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LLA 2021-0006 Parcel D - The QuarryOrder No. Escrow No. Loan No. WHEN RECORDED MAIL TO: City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 DOC # 2021-0394762 06/30/2021 10:57 AM Fees: $120.00 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: ALEJANDRA#1032 DOCUMENTARY TRANSFER TAX $............ Q................ 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 — Firm Name APN: 766-050-017 GRANT DEED LLA 2021-0006 FOR A VALLJABLE 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, ;hate of CALIFORNIA, described as Parcel "D" as described and shown on Exhibits "A" and "B" attached hereto and by reference made a part hereof. NOTE: This grant deed implements the revised lot configuration to Lot Line Adjustment 2021-0006 as approved by the City of La Quinta. Parcel "D" of this lot line adjustment is owned by a single entity; hence ownership conveyance is a nonessential secondary function of this deed. The primary function of this deed is to provide constructive notice of the revised lot configurations pursuant to Government Code Section 66412 (d), and to perfect the intent of Lot Line Adjustment 2021-0006 as approved. LLA 2021-0006 Approved by the City of La Quinta .OWe-77:,� - By: ryan McKinney P. ., City Engineer RCE 49418, Exp. 9-30-2022 The Quarry at La Quinta, Inc., a California Non Profit Mutual Benefit Corporation By: A o #a� Name: 000 It's: Gene�rallMMaana�ger MAIL TAX STATEMENTS TO: The Quarry at La Quinta, Inc. I DOC #2021-0394762 Page 2 of 8 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 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 _ K-\y s id On �. )GJ32U2� before me, '411i 'yl Date Here Insert Name and Title of the Officer personally appeared -Doy) *uy, 1 l `P-i 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 caipacity(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. P. ROYrE �� Notary Public • California Riverside County ` Commission A 2315964 My Comm. Expires Otc 16, 2023 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 Signature of Notary Public Vr I XVl\Ar 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(i'es) 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: ©2018 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 #2021-0394762 Page 3 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 JUNE 29, 2021 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 under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. NICHOIEROMANE Signature Notary PuWc • CatiforniaRiverside County Commission N 2312710 Comm. Expires Nov 16, 2023 am, (seal) DOCUMENT: GRANT DEED LOT LINE ADJUSTMENT 2021-0006 re: APN 766-050-017 - owner(s): THE QUARRY AT LA QUINTA, INC. DOC #2021-0394762 Page 4 of 8 EXHIBIT "A" . LEGAL DESCRIPTION LOT LINE ADJUSTMENT NO. 2021-0006 PARCEL "'D" IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, PARCEL "IB" AS DESCRIBED IN GRANT DEED FOR LOT LINE ADJUSTMENT NO. 2020-015 RECORDED DECEMBER 28, 2020 AS DOCUMENT NO. 2020-.0661120, 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. 