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PM 2013-520c PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: CITY OF LA QUINTA Attn: CITY CLERK DEPT 78-495 Calle Tampico La Quinta, CA 92253 CITY of LA QUINTA DbC # 2013-0256361 Plan Set No. 05/30/2013 02:32 PM Fees: $27.00 Page 1 of 5 0I-� ��� Recorded in Official Records v County of Riverside _... -arty W. Ward Assessor, County Clerk & Recorder **This document was electronically submitted to the County of Riverside for recording— Receipted by: ARIBAC SPACE ABOVE FOR RECORDER'S USE ONLY CERTIFICATE OF PARCEL MERGER NUMBER 2013-520 APN 767-710-034 and THE GRANTOR(S) HEREIN DECLARE(S) APN 767-710-035 DOCUMENTARY TRANSFER TAX IS $ 0 CITY TAX IS $ 0 computed on full value of property conveyed, or computed on full value less value of liens or encumbrances remaining at time of sale, Unincorporated area:OCity of La Quinta THIS AREA FOR RECORDERS USE ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION DOC #2013-0256361 Page 2 of 5 05/30/2013 02:32 PM RECORDING REQUESTED BY CITY OF LA QUINTA When recorded, return to: CITY OF LA QUINTA CITY CLERK 78-495 CALLE TAMPICO LA QUINTA, CA. 92253 THIS AREA FOR RECORDER'S USE ONLY CERTIFICATE OF PARCEL MERGER NO. 2013-520 RECORD OWNERS EXISTING PARCELS (Assessor Parcel Numbers) JAMES & LINDA LIPPMAN 1998 TRUST 767-710-034; 767-710-035 Q LEGAL DESCRIPTION OF MERGED PARCELS z v See attached - Exhibit "A" and Exhibit "B" SIGNATURE(S) OF RECORDED OW R(S) (Musa be Notarized) d C il PrintName/Title: JAMES LIPPMAN/MEMBER Signature,* LL LLJ Y U Print NamaFrdle: Sl natuM C Print NamrlTitle: _ U Si nature: } all ❑ Print Name/Tive: Si nature: ❑ ❑ w o This Certificate of Parcel Merger reflects Parcel Merger No. 2013 - 520 as approved by the City of La Quints. � o a Date:,; r a r NOTARY ACKNOWLEDGEMENT STATE OF CALIFORNIA ) COUNTY OFE'S� On la, ��'/3 before me, oc'r.)Ie5 ,L '16,10, ��• , It /����ir-rc� ✓��%%. . (Date) (Name and title of officer) personally appeared L% 0 ;S I C.c r'L (Name(s) of signer(s)) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(&) is/are subscribed to the within instrument and acknowledged to me that he/she/tMey executed the same in his/herJ#laei authorized capacity(ie&), and that by his/hedibeir signature(a) 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 Sate of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal MELODY SALAIAR Commission 0 f92M:M4 -i Notary Public - Caldornie Los Anpelas County _ Notary Public Los Angeles Count Commission #1929664, expires 3/21/2015 DOC #2013-0256361 Page 3 of 5 05/30/2013 02:32 PM State of California County of Riverside On May 30, 2013 before me, SUSAN MAYSELS, Notary Public, personally appeared TIMOTHY R. JONASSON 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. SUSAN MAYUts Commiaaion # 2017258 . a Notary Public • California Signature 5P�} Riverside County 9 M Comm. irai r b 2017 r Susan Maysels Commission #2017258, expires 4/13/2017 (seal) Riverside County DOCUMENT: CERTIFICATE OF PARCEL MERGER #2013-520 for APNs 767-710-034 and 035, owner: James & Linda Lippman 1998 Trust. DOC #2013-0256361 Page 4 of 5 05/30/2013 02:32 PM EXHIBIT "AV SHEET 1 OF 1 CERTIFICATE OF PARCEL MERGER 2013-520 EXISTING PARCELS RECORD OWNERS ASSESSOR PARCEL NUMBERS I JAMES & LINDA LIPPMAN I 767-710—OJ4 & 