recording requested by-(}!7l'-& i i old republic title ...recording requested by old...

13
RECORDING REQUESTED BY-& I i Old Republic Title Company Order No.: APN: 0621004259-JW 779-06-002 When Recorded Mail Document and Tax Statements to: Indian Muslim Relief and Charities, a California non- profit corporation & South Valley Islamic Center, Inc. a California non profit corporation 1000 San Antonio Palo Alto, CA 94303 Grant Deed 779-06-002 The undersigned grantor(s) declare(s): Documentary Transfer Tax is see declaration attached hereto Wallace for ORTC (X) computed on full value of property conveyed, or ( ) computed on full value less of liens and encumbrances re (X) Unincorporated area: ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, South County Paners, LLC, a California limited liability company, and Cencon Invest LLC, a California limited liability company hereby GRANT(S) to Indian Muslim Relief Charities, a California non profit Corporation as to an undivided 50% interest, and South Valley Islamic Center, a California non profit Corporation, as to an undivided 50% interest, that propey in Unincorporated area of Santa Clara County, State of California, described as follows: See "Exhibit A" attached hereto and made a pa hereof. Date: March OS 2013 Cencon Invest LLC, a California limited liability company, Managing Member Grant Deed THISDEED IS BEING EXECUTED IN COUNTERPART B y : ________ __ _ Rana N. Ahmed Managing Member By : _____ ___ _ _ Manzoor Ghori Managing Member MAIL TAX STATEMENTS AS DIREED ABOVE Page 1 of 2

Upload: others

Post on 21-Mar-2020

0 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

RECORDING REQUESTED BY-(}!7l'-& I jl'" /) i Old Republic Title Company

Order No.: APN:

0621004259-JW 779-06-002

When Recorded Mail Document and Tax Statements to:

Indian Muslim Relief and Charities, a California non­profit corporation & South Valley Islamic Center, Inc. a California non profit corporation 1000 San Antonio Palo Alto, CA 94303

Grant Deed 779-06-002 The undersigned grantor(s) declare(s): Documentary Transfer Tax is see declaration attached hereto __,__=--=-------�]. Wallace for ORTC (X) computed on full value of property conveyed, or ( ) computed on full value less of liens and encumbrances re (X) Unincorporated area: ( ) City of

FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, South County Partners, LLC, a California limited liability company, and Cencon Invest LLC, a California limited liability company

hereby GRANT(S) to Indian Muslim Relief Charities, a California non profit Corporation as to an undivided 50% interest, and South Valley Islamic Center, a California non profit Corporation, as to an undivided 50% interest, that property in Unincorporated area of Santa Clara County, State of California, described as follows: See "Exhibit A" attached hereto and made a part hereof.

Date: March OS 2013

Cencon Invest LLC, a California limited liability company,

Managing Member

Grant Deed

THIS�DEED IS BEING EXECUTED IN COUNTERPART

By: ________ __ _ Rana N. Ahmed Managing Member

By: _____ ___ _ _ Manzoor Ghori Managing Member

MAIL TAX STATEMENTS AS DIRECTED ABOVE Page 1 of 2

Page 2: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

RECORDING REQUESTED BY: �ff L" - & fc1 Old Republic Title Company

Order No.: 0621004259-JW APN: 779-06-002

When Recorded Mail Document and Tax Statements to:

Indian Muslim Relief and Charities, a California non­profit corporation & South Valley Islamic Center, Inc. a California non profit corporation 1000 San Antonio Palo Alto, CA 94303 --------------------------- SPACE ABOVE THIS UNE IS FOR RECORDER'S USE ____ _

Grant Deed 779-06-002

t.

The undersigned grantor(s) declare(s): /1 .Ill ({aL'-Documentary Transfer Tax is see declaration attached hereto -+--UJ __ V<..-______ J. Wallace for ORTC (X) computed on full value of property conveyed, or ( ) computed on full value less of liens and encumbrances re aining at time of sale. (X) Unincorporated area: ( ) C ity of

FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, South County Partners, LLC, a California limited liability company, and Cencon Invest LLC, a California limited liability company

hereby GRANT(S) to Indian Muslim Relief Charities, a California non profit Corporation as to an undiv ided 50% interest, and South Valley Islamic Center, a California non profit Corporation, as to an undivided 50% interest, that property in Unincorporated area of Santa Clara County, State of California, described as follows: See "Exhibit A" attached hereto and made a part hereof.

Date: March 05 2013

alifornia limited liability company Cencon Invest LLC, a California limited liability company,

rr-

Managing Member

Grant Deed

THIS DEED IS BEING EXECUTED IN COUN?