2020-015 DEPICTED ON EXHIBIT "B" AS "LOT 63 AREA", MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTHWEST CORNER OF SAID LOT 63; THENCE SOUTH 89039'47" WEST, A DISTANCE OF 41.07 FEET; THENCE NORTH 21 °43'50" EAST, A DISTANCE OF 6"1.38 FEET; THENCE NORTH 22013'07" EAST, A DISTANCE OF 225.37 FEET; THENCE NORTH 23001'18" EAST, A DISTANCE OF 113.49 FEET TO THE MOST NORTHERLY CORNER OF SAID LOT 63; THENCE SOUTH 18"20'18" WEST, ALONG THE WESTERLY LINE OF SAID LOT 63, A DISTANCE OF 380.76 FEET; THENCE SOUTH 45020'13" EAST, CONTINUING ALONG SAID WESTERLY LINE, A DISTANCE: OF 12.00 FEET, TO THE POINT OF BEGINNING; LOT 63 AREA CONTAINING 5,8!50 SQUARE FEET OR 0.134 ACRES MORE (DR LESS. ALSO EXCEPTING THEREFROM THAT PORTION OF SAID PARCEL "B" OF LOT LINE ADJUSTMENT NO. 2020-015 DEPICTED ON EXHIBIT "B" AS "LOT 64 AREA 1", MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF SAID LOT 64; 1 OF 3 DOC #2021-0394762 Page 5 of 8 EXHIBIT "A" : LEGAL DESCRIPTION LOT LINE ADJUSTMENT NO. 2021-0006 THENCE SOUTH 2300815" WEST, ALONG THE WESTERLY LINE OF SAID LOT 64, A DISTANCE OF 102.83 FEET; THENCE NORTH 67038'44" WEST, A DISTANCE OF 3.21 FEET; THENCE SOUTH 67021'16" WEST, A DISTANCE OF 7.07 FEET; THENCE NORTH 67038'44" WEST, A DISTANCE OF 27.27 FEET; THENCE NORTH 21043-50" EAST, A DISTANCE OF 9-1.98 FEET; THENCE NORTH 89039'47" EAST, A DISTANCE OF 4.1.07 FEET, TO THE POINT OF BEGINNING; LOT 64 AREA 1 CONTAINING 3,631 SQUARE FEET OR 0.083 ACRES MORE OR LESS. ALSO EXCEPTING THEREFROM THAT PORTION OF SAID PARCEL "B" OF LOT LINE ADJUSTMENT NO. 2020-015 DEPICTED ON EXHIBIT "B" AS "LOT 65 AREA", MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF SAID LOT 65, SAID POINT ALSO BEING ON A CURVE, CONCAVE NORTHWESTERLY HAVING A RADIUS OF 250.00 FEET, A RADIAL LINE TO SAID POINT BEARS S 62-05-43" EAST; THENCE SOUTHWESTERLY ALONG THE ARC OF SAID CURVE, THROUGH A CENTRAL ANGLE OF 5803647", AN ARC DISTANCE OF 255.67 FEET TO THE BEGINNING OF A NON -TANGENT CURVE, HAVING A RADIUS OF 210.00 FEET, A RADIAL LINE TO SAID POINT BEARS SOUTH 070462:4" EAST; THENCE NORTHEASTERLY ALONG THE ARC OF SAID CURVE, THROUGH A CENTRAL ANGLE OF 6002946", AN ARC DISTANCE OF 221.73 FEET; THENCE NORTH 21043-50" EAST, A DISTANCE OF 16.88 FEET; THENCE SOUTH 673844" EAST, A DISTANCE OF 27.27 FEET; THENCE NORTH 67021'16" EAST, A DISTANCE OF 7.07 FEET; THENCE SOUTH 67038-44" EAST, A DISTANCE OF 3.21 FEET, 20F3 DOC #2021-0394762 Page 6 of 8 EXHIBIT "A" LEGAL DESCRIPTION LOT LINE ADJUSTMENT NO. 2021-0006 THENCE ;SOUTH 23008'15" WEST, A DISTANCE OF 5.00 FEET TO THE POINT OF BEGINNING; LOT 65 AREA CONTAINING 3,880 SQUARE FEET OR 0.089 ACRES MORE OR LESS. TOTAL ADJUSTED AREA OF PARCEL "D" CONTAINS 6,499,770 SQUARE FEET OR 149.214 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: Le /�'- A. CHARLES R. HARRIS P.L.S. 4989 DATED: / Z/ 30F3 QCHARLES R. HARRIS No. 4888 \ OF CpJ.�F DOC #2021-0394762 Page 7 of 8 CITY OF LA QUINTA - CERTIFICATE OF LOT LINE ADJUSTMENT EXHIBIT •B• I LOT LINE ADJUSTMENT NO. 2021-0006 PAR. "B" LLA 2020-015 DOC. NO. 2020-0661120 REC. 12/28/2020, O.R. POR. OF LOT 68 M.B. _249/1-1;3 PARCEL •D• 6,499,770 SQ. FT 149.214• AC. OWNER: THE QUARRY AT LA QUINTA, INC. APN 766-050-017 FZ� � .\65' 0' 100' 200' NEW ADJUSTED LOT LINE LOT 64� N 89'57'35" W (R) MOST NORTHERLY CORNER LOT 63 NEW ADJUSTED LOT LI N E / 3 I LOT 6:3 AREA /N 5,850 SQ_ FT. �v / CO 18.5 /PARCEL -AI• iV 32,575 SQ. FIT. 63 _ / LOT LINE TO I / BE ADJUSTED /APN 766-045-001 / P.O.B. Yo,�sw LOT 63 AREA & OT OAREA 1 COR LOT 63 ,40 u PARCEL •B• °j /h 25,169 SQ. FT. LOT LINE TO P.O.B. / BE ADJUSTED LOT 65 AREA & v- 64 SCALE 1"=100' LOT 64 AREA 2 SW COR LOT 64 APN 766-045-002 . NW COR LOT 65 / I NEW ADJUSTED LOT LINE -LOT 64 LOT 65 , AREA 2 MOST WESTERLY 97 SQ FT CORNER LOT 65 AREA G1 PARCEL •C• 0. 3,880 SQ. FT. / ,`G�1 31,340 SQ. FT. p,L L.AIND LOT LINE TO BE-ADJUS" SG _ 65 PN 766 0� 00� a C "RIS 0 No..