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HomeMy WebLinkAbout*Other - BOCC (002)//O^t Stewart Title Company stw 117E 4th Ave Moses Lake, WA 98837 TITLE (509) 765-3483 Phone (866) 356-9740 Fax Harmony.White@stewart.com DISCLOSURES TO THE CLIENTS UNDER APR -12 Escrow Number: 1497515 Seller: Grant County Buyer: City Of Quincy Property Address: 0 0 SW 2nd Ave, Quincy, WA 98848 The documents for this transaction have been prepared by a Limited Practice Officer admitted by the Washington State Supreme Court to the Limited Practice of Law under APR 12. Under this Rule: 1) Your Limited Practice Officer may select, prepare and complete documents in a form previously approved by the Limited Practice Board; 2) Your Limited Practice Officer is not acting as the advocate or representative of any of the clients to this transaction; 3) The documents prepared by your Limited Practice Officer will affect the legal rights of the clients to this transaction; 4) Your interest in these documents may differ from the interest of the other clients to this transaction; 5) You have the right to be represented by a lawyer of your own selection; and 6) Your Limited Practice Officer cannot give you legal advice as to the manner in which the documents affect you or any other party to this transaction. The Limited Practice Officer is only permitted to select and complete documents which have been approved by the Limited Practice Board in accordance with a written Purchase and Sales Agreement which contains all of the basic terms of the transaction. The following documents have been prepared for this transaction under the direction of your Limited Practice Officer: Statutory Warranty Deed ❑ Note and Deed of Trust ❑ Real Estate Contract ❑ Request for Full Reconveyance ❑ Note and Mortgage ❑ Quit Claim Deed ❑ Warranty Fulfillment Deed 0 Excise Tax Affidavit The Limited Practice Officer is not permitted to negotiate terms which are not included in the written Purchase and Sales agreement. The Limited Practice Officer is not permitted to practice law. In this transaction, your Limited Practice Officer is Harmony White, LPO No. . Stewart Title Company BY: Harmony White, LPO No. I have received and read a copy of the Disclosure, and understand its contents this day of 12/30/2021 2021. Buyer(s) City of Quincy Docuslgnod by., By: _ 6 �k 4)ftbr-- a Paul Worley, mayor "' I have received and read a copy of the Disclosure, and understand its contents this day of 2021. Seller(s) Grant County By: Cindy Carter, Chair, Board of County Commissioners ►� t+ Stewart Title Company 117 E 4th Ave //*Astewart Moses Lake, WA 98837 TITLE (509) 765-3483 Phone (866) 356-9740 Fax Harmony.White@stewart.com ESCROW INSTRUCTIONS SALE TO: Stewart Title Company, Harmony White, Escrow Officer RE: File No.: 1497515 Associated File No.: Commitment No.: 1497515 Commitment Date: November 8, 2021 PROPERTY: 0 0 SW 2nd Ave, Quincy, WA 98848 City Of Quincy ("Buyer") and Grant County ("Seller") hereby instruct Stewart Title Company ("Escrowee") to act as an independent third party to close this transaction in accordance with the following instructions and the agreement regarding the purchase and sale of the Property between Buyer and Seller dated , and all addendums there (the "Purchase and Sale Agreement"). Prar-fir-e of Law Escrowee may select, prepare and complete certain documents which may substantially affect Buyer's and Seller's legal rights. Buyer and Seller acknowledge they have been advised. that they should consult with an attorney of their choice before signing the documents if they have questions regarding such documents or the impact of such documents on their legal rights. Buyer and Seller acknowledge that neither Escrowee nor its employees: (a) are licensed to practice law or permitted to offer legal advice of any nature; and/or (b) have provided any legal or other advice regarding the merits of this transaction or the manner in which Buyer should hold title. Purchase and Sale Agreement Escrowee has received a copy of the Purchase and Sale Agreement. In the event there is a variance between the terms of the Purchase and Sale Agreement and the final terms of the sale as evidenced by the documents delivered under these or other instructions, and the closing statements agreed to by the parties, closing shall be in accordance with such documents, instructions and closing statements. Buyer and Seller agree that all terms and conditions of the Purchase and Sale Agreement have been met, waived, or satisfied, or will be resolved outside of escrow and that Escrowee shall not be responsible for same. Buyer and Seller acknowledge that Seller's disclosure statement as required under Title 64 of the Revised Code of Washington will be delivered or waived outside of escrow and is not to be considered a condition of closing. Delivery of Documents and Funds Seller has or shall deposit with Escrowee the following: 0 Warranty Deed 0 Excise Tax Affidavit Buyer or Buyer's lender will deliver to Escrowee funds sufficient to close. Buyer and Seller acknowledge that all funds delivered into escrow are subject to immediate deposit, and that all checks must clear and be credited to Escrowee's trust account as good and sufficient U.S. funds before closing can be completed. Any delay in clearing deposits will delay closing. File No.: 1497515 Page 1 of 5 Escrow Instructions Sale WA Escrowee shall