2011-028971 ~ Summer Creek (Fowler) • p,. Washington County, Oregon 2011- 028971
04/16/201103C9:49 PM I REED
D -DW
$40.00 $6.00 $11.00 $16.00 - Total • $71.00
After recording, return to:
016803831011001
The City of Tigard
I, Richard Hobernlcht, Director of Assessment and
Tax Ex•Offlclo Cok r Wealnpo
13125 S W Hall Blvd. ore on, d hereby ca unty Rlfy Cler that the within
Cou nty, Q
Tigard, Oregon 97223 Inst etlon ru of ds of p was received a d fo re orded h In t th
book of records of said cou
Richard Hobernicht,
Taxation, Ex- Officio County Clerk Assessment end
Until a change is requested, all tax statements
shall be sent to the following address:
The City of Tigard
13125 SW Hall Blvd.
Tigard, Oregon 97223
STATUTORY WARRANTY DEED
THE TRUST FOR PUBLIC LAND, a California nonprofit public benefit
corporation, Grantor, conveys and warrants to THE CITY OF TIGARD, an Oregon municipal
corporation, Grantee, the real property located in Washington County, Oregon, and described on
o the attached Exhibit A, free of all encumbrances, except those described on the attached
Exhibit B.
The true consideration for this conveyance is $1,400,000.00.
-8 § BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT, THE PERSON
E TRANSFERRING FEE TITLE SHOULD INQUIRE ABOUT THE PERSON'S RIGHTS, IF
e , ANY, UNDER ORS 195.300, 195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11,
CJ CHAPTER 424, OREGON LAWS 2007, AND SECTIONS 2 TO 9 AND 17, CHAPTER 855,
OREGON LAWS 2009. THIS INSTRUMENT DOES NOT ALLOW USE OF THE
PROPERTY DESCRIBED IN THIS INSTRUMENT IN VIOLATION OF APPLICABLE
z LAND USE LAWS AND REGULATIONS. BEFORE SIGNING OR ACCEPTING THIS
INSTRUMENT, THE PERSON ACQUIRING FEE TITLE TO THE PROPERTY SHOULD
CHECK WITH THE APPROPRIATE CITY COUNTY PLANNING DEPARTMENT TO
VERIFY THAT THE UNIT OF LAND BEING TRANSFERRED IS A LAWFULLY
ESTABLISHED LOT OR PARCEL, AS DEFINED IN ORS 92.010 OR 215.010, TO VERIFY
THE APPROVED USES OF THE LOT OR PARCEL, TO DETERMINE ANY LIMITS ON
LAWSUITS AGAINST FARMING OR FOREST PRACTICES, AS DEFINED IN ORS 30.930,
AND TO INQUIRE ABOUT THE RIGHTS OF NEIGHBORING PROPERTY OWNERS, IF
ANY, UNDER ORS 195.300, 195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11,
CHAPTER 424, OREGON LAWS 2007, AND SECTIONS 2 TO 9 AND 17, CHAPTER 855,
OREGON LAWS 2009.
Dated this 12 day of April, 2011.
-1-
The Trust for Public Land, a California
nonprofit p I ublic benefit c orporation
By: t 1 MA4.0 E. �
Thomas E. Tyner, R gional Counsel
State of WASHINGTON
County of King
This instrument was acknowledged before me on April 12, 2011, by Thomas E.
Tyner, Regional Counsel of The Trust for Public Land, a California nopzofit public benefit
corporation. ►l ow / jM
C"-- 11-1 \
•
otary Public for the State of Washington • •, PUi3OG 1t`: • moo
ACCEPTED: OF W AS ►I
THE CITY OF TIGARD, and Oregon municipal corporation
By:
Title:
Date:
-2-
The Trust for Public Land, a California
nonprofit ublic benefit corporation
By: h' Z440/1
Thomas E. Tyner, Rigional Counsel
State of WASHINGTON
County of King
This instrument was acknowledged before me on April 12, 2011, by Thomas E.