767-710-05 MERGED PARCELS 1 & 2, P.M.B. 2J1/8J-84 PARCEL 'A A IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, IN SECTION 10, T6S, R7E, S.B.M.: PARCEL 1 OF PARCEL MAP J6JO0, AS RECORDED 1N BOOK 2J1 OF PARCEL MAPS A T PAGES 8J THROUGH 84, RECORDS OF RIVERSIDE COUNTY, 70GEND? W N PARCEL 2 OF SAID PARCEL MAP J6J00. CONTAINING 80,869 S.F ( 1.86 AC.) MORE OR LESS SUBJECT TO ALL COVENANTS, CONDITIONS, RESERVARONS, RESTRICTIONS RIGHTS OF WA Y, EASEMENTS, OR EXCEPTIONS OF RECORD, IF ANY. PREPA ED B WA YNE A. McGEE DA TE P.L.S. 5479 EXP. 91JO114 eta THERE MA -,'BE EASEMENTS OF RECORD DELINEATED AND REFERENCED ON THE UNDERLYING MAP, OR THERE MAY BE EASEMENTS WITHIN THE AREA BEING ADkS7FD 7HAT ARE NOT SHOWN AN THIS DOCUMENT THAT COULD ENCUMBER SAID PARCEL HEREIN. DOC #2013-0256361 Page 5 of 5 05/30/2013 02:32 PM EXHIBIT nB n "T�S PLAT WAS PREPARED FROM RECORD DATA AND DOES NOT REPRESENT A SURVEY OF THE PROPERTY CERTIFICATE OF SHOWN HEREON. THIS MAP HAS BEEN APPROVED UPON THE F_XPRESSED CONDITION IHA T BUILDING PARCEL MERGER 2013-520 PERMITS SHALL NOT BE ISSUED FOR ANY DEVELOPMEN" WITHIN THIS ADJUSTMENT PLAT UNTIL NECESSARY DEDICATIONS, IF ANY, HAVE OCCURRED. ,ANAL LANp S G 60 0 30 60 ��7� yNE A. IP 4 1 inch = 60 ft. N0. 5479 Exp. 9/30/14 s9Te O� CAL 1 � 0��`P LOT P' TRACT NO. JJ076-1 MB J88157-79 GOLF COURSE EASEMENT NOTES 1� INDICATES 12.00 FOOT WIDE EASEMENT RESERVED TO THE OWNERS FOR LANDSCAPE AND DRAINAGE PURPOSES PER TRACT NO. 33076-2, M.B. 393/61-80 Q INDICATES 22.00 FOOT WIDE EASEMENT TO THE CITY OF LA QUINTA FOR PUBLIC UTILITY PURPOSES PER TRACT NO. 33076-2, M.B. 393/61-80 © INDICATES 22.00 FOOT WDE EASEMENT TO IMPERIAL IRR- IGATION DISTRICT FOR UTILITY PURPOSES PER IRA CT NO. 33076-2, M.B. 39JI61-80 LOT b" TRACT NO. 3JO76-1 2¢ MB 388/57-7P GOLF COURSE PARCEL 1 PARCEL MAP 36300 PUB 231/83-84 A.P.N. 767-710-034 •P `- LOT LINE TO BE DELETED PER THIS MERGER Q� 3 � PARCEL 2 , 2 � PARCEL MAP 36300 PUB 231/83-84 o A.P.N. 767-710-035 ate. g ti 2 3 i N g2 �T 5r" µ. 175 88' LOT 103 TRACT NO. 33076-2 B A F F I N MB 393/61-80 rA A V E N U E A.P.N. 767-710-016 PRIVATE STREET CURVE TABLE CURVE LENGTH RADIUS DELTA C11 82.35 65.00 72'35'30' C21 22.95 150.00 8'46'01' C31 67.97 150.00 25'57'43' LOT 100 TRACT NO. 33076-2 MB 393/61-80 A,P.N. 767-710-013 Tan9492 3490 .A=.46' R=15q000I Fr;FAIn PLAT- CITY OF LA OUINTA PREPARED BY.• WA YNE A. McGEE DA TE I C' Fd 7Q APPL/CANT JAMES & LINDA LIPPMAN CIO McGEE SURVEYING INC. — 00 GOLF CENTER PKWY, STE. G INDIO, CA 92201 EXIST LOTS LINE TO REMAIN LOT LINE TO BE DELETED t• ut utt�4 ,° LARRY W. WARD Recorder Tsl COUNTY OF RIVERSIDE Riverside, CA 92502-0751 ASSESSOR -COUNTY CLERK -RECORDER (951)486-T000 F` Wobsita 11 mv.nvcrsidcaer.cnm 171 41tiv'� 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 1S SUBJECT TO PROSECUTION FOR SUCH OFFENSE. 7 10 06 ASSESSOR'S PARCEL NO. 7L1--- 71 D-- 03S 1 declare that the documentary transfer tax for this Property Address: IchL 101a 5f f(213. "ADI-'oA CtL)b transaction is: $ C R Q J/n)-tr If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below. I CLAIM THAT THIS TRANSACTION IS EXEMPT FROM DOCUMENTARY TRANSFER TAX BECAUSE: (The Sections listed belotp are taken from the Revenne and Taxation Code. Please check one or explain in ''Other".) 