proceed with closing and thereafter pay out said funds when (a) all documents are signed; (b) all funds are available to close; (c) if Buyer is borrowing funds for the purchase of the Property, Buyer's lender has reviewed and released for recording; (d) the necessary conveying document(s) and/or such other documents as required by this transaction are recorded; and (e) when the title insurance company selected for the transaction can cause to be issued a policy of title insurance as called for in the Purchase and Sale Agreement, and as may be required by the lender, insuring title in (if by Deed) or an interest in (if by Contract), the named Buyer, free from encumbrances other than matters approved below (see "Status of Title and Encumbrances"). Any additional instructions given to Escrowee shall be presented in writing. Buyer and Seller further understand that contemporaneously herewith there may be instructions by third parties which are necessary for the completion of this escrow and are, therefore, made a part hereof; namely, such instructions as may be received from a lender, grantor, vendor, or others, affecting the Property. Status of Title and Encumbrances Buyer and Seller acknowledge receipt of a copy of the title insurance commitment for the Property dated November 8, 2021 at 8:OOAM, including any supplements ("Commitment") and have examined the legal description contained therein and acknowledge the same to be a full and correct description of the Property. Buyer further agrees to accept the Property subject to: (a) all matters attaching by, through or under Buyer; and (b) the following paragraphs as set forth in the Commitment, which paragraphs are numbered as Part 1: 12-4 in the Commitment. Buyer's title insurance policy will also contain those insuring clauses, exceptions, exclusions, provisions and stipulations customarily contained in the printed provisions of such policy or policies. Seller authorizes deduction and payment of all encumbrances except those to be excepted from coverage in the title insurance policy. Seller represents and warrants that at the time of closing there are no liens or other monetary encumbrances (including, but not limited to, mortgages, deeds of trust, mechanic's liens, judgment liens, tax liens, homeowner's or condominium association dues, and special assessments) relating to the Property that are outstanding, payable, or due other than those shown on the estimated closing statement and/or HUD settlement statement (the "Closing Statement"). In the event such representation and warranty is incorrect, Seller agrees to pay any amounts owing and shall indemnify Escrowee for all losses incurred as a result of the incorrect representation and warranty. If there are underlying encumbrances being paid off which require the obtaining of a Fulfillment Deed, Reconveyance, Release or Satisfaction, Seller instructs Escrowee to pay the demand of the appropriate party and obtain and record such document. Seller approves payment of the amount of the demand, including interest and/or penalties and late charges, as shown on the Closing Statement, even if Escrowee has not been able to obtain written verification of the amount claimed as due. Seller authorizes deduction and/or agrees to immediately pay any difference that may result if the final written demand is higher than that shown on the Closing Statement. "Seller acknowledges that Escrowee may use the services of UPF Services, Inc. to either (a) obtain and record fulfillment deeds, reconveyances, releases or satisfactions of encumbrances (collectively, "Releases") paid through this escrow, or (b) monitor public records to determine whether Releases of encumbrances paid through this escrow are recorded by beneficiaries thereof. Seller acknowledges that Seller has the right to request that Escrowee utilize a service provider other than Reconveyances, Inc to provide these services (provided Seller is responsible for fees charged by such other service provider). In the event any of the mortgages or deeds of trust encumbering the Property are a line of credit, Seller authorizes and instructs Escrowee to close and reconvey Seller's line of credit. Seller authorizes Escrowee to deliver these instructions to their lender as evidence of Escrowee's authority to close the line of credit. Seller also confirms that the amount shown on the Closing Statement is accurate and that no further draws will be taken. Seller shall be fully responsible for, and shall immediately pay, any additional amounts due. Seller acknowledges that the payoff figures on existing encumbrances may accrue daily interest and are not to be considered paid in full until received by the party entitled thereto and that interest will be paid to the date of anticipated receipt of funds by the entitled party. The anticipated date of receipt may be five (5) working days following the closing. Any additional funds necessary to satisfy the encumbrances shall be deposited with Escrowee by Seller immediately upon Escrowee's request. In the event any monetary demands are made pertaining to the above referenced matters after closing, Seller herein agrees to immediately pay, remove or otherwise settle said matters. File No.: 1497515 Page 2 of 5 Escrow Instructions Sale WA Closina Statements and Pro -rations Buyer and Seller authorize payment of all disbursements and charges as itemized on