Tyner, Regional Counsel of The Trust for Public Land, a California no�pnrofit public benefit
Ny�
corporation. l i °' . wi<
ssONff•0
A 2C..Q...._/ (di / , i �► v
otary Public for the State of Washington sz. N; • P ��‘ G t,
O 5 .
F
�
ACCEPTED: = OF WAS
THE CITY OF TIGARD, and Oregon municipal corporation
By: dsell110 -
Title: C P\CA.41\aaeAr
Date: Yfr ///
-2-
State of OREGON r^ ,[�,,,
County of 1Alazh 10/I
This instrument was acknowledged before me on hi i i 1 `f'" , 2011,
by C rd J� � rosSe_r , of the City of Tigard, an Oreon municipal corporation.
a t, OFFICIAL SEAL
GREERA GASTON
Notary Public for the State of Oregon PUBLIC - OREGON
COMMISSION NO. arms
MY COMMISSI N EXPIRES OCT 10, 2011
Sfi @fu. Wcrrcrl .mod ,hc .. cl.._ -
-3-
EXHIBIT A
Legal Description
PARCEL 1 (also known as Adjustment Tract 6):
A tract of land situated in the Southeast one - quarter of Section 34, Township 1 South Range 1
West, Willamette Meridian, City of Tigard, Washington County, Oregon, being a part of the
property described in Book 737 Page 630 and Document Number 80- 033695 of the Washington
County Deed Records, described as follows:
Commencing at the Southwest corner of the property described in Document Number 80- 033695
as recorded in Washington County Deed Records; Thence N 01° 27' 13" E, along the westerly
line of said Document Number, a distance of 975.36 feet to the southerly right of way of SW
Tigard Street and the True Point of Beginning; Thence N 88° 19' 25" W, along said southerly
right of way, a distance of 250.77 feet; thence S 01° 27' 13" W, leaving said southerly right of
way, a distance of 45.74 feet; Thence S 19° 36' 18" E a distance of 46.52 feet; Thence S 60°
40'38" E a distance of 24.19 feet; Thence S 36° 01' 59" E a distance of 38.93 feet; Thence N
68° 42' 26" E a distance of 86.18 feet; Thence N 82° 28' 25" E a distance of 107.69 feet;
Thence S 88° 19' 25" E a distance of 245.59 feet; Thence N 68° 24' 38" E a distance of 63.00
feet; Thence N 01° 27' 13" E a distance of 55.37 feet to the southerly right of way of SW Tigard
Street; Thence N 88° 19' 25" W, along said southerly right of way, a distance of 300.43 feet to
the true point of beginning.
Containing 48072 square feet: 1.10 acres.
PARCEL 2 (also known as Adjustment Tract 5):
A tract of land situated in the Southeast one - quarter of Section 34, Township 1 South Range 1
West, Willamette Meridian, City of Tigard, Washington County, Oregon, being a part of the
property described in Book 743 Page 87 and Book 745 Page 911 described as follows:
Commencing at a 5/8" Iron rod set at the Southeast corner of Lot 7 Gallo's Vineyard as recorded
in Book 58 Page 9 of the Washington County subdivision records; Thence N 01° 29' 37" E,
along the easterly line of the plat of Gallo's Vineyard, a distance of 579.43 feet to the southerly
right of way of SW Tigard Street; Thence S 88° 16' 39" E, along said southerly right of way, a
distance of 572.41 feet to The True Point of Beginning; Thence S 88° 16' 39" E, along said
southerly right of way, a distance of 79.86 feet to the angle point in Tigard Street ; Thence S 88°
19' 25" E along said southerly right of way, a distance of 160.14 feet; Thence S 01° 27' 13" W
leaving said southerly right of way, a distance of 170.13 feet; Thence N 88 16' 39" W a
distance of 95.24 feet; Thence N 01° 27' 13" E a distance of 40.32 feet; Thence N 88°16' 39"
W a distance of 14436; Thence N 01° 27' 13" E a distance of 129.68 feet to the true point of
beginning.