1. _ Section 11911. The document is a lease for a term of less than thirty-five (35) years (including options). 2. _ Section 11911. The easement is not perpetual, permanent, or for life. 3. _ Section 11921. The instrument 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 between legal entities, and does not change the proportional interests held. 6. _ Section 11926. The instrument is from a trustor to a beneficiary, in lieu of foreclosure, and no additional consideration was paid. 7. —Section 11926. The grantee is the foreclosing beneficiary and the consideration paid by the foreclosing beneficiary does not exceed the unpaid debt. 8. _ Section 11927. The conveyance relates to a dissolution of marriage or legal separation. 9. — 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 Gin Tax. In such cases, the Transferor (donor/grantor) may be required to file Form 709 (Federal Gift Tax Return) with the Internal Revenue Service, 10. _ Section 11930. The conveyance is to the grantor's revocable living trust. 11. Other (Include explanation and authority) FE040A/ r � I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Executed 's 2 6 day of nj A& C 1a 20 1 3 at L o� AAjG nr LC 5 CA City .0 State Si turc orA(Fiam Pdnied Name orAMant 11-7(n6 W1L5H1a Lira. 1 7w tov/t t<.R CA. ^1oo2S Name of Finn (irapplicable) Address ofAtftont (including City, State, and Zip Code) 310 Z(.W - 834`i Telephone Nurrther ofAfflant (including area code) This form is subject to the California Public Records Act (Government Code 6250 et. seq.) For Recorder's Use: Affix POOR Label Here ACR 521 (Rev. 03/2012) Available in Alternative Fotmots SOE-502-A (P7) REV. 11(07-10) 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 Repart must be filed with each conveyance In the County Recorder's office for the county where the property Is located. Please answer aft questions in each section, and sign and complete the certification before filing. This form may be used in all 58 California counties. If a document evtdencing a change in ownership Is presented to the Recorder for recordation without the concurrent filing of a Preliminary Change of Ownership Report, the Recorder may charge an additional recording fee of twenty dollars ($2p). NOTICE: The property which you acquired may be subject to a Supplemental assessment In an amount to be determined by the County Assessor. Supplemental assessments are not paid by the title or escrow company at close of escrow, and are not Included In lender impound accounts. You may be responsible for the current or upcoming prop arty taxes even If you do not Tocelva the tax bill. TARRY W. WARD, COUNTY OF RIVERSIDE ASSESSOR - COUNTY CLERK - RECORDER PO 90X 12004, RIVERSIDE, CA 92502 2204 (951) 955.5200 www.dverefdoscr.com ASSESSOR'S PARCEL NUMBER f7 L. ri.I 1b-D3t-1 BUYER'S DAMME TELEPHONE (",fN) 7(n0, .0-; to -035 STREETADDRESS OR PHYGJPAL LOCATION OF REAL PROPERTY L-A MAIL PROPERTY TAX INFORMATION TO (NAME) _ ADOA _ CITY ... ZIP CODE ��lv_�� u� ��h FIc>Q� [cam 9o©z5 EYES [:]NO This properly is Intended as my principal residence. If YES, please Indicate the date of occupancy YEnR _ or Intended occupancy. PART 1. TRANSFER INFORMATION Please complete all statements. T 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, farmination settlement, etc.). ❑ • C. Thls is a transfer between: ❑ parent(s) and chlld(ran) ❑grandparent(s) and grandchlld(ren). ❑ • D. ThIs transaction Is to replace a principal residence by a person 55 years of age or older. Within the same county? ❑YES ❑ NO ❑ M • E. This transaction Is to replace a principal residence b a arson who is severely disabled as defined by Revenue and Taxation Code section 69.6. Within the same county? []YES ff NO ❑ ® F. 