLY NORTHWEST CORNER OF SAID LOT 3,
THENCE. SOUTH 00012'35" WEST, ALONG THE WESTERLY LINE OF SAID LOT 3, A
DISTANCE OF 30.00 FEET TO THE POINT OF BEGINNING;
LOT 68 AREA 2 CONTAINING 1,620 SQUARE FEE17 OR 0.037 ACRES MORE OR
LESS. -
TOTAL ADJUSTED AREA OF PARCEL "A" CONTAINS 30,649 SQUARE FEET OR
0.704 ACRES MORE OR LESS.
SUBJECT TO EXISTING EASEMENTS, COVENANTS, RIGHTS AND RIGHTS -OF -
WAY OF RECORD.
AS DEPICTED ON EXHIBIT "B" ATTACHED HERETO AND MADE A PART HEREOF.
PREPARED BY OR UNDER THE DIRECTION OF:
CHARLES R. HARRIS
DATED: . 11 /24/2020
P.L.S. 4989
20F2
QCHARLES R. HARRIS
[a
No.4989
DOC #2020-0657202 Page 6 of 8
EXHIBIT "A"
LEGAL DESCRIPTION
LOT LINE ADJUSTMENT NO. 2020-0015
PARCEL. "B"
IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA,
PARCEL "B" AS DESCRIBED IN GRANT DEED FOR LOT LINE ADJUSTMENT NO. 08-
491 RECORDED DECEMBER 19, 2008 AS DOCUMENT NO. 2008-0663541, OFFICIAL
RECORDS OF SAID COUNTY, (BEING A PORTION OF LOT 68 AS SHOWN ON TRACT
MAP NO. 27728 ON FILE ON BOOK 249 OF MAPS, PAGES 1 THROUGH 13,
INCLUSIVE, RECORDS OF THE RIVERSIDE COUNTY RECORDER, LOCATED IN
THE NORTH HALF OF SECTION 29, TOWNSHIP 6 SOUTH, RANGE 7 EAST, SAN
BERNARDINO MERIDIAN:
EXCEPTING THEREFROM THAT PORTION OF SAID PARCEL "B" OF LOT LINE
ADJUSTMENT NO.08-491 DEPICTED ON EXHIBIT "B" AS "LOT 68 AREA 1", MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST CORNER OF SAID LOT 3;
THENCE: ALONG THE NORTHERLY LINES OF SAID LOT 3, THE FOLLOWING THREE
(3) COURSES:
THENCE: NORTH 89015'02" WEST, A DISTANCE OF 79.48 FEET;
THENCE: SOUTH 43010'57" WEST, A DISTANCE OF 166.38 FEET;
THENCE: NORTH 89047'25" WEST, A DISTANCE OF 27.33 FEET;
THENCE: LEAVING SAID NORTHERLY LINES, NORTH 43010'57" EAST, A DISTANCE
OF 182.45 FEET;
THENCE: SOUTH 89°15'02" EAST, A DISTANCE OF 95.86 FEET TO A POINT ON THE
WESTERLY LINE OF LOT 2 OF SAID TRACT MAP NO. 27728;
THENCE: SOUTH 00012'35" WEST, ALONG SAID WESTERLY LINE, A DISTANCE OF
11.60 FEET, TO THE POINT OF: BEGINNING;
LOT 68 AREA 1 CONTAINING 4,505 SQUARE FEEL- OR 0.103 ACRES MORE OR
LESS.