Containing 34973 square feet
A -1
PARCEL 3 (also known as New Cherry Hills Acre Tracts Lot 6):
A tract of land situated in the Southeast one - quarter of Section 34, Township 1 South Range 1
West, Willamette Meridian, City of Tigard, Washington County, Oregon, being a part of Lots 5
and 6 Cherry Hill Acre Tracts, described as follows:
Commencing at a 5/8" Iron rod set at the Southeast corner of Lot 7 Gallo's Vineyard as recorded
in Book 58 Page 9 of the Washington County subdivision records, also being the southwest
corner of Lot 6 Cherry Hill Acres Tracts; Thence N 01° 29' 37" E, along the easterly line of the
plat of Gallo's Vineyard and the westerly line of said Lot 6, a distance of 100.86 feet to The
True Point of Beginning; Thence S 88° 28' 50" E, leaving said easterly line, a distance of
144.11 to the east line of Lot 5 Cherry Hill Acres Tracts; Thence N 01° 28' 28" E, along the
easterly line of said Lot 5 a distance of 478.06 feet to the southerly right -of -way of SW Tigard
Street; Thence N 88° 16' 39" W, along the southerly right -of -way, a distance of 143.95 feet to
the westerly line of Lot 6 Cherry Hill Acre Tracts and the east line of Gallo's Vineyard; thence
S 01° 29' 37" W, along said east line, a distance of 478.57 feet to the point of beginning.
Containing 68891 square feet or 1.58 acres.
PARCEL 4 (also known as New Cherry Hills Acre Tracts Lot 4):
A tract of land situated in the Southeast one - quarter of Section 34, Township 1 South Range I
West, Willamette Meridian, City of Tigard, Washington County, Oregon, being a part of Lots 3
and 4 Cherry Hill Acre Tracts, described as follows:
Commencing at a 5/8" Iron rod set at the Southeast corner of Lot 7 Gallo's Vineyard as recorded
in Book 58 Page 9 of the Washington County subdivision records, also being the southwest
corner of Lot 6 Cherry Hill Acres Tracts; Thence N 01° 29' 37" E, along the easterly line of the
plat of Gallo's Vineyard and the westerly line of said Lot 6, a distance of 100.86 feet; Thence S
88° 28' 50" E, leaving said easterly line, a distance of 144.11 to the east line of Lot 5 and the
west line of Lot 4 Cherry Hill Acres Tracts and the True Point of Beginning; Thence S 88° 28'
50" E a distance of 30.26 feet; Thence N 33° 20' 21" E a distance of 215.45 feet to the easterly
line of Lot 3 Cherry Hill Acre Tracts; Thence N 01° 28' 28" E, along the easterly line of said
Lot 3 a distance of 294.47 feet to the south right -of -way of SW Tigard Street; Thence N 88° 16'
39" W, along the said south right -of -way, a distance of 144.00 feet to the west line of Lot 4
Cherry Hill Acre Tracts; Thence S 01° 28' 28" W, along said west line, a distance of 478.06 feet
to the true point of beginning.
Containing 58391 square feet or 1.34 Acres.
-B -2-
PARCEL 5 (also known as New Cherry Hills Acre Tracts Lot 2):
A tract of land situated in the Southeast one - quarter of Section 34, Township 1 South Range 1
West, Willamette Meridian, City of Tigard, Washington County, Oregon, being a part of Lots 1
and 2 Cherry Hill Acre Tracts, described as follows:
Commencing at a 5/8" Iron rod set at the Southeast corner of Lot 7 Gallo's Vineyard as recorded
in Book 58 Page 9 of the Washington county subdivision records, also being the southwest
corner of Lot 6 Cherry Hill Acres Tracts; Thence N 01° 29' 37" E, along the easterly line of the
plat of Gallo's Vineyard and the westerly line of said Lot 6, a distance of 100.86 feet; Thence S
88° 28' 50" E, leaving said easterly line, a distance of 174.37; Thence N 33° 20' 21" E a
distance of 215.45 feet to the easterly line of Lot 3 Cherry Hill Acre Tracts and the True Point
of Beginning; Thence N 01° 28' 28" E, along the easterly line of said Lot 3 a distance of
294.47 feet to the south right -of -way of SW Tigard Street; Thence S 88° 16' 39" E along the
said south right -of -way, a distance of 83.94 feet; Thence S 01° 28' 28" W, along said west line,
a distance of 159.06 feet; Thence S 33° 20' 21" W a distance of 159.01 feet to the true point of
beginning.