�39� F OF CF�L\F DATED: :5 LEGEND AREA 1 3,631 SQ. FT. SEE DETAIL •A• ON SHEET 2 - S 07'46'24" 7� 18.5' H M Z a J O N Q U- 2 O 10" P.U.E. PER / M.B.249/1-13 TOM FAZIO LANE SOUTH EXISTING LOT LINE TO BE ADJUSTED — — — — EXISTING LOT LINE TO REMAIN NEW ADJUSTED LOT LINE (-) INDICATES RECORD DATA PER M.B. 249/'1-13 SEE SHEET 2 FOR LINE AND CURVE DATA IBMSA CONSULTING, INC. PLANNING ■ CIVII. ENGINEERING F LAND SURVF?YING J.N. 2679 SHEET 1 OF 2 DOC #2021-0394762 Page 8 of 8 CITY OF LA QUINTA - CERTIFICATE OF LOT LINE ADJUSTMENT EXHIBIT •B• I LOT LINE ADJUSTMENT NO. 2021-0006 LOT 64 AREA 1 3,631 SQ. FT. PARCEL W 25,169 SQ. FT. ;6 / LOT 64 AREA 2 N 6 - 97 SQ. FT. W P.O.B. LOT 65 AREA & / LOT 64 AREA 2 LOT 65 SW COR LOT 64 NW COR LOT 65 AREA /CS 62'05'43" E 3,880 SQ. FT. R / PARCEL 'C• DETAIL •A• 31,340 SO. FT. 1' = 10, LINE DATA NO. BEARING LENGTH L1 S 89'39'47" W 41.07' L2 N 21'43'50" E 61.38' L3 N 23*01'18" E 113.49' L4 S 45'20'13" E 12.00' L5 IS 23*08'15" W 102.83' L6 N 67'38'44" W 3.21' L7 S 67*21'16" W 7.07' L8 N 67'38'44" W 27.27' L9 N 21'43'50" E 91.98' L10 N 67'38'44" W 16.79' L11 IS 22'38'44" E 7.07' L12 N 67'38'44" W 21.86' 3 N 23'08'15" E 5.00' E4 N 21'43'50" E 16.88' L15 N 21'43'50" E 170.24' CURVE DATA NO. DELTA RADIUS LENGTH Cl 60'29'46" 210.00' 221.73' C2 58'35'47" 250.00' 255.67' 0' 10' 20' SCALE 1 "=10' MSA CONSUMING, INC. PLANNING ■ CIVEL ENGINEERING PF LAND SURVEYING J.N. 2679 SHEET 2 OF 2 J , _. _ ' PETER ALDANA P o Ba �s 1 COUNTY OF RIVERSIDE Riverside, CA 92502-0751 (951) 486-7000 ASSESSOR -COUNTY CLERK -RECORDER . .. : _ Website: W".riversideacncom cL`R DOCUMENTARY TRANSFER TAX AFFIDAVIT WARNING - ANY PERSON WHO MAKES ANY MATERIAL MISREPRESENTATION OF FACT FOR THE -PURPOSE OF AVOIDINGALL 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 =-05o -=017 I declare that the 7documentarytransfer tax for this Property Address: pre Qu Quarry: n. I :a( i dritn; rA. g295,1. transaction is: $.0:00 If this transaction. is. exempt from Documentary Transfer Tax, the reason must be identified below. I CLAIM THAT THIS TRANSACTIONIS EXEMPT FROMDOCUMENTARYTRANSFER TAX BECAUSE. -(The Sections listed below are taken from the.Revenue and Taxation Code with the exception of items 9 and 10 which are taken from Riverside County Ordinance 516).. Please check one or:explain in "Other': 1." X Section 1191.1..:. The consideration. or value bf_the property, exclusive of any. liens and encumbrances is $100.00 :or less arid: there is no additional consideration received by the grantor.:. 2... Section 1191.1. 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- 11 925. The transfer is between individuals- and a -legal entityor 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 maybe 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 bygovernmenta.I 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 Forin 709 (Federal Gift Taz Return) with the Internal Revenue Service. 9. Section 8. The easement is � e etual ermanent, or for life. ]14�.P 1P , p .. 10. - Section 9. The_document-is-a lease for a term of LCILthan (35) years (including written options:) 11. . ' .Other (Include explanation, and legal authority). - -- I DECLARE UNDER ENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. 1l.-. ..... _ .... .ExecutedthisJ day of: 1-46V ,20 ..at I a Oiiinta ('.A City State oilc Don -Hurter Signature of Affiant Printed Name of Affrant _a�Zuinta Inc One Quarry an _; La Quinta; A A225. - Name of.Firm (if applicable) Address of Afffant (including City, State, and Zip Code) IUD-111- 1100 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 Foi mats BOE-502-A (P1) REV. 15 (02-21) 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. APreliminary Change of Ownership Report must be filed with each conveyance in the County Recorder's