the Closing Statement. Buyer and Seller agree that the Closing Statement is subject to final adjustment and audit, and may be amended to reflect actual charges and adjustments at the time of closing. If any monetary error is discovered, the party responsible for the item due shall immediately pay into escrow for disbursement such amounts as may be necessary. All pro -rating is to be done as of the date of recording of documents and shall be based on a 365 -day year. Property taxes will be prorated on the latest available tax figures. Buyer and Seller acknowledge that in the event property taxes are recalculated by a taxing authority after the closing date (because of recent improvements constructed upon the Property or for any other reason), Buyer and Seller will handle the matter outside of escrow and agree to hold Escrowee harmless from any and all losses or damages stemming therefrom. Taxes for the first half of a calendar year are due and payable on or before April 30; however, taxes for the first half of the current year cannot be paid prior to February 15 (state certification date) and taxes for the second half of the year are due and payable on or before October 30. Tax notices are customarily sent out to the current owner around February 15 for the current year. Escrowee will prorate between the parties as indicated and also collect the next tax installment due for the current year from the Buyer to be paid through the closing. It is the Buyer's responsibility to request from the county treasurer a tax billing for future installments. If the Buyer instructs Escrowee not to collect for the next tax installment due for the current year, the Buyer assumes all responsibility for payment of such installment(s) and understands that the taxing authority may not send out a subsequent billing until February 15 of the following year. The value of fuel oil remaining on the Property shall be pro -rated and paid for outside of escrow between the Buyer and Seller. Buyer and Seller acknowledge that Seller is responsible for the liens set forth in R.C.W. 35.21.290; 35.67.200; 36.36.045; 36.89.090; 36.94.150; 56.16.100; 57.08.080 or 87.03.445. In accordance with R.C.W. 60.80, Seller may request that Escrowee administer disbursement of closing funds necessary to satisfy the unpaid charges set forth above. Escrowee is not liable if the Escrowee's refusal to comply is based on the Seller's inaccurate or incomplete identification of utilities providing service to the property or if a utility company fails to provide an estimated or actual final billing, or written extension of the per diem rate or if disbursement of closing funds necessary to satisfy unpaid charges would violate R.C.W. 18.44.070. A fee may be charged for performing the services described herein above. Additional Property Taxes for Recent Improvements Washington state law permits the County Assessor to reassess real property upon which new improvements have been constructed (such as a new residence) for a three year period after completion of construction. Escrowee has pro -rated the real property taxes on the basis of the taxes for the current year and has not set aside any funds for payment of any additional taxes which may be subsequently due for the current year and prior years because of reassessment. As a reassessment covers a portion of the time the Property was owned by the Seller, the Seller is responsible for paying that portion of the increased taxes attributable to the period prior to the tax pro -ration date, and the Seller should pay the amount due upon receipt of notice from the Buyer. Such adjustments between Buyer and Seller shall be handled outside of escrow and Escrowee shall have no responsibility or liability therefore. Homeowners Association Escrowee has been instructed to close this transaction, which may or may not have dues payable to a homeowner's association. Per the seller, there are currently no dues payable to an active association and should it be found that after closing there are in fact dues owing, these will be paid directly by the Seller outside of this escrow and Stewart Title will be not be held liable for the payment or proration thereof. Condition of the Prooert Neither possession of the property nor the condition thereof or suitability for its intended use shall be in any way an obligation of the Escrowee. The compliance with ordinances required by any governing bodies including City or County Short Plat (Subdivision) ordinances will be the responsibility of the Buyer and Seller and Escrowee is relieved of all liability in connection therewith. Any and all charges for building permits or assessed charges in connection therewith will be handled outside of escrow. File No.: 1497515 Page 3 of 5 Escrow Instructions Sale WA Authorization to Record. Correct and Comalete Buyer and Seller authorize Escrowee to: (a) fill in the date of close of escrow (e.g., the date documents are recorded) and such other necessary dates on any documents related to this transaction; (b) correct any typing, scriveners' or other similar errors on any documents delivered into escrow; and (c) record any document delivered into this escrow, if necessary or proper for the issuance of policies of title insurance. Handlina of Funds All disbursements shall be in U.S. funds and shall be by Escrowee's check, or by wire transfer. Escrow funds will be placed in