Containing 19034 square feet or 0.44 Acres.
-B -3-
.
EXHIBTI' B
Permitted Encumbrances
1. General and special taxes and assessments for the fiscal year 2010 -2011 are exempt. If the
exempt status is terminated, an additional tax may be levied.
2. Easement, including terms and provisions contained therein:
Recording Information: May 23, 1972 in Book 868, page 455
In Favor of: Unified Sewerage Agency of Washington County
For: Sewer
Affects: Parcel I
3. Easement, including terms and provisions contained therein:
Recording Information: June 22, 1998 as Fee No. 98066323
In Favor of: The City of Tigard
For: Bikeway and pedestrian way
Affects: Parcel I
Document re- recorded November 3, 1998 as Fee No. 98- 123648 of Official Records.
The terms and provisions contained in the document entitled "Amendment to Easement for
Bikeway and Pedestrian Way" recorded December 9, 2010 as Fee No. 2010- 099469 of Official
Records.
Said Amendment was re- recorded December 14, 2010 as Fee No. 2010- 100759 of Official
Records.
4. The terms and provisions contained in the document entitled "Stormwater Easement"
recorded December 16, 2010 as Fee No. 2010- 101736 of Official Records.
(Affects Parcel No. I)
5. The terms and provisions contained in the document entitled "Stormwater Easement"
recorded December 16, 2010 as Fee No. 2010-101737 of Official Records.
(Affects Parcel No. II)
•
6. The terms and provisions contained in the document entitled "Stormwater, Sewer and Water
Easement" recorded December 16, 2010 as Fee No. 2010- 101738 of Official Records.
(Affects Parcel No. III, IV and V)
7. The terms and provisions contained in the d cument entitled "Buy -Back Option Agreement
Tigard Street Properties" recorded y d (( , 2011 as Fee No. 2011-0 78 6 9
of Official Records.
-1-
First American Title Insurance Company
National Commercial Services
818 Stewart Street
Suite 800
Seattle, Washington 98101
Victoria L. Coats Direct Phone Number:(206)615-3126
Escrow Officer FAX:(866)678-0590
vcoats@firstam.com
Jordan Schrader April 20, 2011
Two Centerpointe Drive, 6th Floor File No: NCS-479098-WA1 ( vlc)
Lake Oswego, OR 97035
Attn: Jeff Bennett
Re: Summer Creek II
Enclosed please find the following items with respect to the above named transaction:
1. Buyer Final Settlement Statement
2. Fully executed Bill of Sale
3. Seller's FIRPTA executed by The Trust for Public Land
4. Check for $29.00 representing excess funds on file due the City of Tigard
Sincerely,
First American rjIle Insurance Company
4 AI ,A
FI4
Escrow o (icer
vlc/04/20/2011
First American Title Insurance Company
rn*` National Commercial Services
818 Stewart Street,Suite 800•Seattle,WA 98101 •
Buyer's Final Settlement Statement
Property: Summer Creek II, Tigard, OR File No: 479098A
Officer: Victoria L. Coats/vie
New Loan No:
Settlement Date:
Disbursement Date:
Print Date: 04/20/2011, 10:52 AM