FIIII0019V
DOC #2020-0657:202 Page 7 of 8
EXHIBIT "A"
LEGAL DESCRIPTION
LOT LINE ADJUSTMENT NO. 2020-0015
ALSO EXCEPTING THEREFROM THAT PORTION OF SAID PARCEL "B" OF LOT LINE
ADJUSTMENT NO.08-491 DEPICTED ON EXHIBIT "B", AS `:`LOT 68 AREA 2",. MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE SOUTHWEST CORNER OF SAID LOT 3;
THENCE: NORTH 89047'25" WEST, ALONG THE SOUTHERLY LINE.OF SAID LOT 68,
A DISTANCE OF 54.00 FEET;
THENCE: NORTH 00012'35" EAST, A DISTANCE OF 30.00 FEET;
THENCE: SOUTH 89047'25 EAST, A DISTANCE OF: 54.00 FEET TO THE MOST
WESTERLY NORTHWEST CORNER OF SAID LOT 3,
THENCE: SOUTH 00012'35" WEST, ALONG THE WESTERLY LINE OF SAID LOT 3, A
DISTANCE OF 30.00 FEET TO THE POINT OF BEGINNING;
LOT 68 AREA 2 CONTAINING 1,620 SQUARE FEET OR 0.037 ACRES MORE OR
LESS.
TOTAL ADJUSTED AREA OF PARCEL "B" CONTAINS 6,513,131 SQUARE FEET OR
149.520 ,ACRES MORE OR LESS.
SUBJECT TO EXISTING EASEMENTS, COVENANTS, RIGHTS AND RIGHTS -OF -
WAY OF RECORD.
AS DEPICTED ON EXHIBIT "B" ATTACHED HERETO AND MADE A PART HEREOF.
PREPARED BY OR UNDER THE DIRECTION OF:
��il `iLlto �O CHARLES a HARFIB -C
a
1 _ 1
CHARLE:S R. HARRIS P.L.S. 4989 No.4888
OF CA1-/
DOC #2020-0657202 Page 8 of 8
PAR. "B" LLA 08-491
DOC. NO. 2008-0663541
REC. 12/19/2008, O.R.
POR. OF LOT 68
LINE DATA
NO.
BEARING
LENGTH
L1
N 89' 15'02" W
79.48'
L2
N 89'47'25" W
27.33'
L3 'S
.89' 15'02" E
95.86'
L4
IS 00' 12'35" W
11.60' .
L5
N 89'47'25". W
45.62'
L6
S 00` 12'35" .W
30.00'.
L7
N 89'47'25" W
54.00'
L8
N 00' 12'35" E
30.00'
L9
S 89-47.25" E
54.00'
LSO �G\
O CL�s R. FlrwRit�
b'
*A, No. 4989 ,*,
qTF OF CAS-�FOQ�
DATED: 1-1 /24/2020' -
M.B. 249/1-13
PARCEL •B•
6,513,131 SQ. FT.
149.520 AC..
LOT 68
AREA 2
1,620 SQ. FT.
0.037 AC.
— L5
NW COR.
LOT 68 LOT 2
AREA 1 L3
4,505 SQ. FT.
0.103 AC. (L1)
LOT LINE TO
r c�0'PG� BE ADJUSTEI
PARCEL •A'
24,524 SQ. FT.
0.563 AC.
L2 LOT 3
LINE TO M.B. 249/1-13
DJJSTE9__
L7 TOM FAZIO LANE SOUTH
LOT 68 AREA 2 ;n .
ISW COR. LOT 3 c6
P.0.8.
LOT 68 AREA 1
NE COR. LOT 3
LOT 2 -
M.B. 249/1-13
LEGEND
EXISTING LOT LINE TO BE ADJUSTED —
EXISTING LOT LINE TO REMAIN
NEW ADJUSTED LOT LINE
(-} RECORD PER M.B. 249/1-13
MSA CONSULTING, INC.
0' 60' 120' > PLANNING > CIVIL ENGINEERING > LAND SURVEYING
34200 BOB HOPE DRIVE, RANCHO MIRAGE, CA 92270.
760.320.9811 MSACONSULTINGINC.COM
SCALE 1"=60' J.N. 2624 SHEET 1 OF 1
BOE-502-A (P1) REV. 13 (06-17)
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.
FOR ASSESSOR'S USE ONLY
r
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
766-050-017
SELLER/TRANSFEROR
The Quarry at La Quinta, Inc.,
BUYER'S DAYTIME TELEPHONE NUMBER
( 760 ) 777-1100
L J BUYER'S EMAILADDRESS
mschelbach@thequarrygc.com
STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY
One Quaa Lane, La Quinta, CA 92253
❑ YES ❑✓ NO This property is intended as my principal residence. If YES, please indicate the date of occupancy Mo DAY Y7gr1
or intended occupancy.