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 explalw ❑ ® G. The recorded document creates, terminates, or reconveys a lender's Interest In the property. ❑ H. 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: ❑ ® I. The recorded document substitutes a trustee of a trust, mortgage, or other similar document J. This Is a transfer of property: ❑ © 1, toffrom a revocable trust that may be revoked by the transferor and Is for the benard of ❑ the transferor, andlor ❑ the transferor's spouse ❑ registered domestic partner. ❑ 2. tolfrom a trust that may be revoked by the crealar/grantor/trustor who Is also a joint tenant, and which names the other joint tenants) as benellclarles when the creator/grantorltrustor dies. ❑ ® 3, to/from an Irrevocable trust for the benefit of the ❑ creatorlgrantor/Irustor and/or ❑ grantor'aRrustor-s spouse ❑ grantor'sitrustor's registered domestic partner. ❑ ® 4. telfrom an Irrevocable trust from which the property reverts to the createrlgrantoritrustor within 12 years. ❑ ® K. This property Is subject to a lease with a remaining lease term of 35 years or more Including written options. ❑ L. This is a transfer between parties In which proportional Interests of the transferor(s) and transferse(s) in each and every parcel being transferred remain axactly the same after the transfer. ❑ M. This is a transfer subject t0 subsidized low-income housing requirements with governmentally imposed restrictions. ❑ 9• N. This transfer is to the first purchaser of a new bullding containing an active solar energy system. If you checked YES to statements C, 0, or E, you may qualify for a property lax reassessment exclusion, which may allow you to maintain your previous tax base. If you checked YES to statement N, you may qualify for a property tax new construction exclusion. A claim form must be filed and all requirements met in order to obtain any of these exclusions. Contact the Assessor for elalm forms. 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.11 (07-10) PART 2.OTHER TRANSFER INFORMATION A. Date of transfer, if other than recording date: Check and complete as applicable. B. Type of transfer: Purchase ❑ Foreclosure ❑ Glft ❑ Trade or exchange ❑ Merger, stock, or partnership acquisition (Form BOE-100-B) ❑ Contract of sale. Dale 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 (lnduding written options): Other. Please explain: 1Y 0 f rA1V:5FEk ■ DW Neva o w �M' -6r h l�ro�e r l C s C. Only a partial Interest In the property was transferred. YES ❑ NO If YES, Indicate the PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable. A. Total purchase or acquisition price. Do not Include closing costs or mortgage Insurance. :5 Down payment: $ Interest rate: % Seller-pold points or dosing costs: S Balloon payment: $ Loan carried by seller Assumption of Contractual Assessment' with a remaining balance of: S An assessment used to finance property-speclffc Improvements