By� L______f_ naN:Ahmect Managing Member

By: _________ _ Manzoor Ghori Managing Member

MAIL TAX STATEMENTS AS DIRECTED ABOVE Page 1 of 2

Page 3: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

RECORDING REQUESTED BY: c:K:t?! 4;,:.� Old Republic Title Company

Order No.: APN:

0621004259-JW 779-06-002

When Recorded Mail Document and Tax Statements to:

Indian Muslim Relief and Charities, a California non­profit corporation & South Valley Islamic Center, Inc. a California non profit corporation 1000 San Antonio Palo Alto, CA 94303

SPACE ABOVE THIS LINE IS FOR RECORDER'S USE ����----------------------- -----Grant Deed

779-06-002

The undersigned grantor(s) declare(s): . Documentary Transfer Tax is see declaration attached hereto J. Wallace for ORTC (X) computed on full value of property conveyed, or ( ) computed on full value less of liens and encumbrances remaining at time of sale. (X) Unincorporated area: ( ) City of

FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, South County Partners, LLC, a California limited liability company, and Cencon Invest LLC, a California limited liability company

hereby GRANT(S) to Indian Muslim Relief Charities, a California non profit Corporation as to an undivided 50% interest, and South Valley Islamic Center, a California non profit Corporation, as to an undivided 50% interest, that property in Unincorporated area of Santa Clara County, State of California, described as follows: See "Exhibit A" attached hereto and made a part hereof.

Date: March 05 2013

South County Partners, LLC, a California limited liability company Cencon Invest LLC, a California limited liability company,

By: ________ __ _ Sharif Razzaqui Managing Member

By: _______ ___ _ Sohail Akhter Managing Member

Grant Deed

THIS DEED IS BEING EXECUTED IN COUNTERPART

By: _ ___ ______ _ Rana N. Ahmed Managing Member

By )-�li)�,4,, ' Manzoor Gho Managing Member

MAIL TAX STATEMENTS AS DIRECTED ABOVE Page 1 of 2

Page 4: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

DO NOT RECORD

FILOR REQUESTS DO NOT RECORD STAMP VALUE

DECLARATION OF T AX DUE: SEPARATE PAPER: {Revenue and Taxation Code 11932-11933)

NOTE: This Declaration is not a publlc record

DOCUMENT#��������-

Property located In:

�nlncorporated

[ ] City of. ______________ _ APN:_1-..:..-..i1f.__-_CJ_6_ ... --'-t1_tJ_Z-____ _

v_c

DOCUMENTARYTRANSFERTAX $�--�-=-- __,__/_���� -'-----���-�omputed on full value

[ ] Computed on full value less liens or encumbrances remaining at the time of conveyance

. CITY CONVEYANCE TAX $ �

"I declare under penalty of perjury under the laws of the State of California that the foregoing Is true and correct."

Date

Print Name

&�t &�,;:�Iii!(/!__ For (Firm Name) I

Rev. 01/97 DO NOT RECORD

Page 5: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

srate ofa� County of ���

On J--f-Neta� Pu�k. pe�onally appeare� d���������� ������������������������� who proved to me on the basis of satisfacto� evide to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/the'( executed the same in his/her/thejr 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 instrumer I certify under PENAL TY 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.__#��&:����===;:����� Name

Grant Deed

r;;q����rA;E· * 1 � �-:��r-� Commission # 18�968_9 z �I.�:& .,U,:i1 ;;1. Notary Public - Cal1fo1nia z z � \.\___........,� ,ti' .,,, z �f'..r Santa Cl�ra County � � M�£o�r2. zx�ir;s}"�9�� '9"7-

(Area reserved for official notarial seal)

Page 2 of 2

Page 6: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

State of -�c�C'\_I_, {_c)_f n_,_"1'--------

County of A t � un e J11 On t'v\ 1c. �' �+" ' 0 \ Notary Public, personally appeared who proved to me on the basis of satisfactory evidence to be the person(5f whose name� is/are- subscribed to the within instrument and acknowledged to me that he,t4iefthey executed the same in his/her'ftl=l9ir authorized capacity(i�, and that by his/l=ler/tl=leir signature'5} on the instrument the personfst, or the e1tity upon behalf of which the personfsj. acted, executed the instrument.