❑ YES ❑✓ 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)
The Quarry at La Quinta, Inc.,
MAIL PROPERTY TAX INFORMATION TO (ADDRESS) CITY STATE ZIP CODE
One Quarry Lane La Quinta CA 92253
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 or removal 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).
❑ ✓❑ * D. This transfer is the result of a cotenant's death. Date of death
❑ ` 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
❑ LV] * F. This transaction is to replace a principal residence b a person who is severely disabled as defined by Revenue and Taxation Code
section 69.5. Within the same county? ❑ YES NO
❑ 0 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:
❑
0
H. The recorded document creates, terminates, or reconveys a lender's interest in the property.
❑
F,(]
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:
❑
[vl]
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.
❑
y,
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.
❑
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.
❑ 0 N. This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions, or restrictions
imposed by specified nonprofit corporations.
❑ * O. This transfer is to the first purchaser of a new building containing an active solar energy system.
❑ P. Other. This transfer is to Consideration is less than $100
* 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. 13 (06-17)
PART 2. OTHER TRANSFER INFORMATION Check and complete as applicable.
A. Date of transfer, if other than recording date:
B. Type of transfer.
CI Purchase -1 Foreclosure ❑ Gift ❑ Trade or exchange ❑ Merger, stock, or partnership acquisition (Form BOE-100-B)
❑ Contract of sale. Date of contract: I -I 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:
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 s
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 $
❑ FHA( Discount Points) ❑ Cal Vet ❑ VA (_Discount Points) ❑ Fixed rate ❑ Variable rate
Bank/Savings & Loan/Credit Union ❑ Loan carried by seller
❑ Balloon payments Due date:
D. Second deed of trust @ % 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? F—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:
❑ 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
I -I Single-family residence ❑ Co-op/Own-your-own L Manufactured home
I_I Multiple -family residence. Number of units: ❑ Condominium ❑ Unimproved lot
❑ Other. Description: (i.e., timber, mineral, water rights, etc.) ❑ Timeshare ❑ Commercial/Industrial
B. L IYES —_'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. [—]YES ❑ NO A manufactured home is included in the purchase price.
If YES, enter the value attributed to the manufactured home: $
[]YES 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
Please describe:
[—]Average F_I Fair ❑ 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.
SIGNATu IT SF R OR CORPORATE OFFICER DATE TELEPHONE
NAME ❑ 11YI%RlF r F REEIPE N P% SENTA71 EICORPORATE OFFICER (PLEASE PRINT) TIy�E &. f IA
r - � EMAILApOR `5 �
The Assessor's office may contact you for additional information regarding this transaction
`tit ur �rr�
R'= PETER ALDANA Recorder
P.O. Box 751
COUNTY OF RIVERSIDE Riverside, CA 92502-0751
' ASSESSOR -COUNTY CLERK -RECORDER (951) 486-7000
;s.S""',
Website: wwwAversideafmcam
` DOCUMENTARY TRANSFER TAX AFFIDAVIT
WARNING
ANY PERSON WHO MANS ANY MATERIAL NIISREPRESENTATION 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. 766 --050 --0 117 I declare that the documentary transfer tax for this
Property Address: One
Quarry I N, I n Oiiintn, CA 99951 transaction is: $0_00
If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below.
ICLAIM THATTHIS TRANSACTIONISEXEMPTFROMDOCUMENTARYTRANSFERTAXBECAUSE: (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 not perpetual, 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. /�
Execut d s day of 20 2 at La u2, ht� C A
City State
4WIZ "V— SCl W\C; a c&
S' of t j Printed Name of Affiant
Name of Firm (if applicable) Address of Affiant (includtate, and Zip Code)
11% U_VVP(� Oar Uk (ZJ iv4tG )_J1A C. J u o - 2 5v - $ 3b S
Telephone Number of Affiant (including area code)
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