that constitutes a lien against the real property. B. The property was purchased: ❑Through real estate broker. Broker name: Phone number: ❑ Direct from seller ❑ From a family member ❑ Other. Please explain: C. Please explain any special terms, seller concessions, financing, and any other Information (e.g., buyer assumed the exlsling loan balance) that would assist the Assessor in the valuation of your property. PART 4, PROPERTY INFORMATION A. Type of property transferred ❑ Single-family residence ❑ Multiple -family residence, Number of units: ❑ Other. Description: (I.e., timber, mineral, water rights, etc.) Check and complete as applicable. ❑ Co-op/Own-your-own ❑ Condominium ❑ Timeshare ❑ Manufactured home ❑ Unimproved lot ❑ Commeroialnndustr(al B.❑YES []NO Personallbusiness property, or Incentives, are included in the purchase price. Examples are furniture, farts equipment, machinery, club memo vrshlps, etc. Attach list If available. If YES, enter the value of the personal/business properly: $ C.❑YES []NO Amanufactured home Is inciuded 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: ❑ Leaseirent ❑ Contract ❑ Mineral rights ❑ Other: E. The condition of the property at the time of sale was: ❑Good []Average ❑Fair ❑Poor �J CERTIFICATION I certify (or declare) under penally of perjury under the laws of the state of California that the foregoing and all Information hereon, including any accompanying statements or documents, /s true and correct to the best of my knowledge and belief. This declaration Is binding on each and every buyer) sferee. I$ UYATURE OF SFFREF OR COR PCRATE CIFF IC EAnerc 0. k r 3-2- c. - i 3 The Assessor's office may contact you for additional information regarding this transaction. are e M z�or3- sz� City of La Quinta Public Works Department 1- 4 7- 78-495 Calle Tampico a f ' t` La Quinta� California 92253 �k wu PHONE: (760) 777-7075 FAX: 777-7155 APPLICATION FOR PARCEL MERGER APPROVAL Finance Codc: W3 OFFICE USE ONLY LCN No. 11J OZ?7 Date Recvd. Fee: 200 Related Apps: Received by: PARCEL MERGER applications are reviewed and approved by the Public Works Director pursuant to Chapter 13.36 of the Subdivision Regulations. The purpose is to allow merger of contiguous parcels or units of real property, under common ownership. 4..•..•..•..•..•..•. 0..•..•..•..•..•..•. o..•..•..•..•. + 4. 4. 4. 4..•..•..•..•. 4..•..•. o. o. 4..•..•. 4..•..•..•..•..•. 4. 4. 4. 4. 4..•..•. 4..•..•. .................................................... \\ rr g APPLICANT �l�t"►�3 -b L-t'�l y � h a - - (Print) 1-1 MAILING ADDRESS I jI(A.. 91y 4 jeI FI rP ( Phone No. 310 CITY, STATE, Fax No. 31 O 210 7 G— PROPERTY OWNER (If different): J 4IYlC5 w is N DA , L,4 4?ama n 1941 g 70U 6 f (Print) MAILING ADDRESS -il710 (g W j 1j 1,�h l t^� �_�_ 0 f � ,��(Phone No._ 3 l0 - 24 $" k349 CITY, STATE, ZIP:. LOS a rw-y-jCS5 g�A 9 = 2_Fax No. 51 O -vow -79 4 3 MERGER LOCATION V ol Assessor Parcel Number r)of Parcels to be Merged: Parcel 1 7 7 - '7 i e - o 3 q �� Parcel 2 7 - 71 o - 03 ar �� 3 Parcel 3 - - � N TY �F QUTAIZA Parcel 4 - - ��P'r (Attach additional sheets, if necessary) APPLICABILITY: Merger may be processed if the following requirement is satisfied: ❑ At least one of the affected parcels is undeveloped by any structure for which a building permit was