I certify under PENAL TY 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 M . C h&ia d l...V "'I" Name 1\1. C�1c."d1..vc-,/1J

(typed or printed)

Grant Deed

(Area reserved for official notarial seal)

Page 2 of 2

Page 7: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

state of ��(\IC County of _{Q ��·VO On \1\(:),\- -h Notary Public, personally appeared , who proved to me on the basis of satisfa�ory evidence to be the person(s�,whose name(s) i are subscribed to the within -instrument and acknowledged to me that he he/they executed the same in is7 er/their authorized capacity(ies), and that by �er/their signature(s) on the instrumen� person(s), or the entity upon e alf of which the person(s) acted, executed the

instrument.

I certify under PENAL TY 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

Name

Grant Deed

(typed or printed) (Area reserved for official notarial seal)

Page 2 of 2

Page 8: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

ORDER NO.: 062100425g·JW

EXHIBIT A

The land referred to is situated in the unincorporated area of the County of Santa Clara, State

of California, and is described as follows:

All that certain real property situated in the Unincorporated Area of the County of Santa Clara,

State of California, being more particularly described as follows:

Beginning at a point in the present Westerly line of the Monterey Road, as now widened by the

State of California, that is distant thereon N. 24° 41' W., 9.545 chs from the intersection of said

Westerly line with the center line of California Avenue, as said California Avenue is shown upon the Map of the Lion Ranch, hereinafter referred to; thence leaving said Westerly line and running parallel with the center line of California Avenue S. 64° 56' W., 14.876 chs. to a point in the line dividing Lots 42 and 43, that is distant thereon N. 25° 04' W., 9.545 chs. from the center line of California Avenue; thence along said dividing line and the Northerly prolongation

thereof N. 25° 04' W., 12.g75 chs. to a 2" x 3" stake marked "Al"; thence No. 67° 17' E., 2.70 chs. to a 2" x 3" stake "B", N. a2° 20' E., i.go chs. to a 2" x 3" stake "C"; N. 77° 06' E., 1.50 chs. to a 2" x 3" stake "D"; S. ag0 54' E., 2.20 chs. to a 2" x 3" stake "E", S. a6° 22' E., 2.70 chs

to a 2" x 3" stake "F"; N. a3° 33' E., 2.40 chs to a 2" x 3" stake "G "; N. ago 04' E., 1.60 chs. to

a 2" x 3" stake "H"; and S. 60° 54' E., 0.50 chs to said presently Westerly line of the Monterey

Road; thence along said line Southerly 7.9489 chs. to the point of beginning, and being a part of Lot 42 of the Lion Ranch as shown and delineated upon that certain Map entitled, "Map of

the Lion Ranch, being the Lion Ranch Company's Subdivision of the Original Lion and Buckley Tract, in the Rancho San Francisco de las Llagas", and which said Map was filed November 12,

1920 in the Office of the County Recorder of the County of Santa Clara, State of California in Volume "P" of Maps, Pages 46, 47, 4a, 49 and 50.

EXCEPTING THEREFROM, that portion thereof, described in the Deed from Arthur 0. Zink, et ux, to Nicholas Bayto, recorded April 19, 1g44 in Book 1196 of Official Records, page 356.

APN: 77g-06-002

Page 1 of 1

Page 9: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

d);£ I !)tJ�( RECORDING REQUESTED BY

OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259

M

APN #: 779-06-002 WHEN RECORDED MAIL TO

South County Partners LLC 7881 Church Street #C Gilroy, Ca 95020

SPACE ABOVE THIS UNE FOR RECORDER'S USE

Substitution of Trustee and Deed of Reconveyance The undersigned, Connie Yu

as the present Beneficiary of the Note secured by Deed of Trust dated June 25, 2008

made by: South County Partners, LLC a California limited liability company and Cencon Invest LLC a Calfirnia limited liability company

Truster, to Chicago Title Company

Trustee, for Connie Yu

Beneficiary, which Deed of Trust was recorded July 1, 2008

Series No. 19903699, in Book , Page

of Official Records of Santa Clara, County, CA and hereby substitutes

Connie Yu as Trustee in lieu of the Trustee herein.

Connie Yu, hereby accepts said appointment as Trustee under the above Deed of Trust, and as Substituted Trustee, and pursuant to the request of said owner and holder and in accordance with the provisions of said Deed of Trust, does hereby RECONVEY WITHOUT WARRANTY, to the person or persons legally entitled thereto, all the estate now held by it under said Deed of Trust.

IN WITNESS WHEREOF the present Beneficiary above named, and Connie Yu as Substituted Trustee, has caused this instrument to be executed, each in its respective interest.