Buyer: The City of Tigard
Address: 13125 SW Hall Blvd.,Tigard, OR 97223
Seller: The Trust for Public Land
• Address: 1011 Western Avenue, Suite 605, Seattle, WA 98104
Charge Description _Buyer Charge Buyer Credit
Consideration:
Total Consideration 1,400,000.00
Deposits in Escrow:
Receipt No. 34548 on 04/15/2011 by The City of Tigard 1,425,658.45
Adjustments:
Purchase Price for Portable Building 25,000.00
Title/Escrow Charges to:
Closing-Escrow Fee to First American Title Insurance Company National Commercial Services 558.45
$510.00 Sales Tax:$48.45
Recording Fees 71.00
Cash( From)(X To)Borrower 29.00
Totals 1,425,658.45 1,425,658.45
Page 1 of 1
••
BILL OF SALE
For valuable consideration, receipt of which is hereby acknowledged, Tigard-
Tualatin School District 23J ("Seller") hereby sells, transfers and assigns to The City of Tigard
("Buyer") the portable building located on property, located in Tigard, Oregon, and described on
Exhibit A to this Bill of Sale (the "Portable"). Seller represents and warrants to Buyer that it has
all lawful right and authority to sell and transfer to Buyer the Portable and that it sells and
transfers the Portable to Buyer free and clear of all liens, encumbrances and third-party interests
or claims.
BY ACCEPTANCE OF THIS INSTRUMENT,BUYER ACKNOWLEDGES AND AGREES
THAT,EXCEPT AS SET FORTH IN THIS INSTRUMENT,SELLER HAS NOT MADE,DOES NOT MAKE
AND SPECIFICALLY DISCLAIMS ANY REPRESENTATIONS,WARRANTIES,PROMISES,COVENANTS,
AGREEMENTS OR GUARANTIES OF ANY KIND OR CHARACTER WHATSOEVER,WHETHER EXPRESS
OR IMPLIED,ORAL OR WRITTEN,PAST,PRESENT OR FUTURE,OF,AS TO,CONCERNING OR WITH
RESPECT TO: (A) THE NATURE,QUALITY OR CONDITIONS OF THE PORTABLE,(B) THE INCOME
TO BE DERIVED FROM THE PORTABLE,(C) THE SUITABILITY OF THE PORTABLE FOR ANY AND
ALL ACTIVITIES AND USES,(D) THE COMPLIANCE OF OR BY THE PORTABLE OR ITS OPERATION
WITH ANY LAWS,RULES,ORDINANCES OR REGULATIONS OF ANY APPLICABLE GOVERNMENTAL
AUTHORITY OR BODY,(E) THE HABITABILITY,MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE OF THE PORTABLE,OR(F) ANY OTHER MATTER WITH RESPECT TO THE
PORTABLE. BY ACCEPTANCE OF THIS INSTRUMENT,BUYER FURTHER ACKNOWLEDGES AND
AGREES THAT,IT HAS BEEN GIVEN THE OPPORTUNITY TO INSPECT THE PORTABLE,BUYER IS
RELYING SOLELY ON ITS OWN INVESTIGATION OF THE PORTABLE AND NOT ON ANY
INFORMATION PROVIDED OR TO BE PROVIDED BY SELLER. BY ACCEPTANCE OF THIS
INSTRUMENT,BUYER FURTHER ACKNOWLEDGES AND AGREES THAT ANY INFORMATION
PROVIDED OR TO BE PROVIDED WITH RESPECT TO THE PORTABLE WAS OBTAINED FROM A
VARIETY OF SOURCES AND THAT SELLER HAS NOT MADE ANY INDEPENDENT INVESTIGATION OR
VERIFICATION OF SUCH INFORMATION. BY ACCEPTANCE OF THIS INSTRUMENT,BUYER
FURTHER ACKNOWLEDGES AND AGREES THAT THE SALE OF THE PORTABLE AS PROVIDED FOR
HEREIN IS MADE ON AN "As IS,WHERE IS" CONDITION AND BASIS "WITH ALL FAULTS."
Dated: 6 , 2011.