issued or for which a building permit was not required at the time of construction, or is developed only with an accessory structure or accessory structures, or is developed with a single structure, other than an accessory structure, that is also partially sited on a contiguous parcel or unit. CADocuments and Settings,,,azarcolDes ktopTarcel Merger Approval.doc 1), CRITERIA FOR APPROVAL: To obtain approval of a merger, the following criteria shall be met: ❑ The merger complies with the standards specified in Section above. ❑ The parcel will be consistent with the zoning of the property. ❑ The parcel will not conflict with the location of existing structures on the property. ❑ The parcel will not be deprived of adequate access as a result of the merger. ❑ Access to adjoining properties will not be restricted as a result of the merger. ❑ No new lot lines are created by the merger. MINIMUM SUBMISSION REQUIREMENTS: Existing grant deeds or title reports for all affected parcels. © New, original, unrecorded Certificate of Parcel Merger for each resulting parcel with the following: Correct legal description of the merged parcel and the statement, "This Certificate of Parcel Merger" % reflects Parcel Merger No. , as approved the City of La Quinta." Completed Certificate of Parcel Merger No. , "Exhibit A" / Completed Certificate of Parcel Merger No. , "Exhibit B" - Plat showing merged parcels ❑' Completed Site Plan, showing merger parcels and existing structures and improvements; if any. ❑ If metes and bounds legal description is used for merged parcels, closing calculations shall be / submitted. �i Filing fee for Parcel Merger. If filing multiple applications, the most expensive application will be charged full fee, with remaining related applications discounted 50% for each. ❑ / Assessor's Plat Copy of record map which created or amended parcels or proof that the parcels were legally created (a deed for the property recorded prior to March 4, 1972 is acceptable). ❑ Please download, complete and submit the following required forms from the County of Riverside ACR website htti):/Iriverside.asi-clkrec;.com/fo--Mare.aM Documentary Transfer Tax Affidavit (ACR 521) +� Preliminary Change of Ownership Report (BOE 502 A) ❑ A check made out to the County of Riverside http://riverside.asrclkree.com/foams/Fee°/n2OSchedule.vdf for Basic Recording Fees to be calculated as follows: o First Page $15.00 o Each Additional Page $3.00 o Surveyor Monument Preservation Fund $10.00 (Please refer to the Cuugof Riverside link above for updated fee schedule information) ♦•i ♦♦i ♦O O♦ 4. ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦i •♦♦ ♦♦i ♦♦♦ ♦` ��� o♦♦ ♦♦i ♦♦i ♦♦i O♦ ♦♦♦ ♦♦i O♦ ♦♦i ♦♦i ♦♦♦ ♦♦♦ O♦ ♦♦i ♦♦i ♦♦i ♦♦i ♦♦i ♦♦i ♦♦♦ Di Oi ♦• ♦O ♦♦► ♦♦i ♦O ♦♦i O♦ ♦♦♦ ♦♦i ♦♦i ♦ ♦ ♦ ♦ ♦ • ♦ • ♦ ♦ ♦ • • • ♦ • ♦ • a� • ♦ ♦ ♦ • • ♦ ♦ ♦ ♦ • • ♦ ♦ ♦ ♦ ♦ ♦ ♦ • • ♦ ♦ ♦ ♦ ♦ • ♦ ♦ • SIGNATURE OF APPLICANT DATE_ NAME OF APPLICAN`lA/Y%ES ij'1 c7� T (Please print) SIGNATURE OF PROPERTY OWNER(S) IF NOT SAME AS APPLICANT: DATE NAME OF OWNER (Please print) (Separate written authority by owner to submit application may be submitted) NOTE: FALSE OR MISLEADING INFORMATION GIVEN IN THIS APPLICATION SHALL BE GROUNDS FOR DENYING APPLICATION. CADocuments and Settings\azarco\Desktop\Parcel Merger Approval.doc