an escrow account that will pay no interest to the depositor. Buyer and Seller acknowledge that because of these and other banking relationships with the depository institutions, Escrowee and its affiliates may receive from some of the depository institutions an array of banking services, accommodations or other benefits. Escrowee and its affiliates also may elect to enter into other business transactions with or obtain loans for investment or other purposes from some of the depository institutions. All of such services, accommodations and other benefits shall accrue, directly or indirectly to Escrowee and its affiliates and they shall have no obligation to account to Buyer and Seller for the value of such services, accommodations or other benefits. Property Insurance Coverage of the Property with fire or any other type of hazard insurance is the sole responsibility of the Buyer and Escrowee is relieved of any responsibility or obligation in connection therewith. HOWEVER, when a fire/hazard insurance Binder or Policy is required as a condition of closing it shall be submitted to Escrowee and paid for as required. Cancellation Fees In the event this escrow fails to close, a sum sufficient to pay title commitment and escrow cancellation charges shall be paid, and as appropriate, may be deducted from funds held. Disoutes. I nterDleader In the event any dispute shall arise involving a party to this escrow concerning the Property, or in the event conflicting demands or claims are made with respect to this escrow or the rights of any of the parties hereto, it is expressly agreed that Escrowee shall have the absolute right, at its election, to do any or all of the following: (a) withhold and stop all further proceedings in performance of this escrow; (b) file suit in interpleader and obtain an order from the court requiring the parties to interplead and litigate their claims and rights among themselves (in the event Escrowee files such an interpleader action, Escrowee shall be entitled to use the funds held in escrow to pay all filing fees, attorney's fees and other costs and expenses associated with such suit, and any provisions of the Purchase and Sale Agreement limiting or prohibiting interpleader are hereby superseded); or (c) issue a check to either Seller or Buyer made payable jointly to Seller and Buyer in the amount of the sums in dispute. In the event an interpleader suit is brought, Escrowee shall be immediately fully released and discharged from all obligations to further perform any and all duties or obligations imposed upon it in this escrow. Buyer agrees jointly and severally with Seller to pay Escrowee all costs, damages, judgments and expenses suffered, expended or incurred by Escrowee in connection with or arising out of this escrow, including, but not limited to, reasonable attorneys' fees. Counterparts These escrow instructions, and amendments hereto, may be executed in one or more counterparts, each of which independently shall have the same affect as if it were the original, and all of which taken together shall constitute one and the same instruction. Personal Property Title to equipment, fixtures, personal property or encumbrances or liens thereon or personal property tax or sales tax associated therewith are not a part of this escrow and will be handled outside of escrow. File No.: 1497515 Page 4 of 5 Escrow Instructions Sale WA Retention of Records Buyer and Seller authorize Escrowee to destroy these instructions and all records of this escrow at any time after seven (7) years from the date of these instructions without liability and without need for further notice or approval. Tax Reporting Seller warrants to Escrowee that if Seller is an individual, Seller is not a non-resident alien for purposes of U.S. income taxation, or if Seller is a corporation, partnership, trust or estate, Seller is not a foreign entity. The Foreign Investment in Real Property Tax Act of 1980 as amended by the Tax Reform Act of 1984 places special requirements for tax reporting and withholding on the parties to a real estate transaction where the transferor (seller) is a non-resident alien or non- domestic corporation or partnership or partnerships. It is understood and acknowledged by the undersigned that: (a) Escrowee will not take an active role in either the determination of the non -alien status of the seller transferor or the withholding of any funds; and (b) Escrowee makes no representations and (c) Buyer and Seller are seeking an attorney's, accountant's or other tax specialists opinions concerning the effect of this Act on this transaction and are not acting on the statements made or omitted by the Escrowee. Utilities A a completed Form 22K was not provided and therefore the request for utilities to be handled through this escrow is hereby waived. Outstanding balances, if any, will be handled by and between the Buyer and Seller outside of escrow. These instructions shall be irrevocable by either Buyer or Seller for a period of thirty (30) days from the date of last execution hereof and shall be performed within said period or thereafter until written demand is made upon Escrowee for the cancellation thereof. Buyer and Seller acknowledge that they have been afforded adequate time and opportunity to read, understand and approve these escrow instructions and all documents referred to herein. The parties acknowledge