SELLER: BUYER:
Tigard-Tualati Sc 1 i of 1 istr'ct 23J The City of Tigard
By: �1_ . VU��� By:
Rob Saxton, Superi tendent Name:
Its:
PDXDOCS:1922657.1
BILL OF SALE
For valuable consideration, receipt of which is hereby acknowledged, Tigard-
Tualatin School District 23J ("Seller")hereby sells, transfers and assigns to The City of Tigard
("Buyer")the portable building located on property, located in Tigard, Oregon,and described on
Exhibit A to this Bill of Sale (the "Portable"). Seller represents and warrants to Buyer that it has
all lawful right and authority to sell and transfer to Buyer the Portable and that it sells and
transfers the Portable to Buyer free and clear of all liens, encumbrances and third-party interests
or claims.
BY ACCEPTANCE OF THIS INSTRUMENT,BUYER ACKNOWLEDGES AND AGREES
THAT,EXCEPT AS SET FORTH IN THIS INSTRUMENT,SELLER HAS NOT MADE,DOES NOT MAKE
AND SPECIFIC:ALLY DISCLAIMS ANY REPRESENTATIONS,WARRANTIES,PROMISES,COVENANTS,
AGREEMENTS OR GUARANTIES OF ANY KIND OR CHARACTER WHATSOEVER,WHETHER EXPRESS
OR IMPLIED,ORAL OR WRITTEN,PAST,PRESENT OR FUTURE,OF,AS TO,CONCERNING OR WITH
RESPECT TO: (A)THE NATURE,QUALITY OR CONDITIONS OF THE PORTABLE,(B) THE INCOME
TO BE DERIVED FROM THE PORTABLE,(C) THE SUITABILITY OF THE PORTABLE FOR ANY AND
ALL ACTIVITIES AND USES,(D)THE COMPLIANCE OF OR BY THE PORTABLE OR ITS OPERATION
WITH ANY LAWS,RULES,ORDINANCES OR REGULATIONS OF ANY APPLICABLE GOVERNMENTAL
AUTHORITY OR BODY,(E)THE HABITABILITY,MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE OF THE PORTABLE,OR(F)ANY OTHER MATTER WITH RESPECT TO THE
PORTABLE. BY ACCEPTANCE OF THIS INSTRUMENT,BUYER FURTHER ACKNOWLEDGES AND
AGREES THAT,IT HAS BEEN GIVEN THE OPPORTUNITY TO INSPECT THE PORTABLE,BUYER 1S
RELYING SOLELY ON ITS OWN INVESTIGATION OF THE PORTABLE AND NOT ON ANY
INFORMATION PROVIDED OR TO BE PROVIDED BY SELLER. BY ACCEPTANCE OF THIS
INSTRUMENT,BUYER FURTHER ACKNOWLEDGES AND AGREES THAT ANY INFORMATION
PROVIDED OR"TO BE PROVIDED WITH RESPECT TO THE PORTABLE WAS OBTAINED FROM A
VARIETY OF SOURCES AND THAT SELLER HAS NOT MADE ANY INDEPENDENT INVESTIGATION OR
VERIFICATION OF SUCH INFORMATION. BY ACCEPTANCE OF THIS INSTRUMENT,BUYER
FURTHER ACKNOWLEDGES AND AGREES THAT THE SALE OF THE PORTABLE AS PROVIDED FOR
HEREIN IS MADE ON AN "AS IS,WHERE IS" CONDITION AND BASIS"WITH ALL FAULTS."
Dated: y/(Y , 2011.