office for the county where the property is located. NAME AND MAILING ADDRESS OF BUYER/TRANSFEREE (Make necessary corrections to the printed name and mailing address) r- L PETER ALDANA, COUNTY OF RIVERSIDE ASSESSOR - COUNTY CLERK - RECORDER PO BOX 751, RIVERSIDE, CA 92502-0751 (951) 955-7006 www.dversideaer.com ASSESSOR'S PARCEL NUMBER 7 766-050-017 SELLER/TRANSFEROR The Qaurry at La Quinta, Inc. BUYER'S DAYTIME TELEPHONE NUMBER (760 ) 777-1100 J BUYER'S EMAIL ADDRESS dhurter@thequarrygc.com STREETADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY One Quarry Lane, La Quinta, CA 92253 This roe Is intended as m principal residence. If YES, lease indicate the date of occupancyMo DAY YEAR YES � NO property rtY Y P P P 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 ICA 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 orremoval of a spouse, death of a spouse, divorce settlement, etc.). aB. 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) ❑ between grandparent(s) and grandchild(ren). Was this the transferor/grantor's principal residence? ❑ YES ❑ NO * 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 P/ * F. This transaction is to replace a principal residence by a person who is severely disabled. Within the same county? ❑ YES ❑ NO *G. This transaction is to replace a principal residence substantially damaged or destroyed by a wildfire or natural disaster for which the Governor proclaimed a state of emergency. Within the same county? ❑ YES NO H. 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: W] I. The recorded document creates, terminates, or reconveys a lender's interest in the property. ❑ J. 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: ❑ K. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. L. This is a transfer of property: ❑ W 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 11registered domestic partner. 0 2, to/from an irrevocable trust for the benefit of the 1-1 creator/grantor/trustor and/or grantor's/trustor's spouse F grantor's/trustor's registered domestic partner. M. This property is subject to a lease with a remaining lease term of 35 years or more including written options. [VI F1 N. 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 O. This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions, or restrictions imposed by specified nonprofit corporations.. * P. This transfer is to the first purchaser of a new building containing an active solar energy system. 0 Q. 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. 15 (02-21) 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: 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 Is 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 payment $ Due date: D. Second deed of truss: @ % 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? []YESNO 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 ❑ Unimproved lot ❑ Other. Description: (i.e., timber, mineral, water rights, etc.) Timeshare ❑ Commercial/industrial B. ❑YES ❑ NO Personal/business property, 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 rl 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: [I Good ❑Average n Fair ❑Poor Please describe: 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. SIGNATWERJrP,ANSFWORPORATE OFFICER DAT TELEPHONE �wwKK//�'.• �� j ( 442 ) 256-6535 NAME OF BUYER/TRA SFEREEIPERSONAL REPRESENTATIVEXORPORATE OFFICER (PLEASE PRINT) TITLE EMAILADDRESS Don Hurter, General Manager l 'VK 159AA dhurter@thequarrygc.Coyh , The Assessor's office may contact you for additional information regarding this transaction.