Date: March 01, 2013

Page 10: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

Substituted Trustee Beneficiary

& � 2 Connie Yu -� Connie Yu /

State of (at�UtlrL· County of �-td/-d l!f!a{. d_

On _ ___,'--'-+-�-..-- before me, //.JZ(utdJ ikf2/u;IJG a Notary Public,

�������-"'""'::...IL...LJ.:JL.LL-'-�-b.L¥-�������������������·'who proved to me on the basis of satisfactory evidence to be he person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they el cuted 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.

I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

ORT 164 [2/06]

)A,C...�f'-<><'� r���MELIND1 ·\ HUTCHISON� 0 -' · . · � Cf>M\tl. # 1�597'32 Cl . .,;�.: .�. !.) N0111RY i'Uf<LIC - CALIFuRNIA Glo f-� SANTA Cl ARA COUNTY � · A,�1.Y G (Jl\IM. EX"''RES DEC. 7, 2015 _. � . - ·

(Seal)

Page 11: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

ORDER NO. : 0621004259-JW

EXHIBIT A The land referred to is situated in the unincorporated area of the County of Santa Clara, State

of California, and is described as follows:

All that certain real property situated in the Unincorporated Area of the County of Santa Clara,

State of California, being more particularly described as follows:

Beginning at a point in the present Westerly line of the Monterey Road, as now widened by the

State of California, that is distant thereon N. 24° 41' W., 9. 545 chs from the intersection of said

Westerly line with the center line of California Avenue, as said California Avenue is shown upon the Map of the Lion Ranch, hereinafter referred to; thence leaving said Westerly line and

running parallel with the center line of California Avenue S. 64° 56' W., 14.876 chs. to a point in the line dividing Lots 42 and 43, that is distant thereon N. 25° 04' W., 9.545 chs. from the center line of California Avenue; thence along said dividing line and the Northerly prolongation thereof N. 25° 04' W., 12.975 chs. to a 2" x 3" stake marked "Al"; thence No. 67° 17' E., 2.70

chs. to a 2" x 3" stake "B", N. 82° 20' E., 1.90 chs. to a 2" x 3" stake "C''; N. 77° 06' E., 1.50

chs. to a 2" x 3" stake "D"; S. 89° 54' E., 2.20 chs. to a 2" x 3" stake "E", S. 86° 22' E., 2.70 chs

to a 2" x 3" stake "F"; N. 83° 33' E., 2.40 chs to a 2" x 3" stake "G"; N. 89° 04' E., 1.60 chs. to

a 2" x 3" stake "H"; and S. 60° 54' E., 0.50 chs to said presently Westerly line of the Monterey Road; thence along said line Southerly 7.9489 chs. to the point of beginning, and being a part of Lot 42 of the Lion Ranch as shown and delineated upon that certain Map entitled, "Map of the Lion Ranch, being the Lion Ranch Company's Subdivision of the Original Lion and Buckley

Tract, in the Rancho San Francisco de las Llagas", and which said Map was filed November 12,

1920 in the Office of the County Recorder of the County of Santa Clara, State of California in

Volume "P" of Maps, Pages 46, 47, 48, 49 and 50.

EXCEPTING THEREFROM, that portion thereof, described in the Deed from Arthur O. Zink, et

ux, to Nicholas Bayto, recorded April 19, 1944 in Book 1196 of Official Records, page 356.

APN: 779-06-002

Page 1 of 1

Page 12: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

BOE-502-A (P1) 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 Report must be filed with each conveyance in the County Recorder's office for the county where the property is located. Please answer all 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 evidencing a change in ownership is presented lo 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 ($20). 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 property taxes even if you do not receive the tax bill. FOR RECORDER'S / ASSESSOR'S USE ONLY SELLERfTRANSFEROR ASSESSOR"S PARCEL NUMBER

South County Partners LLC, et al. 779-06-002 BUYERfTRANSFEREE BUYER"S DAYTIME TELEPHONE NUMBER

Indian-Muslim Relief and Charities Inc, a non profit corporation, et al. STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY

14045 Monterey Highway, San Martin, CA 95046 MAIL PROPERTY TAX INFORMATION TO (NAME)

South Valley Islamic C_ en_ t_ e_r ____ ___ ______ ���-------------ADOREss CITY

Po Box 1777 Morgan Hill

-0 YES ti'7 NO This property is intended as my principal residence. If YES. please indicate the date of occupancy or intended occupancy.

PART 1. TRANSFER INFORMATION

YES NO

Please complete all statements.

MO

STATE IZIP CODE

CA 95037 DAY YEAR

D D

� A. This transfer is solely between spouses (addition or removal of a spouse. death of a spouse. divorce settlement, etc.).

D

c;d 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.).