SELLER: BUYER:
Tigard-Tuai:stir)Set pol ,listr;et-23.) The City, or
'Rob Saxton. Super: !tcndeal. Name _.' ?k .t..,�__....._...._.�
Its: y
i
PDXDOCS:1922657
•
•
•
Exhibit A
Legal Description
A tract of land situated in the Southeast one-quarter of Section 34, Township 1 South Range 1
West, Willamette Meridian, City of Tigard, Washington County, Oregon, being a part of Lots 5
and 6 Cherry Hill Acre Tracts, described as follows:
Commencing at a 5/8" Iron rod set at the Southeast corner of Lot 7 Gallo's Vineyard as recorded
in Book 58 Page 9 of the Washington County subdivision records, also being the southwest
corner of Lot 6 Cherry Hill Acres Tracts; Thence N 01° 29' 37"E, along the easterly line of the
plat of Gallo's Vineyard and the westerly line of said Lot 6, a distance of 100.86 feet to The
True Point of Beginning; Thence S 88° 28' 50" E, leaving said easterly line, a distance of
144.11 to the east line of Lot 5 Cherry Hill Acres Tracts; Thence N 01° 28' 28" E, along the
easterly line of said Lot 5 a distance of 478.06 feet to the southerly right-of-way of SW Tigard
Street; Thence N 88° 16' 39" W, along the southerly right-of-way, a distance of 143.95 feet to
the westerly line of Lot 6 Cherry Hill Acre Tracts and the east line of Gallo's Vineyard; thence
S 01° 29' 37" W, along said east line, a distance of 478.57 feet to the point of beginning.
Containing 68891 square feet or 1.58 acres.
PDXDOCS:1922657.1
SELLER'S CERTIFICATION OF NON-FOREIGN STATUS UNDER
FOREIGN INVESTMENT IN REAL PROPERTY TAX ACT ("FIRPTA")
(26 U.S.C. 1445)
File No: 479098A April 07, 2011
THIS SECTION FOR INDIVIDUAL TRANSFEROR:
Section 1445 of the Internal Revenue Code provides that a transferee (buyer) of a U.S. real property interest must
withhold tax if the transferor(seller) is a foreign person. To inform the transferee (buyer) that withholding of tax is not
required upon my disposition of a U.S. real property interest, I, Ti-E.7'RV51. [DR WBLLC LAUD , hereby certify the
following:
1. I am not a nonresident alien for purposes of U.S. income taxation;
2. My U.S. taxpayer identification number(Social Security Number) is
3. My home address is
I understand that this certification may be disclosed to the Internal Revenue Service by the transferee and that any
false statement I have made here could be punished by fine, imprisonment, or both.
Under penalties of perjury I declare that I have examined this certification and to the best of my knowledge and belief
it is true, correct, and complete.
Date Signature
Typed or Printed Name
THIS SECTION FOR ENTITY TRANSFEROR:
Section 1445 of the Internal Revenue Code provides that a transferee of a U.S. real property interest must withhold
tax if the transferor is a foreign person. For U.S. tax purposes (including Section 1445), the owner of a disregarded entity
(which has legal title to a U.S. real property interest under local law) will be the transferor of the property and not the
disregarded entity. To inform the transferee that withholding of tax is not required upon the disposition of a U.S. real
property interest by " 11 J$` ' MR Qu FAX L'&JO [name of transferor] ("Transferor"), the undersigned
hereby certifies the following on behalf of Transferor:
1. Transferor is not a foreign corporation, foreign partnership, foreign trust, or foreign estate (as those
terms are defined in the Internal Revenue Code and Income Tax Regulations);
2. Transferor is not a disregarded entity as defined in Section 1.1445-2(b)(2)(iii);
3. Transferor's U.S. employer identification number is 93-N31--3 ;
4. Transferor's office address is LO ( Tim A Ve SU Cie Co 0 5 . ;
'7TLL. WA. eo,
Transferor understands that this certification may be disclosed to the Internal Revenue Service by transferee and that
any false statement contained herein could be punished by fine, imprisonment, or both.
Under penalties of perjury I declare that I have examined this certification and to the best of my knowledge and belief
it is true, correct, and complete, and I further declare that I have authority to sign this document on behalf of Transferor.
4/0_011 ekbt
Date Signature
It Wm AS E. -Iz!h1 L ) gEatONALCDV iSE l_
Typed or Printed Name