,(2l ·c. This is a transfer between: D parent(s) and child(ren) D grandparent(s) and grandchild(ren).

D jZI ·o. This transaction is to replace a principal residence by a person 55 years of age or older.

Within the same county? D YES D NO

D

D D D

D

D

D 0

0 D D D D

� ·E. 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? D YES D NO 2'.) 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 explain:

G. The recorded document creates. terminates, or reconveys a lender's interest in the property.

i;t' H. This transaction is recorded only as a requirement for financing purposes or to create, terminate. or reconvey a security interest

ct

(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. to/from a revocable trust that may be revoked by the transferor and is for the benefit of

D the transferor, and/or D the transferor's spouse D registered domestic partner. 2. to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint tenant, and which

names the other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies. 3. to/from an irrevocable trust for the benefit of the

0 creator/grantor/trustor and/or 0 grantor's/truster's spouse 0 grantor's/trustor's registered domestic partner.

� 4. to/from an irrevocable trust from which the property reverts to the creator/grantor/lrustor within 12 years.

!l.J K. This property is subject to a lease with a remaining tease term of 35 years or more including written options.

i:z{ L. 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.

� -This is a transfer subject to subsidized tow-income housing requirements with governmentally imposed restrictions.

� ·N. This transfer is to the first purchaser of a new building containing an active solar energy system.

• If you checked YES to statements C, D, or E, you may qualify for a property tax 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 claim 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

Page 13: RECORDING REQUESTED BY-(}!7l'-& I i Old Republic Title ...RECORDING REQUESTED BY OLD REPUBLIC TITLE COMPANY ORDER #: 0621004259 M APN #: 779-06-002 WHEN RECORDED MAIL TO South County

BOE-502-A (P2) REV. 11 (07-10)

PART 2. OTHER TRANSFER INFORMATION

A. Date of transfer. if other than recording date: eS/JM.,t......-B. Type of transfer:

Check and complete as applicable.

.)2r Purchase D Foreclosure 0 Gift 0 Trade or exchange 0 Merger, stock, or partnership acquisition (Form BOE-100-B)

0 Contract of sale. Date of contract: D Inheritance. Date of death: -------0 Sale/leaseback D Creation of a lease D Assignment of a lease D Termination of a lease. Date lease began: --------

Original term in years (including written options): Remaining term in years (including written options): ----0 Other Please explain:

% C. Only a partial interest in the property was transferred. D YES D NO If YES. indicate the percentage transferred:

---========= 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.

Down Payment: $ ______ _

0 Loan carried by seller

Interest rate: ____ % Seller-paid points or closing costs:

Balloon payment:

0 Assumption of Contractual Assessment• with a remaining balance of:

$ < /t't;: Cd f• $ _____ _ $ ___ _ _ $

·An assessment used to finance property-specific improvements that constitutes a lien against the real property.

B. �e �perty was purchased: 0 Through real estate broker. Broker name: Phone Number: .,._ _ _,__ __ __ _ [J/Direct from seller 0 From a family member

0 Other. Please explain: -----------------------------------------C. Please explain any special terms. seller concessions, 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

0 Single-family residence

0 Multiple-family residence. Number of units: ----0 Other. Description: (i.e., timber, mineral. water rights. etc.)

D Co-op/Own-your-own

0 Condominium

0 Timeshare

D Manufactured home

�proved lot

D Commercial/Industrial

B. 0 YES 0 NO Personal/business property. or incentives, are included in the purchase price. Examples are furniture. farm equipment. machinery. club membership. etc. Attach list if available.

If YES, enter the value of the personal/business property:

$ ______ _ C. D YES D NO A manufactured home is included in the purchase price.

If YES, enter the value attributed to the manufactured home: $ ___ _____ _ D YES D NO The manufactured home is subject to local property tax. If NO, enter the decal number:

D. D YES D NO The property produces rental or other income.

If YES, the income is from: 0 Lease/rent 0 Contract 0 Mineral rights D Other: ----- ---�-_,_ __ _

E. The condition of the property at the time of sale was: D Good 0 Average D Fair 0 Poor � 1/l-CERTIFICATION

I certify (or declare) under penalty of perjury under the laws of the State of California 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. This declaration is binding on each and ev.ery buyer/transferee.

�NATUREOF BU-Y=ER�n=R�A-N-S-F E_ R_E_E _O_R_C_O_R_PO_ R_ A_T_E _O_F_Fl -C -ER-------

t�E�ERnR�R /LEGAL REPRESE�R�ATE OFFICER (PLEASE PRINT)

'DATE

TITLE

The Assessor's office may contact you for additional information regarding this transaction.