that if a fee is incurred for mobile notary services and the transaction fails to close for any reason the cost of these services will be charged to the party requesting the services. Dated: , 2021 SELLER(S): Grant County By: Cindy Carter, Chair, Board of County Commissioners Dated: 12/30/2021 2021 BUYER(S): City Of ' I�QySigned by: By: Pau r y, y File No.: 1497515 Page 5 of 5 Escrow Instructions Sale WA WHEN RECORDED RETURN TO: DS City Of Quincy P.O. Box 335 Quincy, WA 98848 File No.: 1497515 HW Filed for Record at Request of. Stewart Title Company iijflho: 1 1 1 1 ' I THE GRANTOR(S), Grant County, a political subdivision of the State of Washington for and in consideration of Ten Dollars and other valuable consideration in hand paid, conveys, and warrants to City Of Quincy, a Washington municipality the following described real estate, situated in the County of Grant State of Washington: Lots 1, 23 3 and, 4, Block 3, Original Townsite of Quincy, Washington, according to the plat thereof recorded in Volume I of Plats, page 9, records of Grant County, Washington. Situate in the County of Grant, State of Washington. Subject to: This conveyance is subject to covenants, conditions, restrictions and easements, if any affecting title which may appear in the public record, including those shown on any recorded plat or survey. Abbreviated Legal: Tax Parcel Number(s): 040017000, 040018000s 040019000, 040020000 LPB 10-05(r) Page 1 of 2 Datied: 1.2021 Gran C MY A r Cin atter, , -ai?" oar 6# County By: - Commissioners State of Washington County of Grant This record was acknowledged before me on Ze? 2021 by Cindy Carter, the Board Chairperson of Grant County,, N" (Stamp) PrihtecKName:..„, Notary Publicv lb fill. My commission expires: 23 q" NX 0 V4. J-0 376 0 9 4t it, OF W Iks nt� LPB 10-05(r) Page 2 of 2 Departmenit ofReal Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61 A) e(Ces Only for sales in a single location code on or after January 1, 2020. ��' 84 0001 » State to This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 0 1�V001a This form is your receipt when stamped by cashier. Please type or print. ❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor 2 Buyer/Grantee Name Grant County, a political subdivision of the State of Washington Name City Of Quincy, a Washington municipality Mailing Address 35 C Street NW Mailing Address P.O. Box 335 City/State/Zip Ephrata, WA 98823 City/State/Zip Quincy, WA 98848 Phone No. (including area code) 509-754-2011 Phone No. (including area code) 509-787-3523 3 Send all property correspondence to:❑ Same as Buyer/Grantee Name City Of Quincy Mailing Address P.O. Box 335 City/State/Zip Quincy, WA 98848 List all real and personal property tax parcel account numbers 040017000 040018000 Personal Assessed property? value(s) ❑ 0.00 ❑ 0.00 4 Street address of property: 0 0 SW 2nd Ave, Quincy, WA 98848 The property is located inpuincy7 I (for unincorporated locations please select your county) ❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged. Legal description of property (if you need more space, attach a separate sheet to each page of the affidavit) Lots 1, 2, 3 and 4, Block 3, Original Townsite of Quincy, Washington, according to the plat thereof recorded in Volume 1 of Plats, page 9, records of Grant County, Washington. Situate in the County of Grant, State of Washington. 5 Land use code: 91 - Undeveloped Land (land only) 7 List all personal property (tangible and intangible) included in selling price. Enter any additional codes: (See back of last page for instructions) If claiming an exemption, list WAC number and reason for exemption: Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior WAC No. (section/subsection) 458-61A-205(2) citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No Reason for exemption Is this property predominantly used for timber (as classified under RCW 84.84 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in its current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑ Yes N No Government entity seller 6 Is this property designated as forest land per RCW 84.33? ❑ Yes R No Type of Document Statutory Warranty Deed Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes N No Date of Document , 2021 Is this property receiving special valuation as historical Gross selling price $ - property per RCW 84.26? El Yes R No *Personal property (deduct) $ - If any answers are yes, complete as instructed below. Exemption claimed (deduct) $ - (1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) Taxable selling price $ - NEW OWNER(S): To continue the current designation as forest land or classification as current use (open space, farm and agriculture, or Excise tax: state timber) land, you must sign on (3) below. The county assessor must then Less than $500,000.01 at 1.1 % $ - determine if the land transferred continues to qualify and will indicate From $500,000.01 to $1,500,000 at 1.28% $ - by signing below. If the land no longer qualifies or you do not wish to continue the designation or classification, it will be removed and the From $1,500,000.01 to $3,000,000 at 2.75% $ - compensating or additional taxes will be due and payable by the seller Above $3,000,000 at 3.0% $ - or transferor at the time of sale (RCW 84.33.140 or RCW 84.34.108). Prior Agricultural and timberland at 1.28% $ - to signing (3) below, you may contact your local county assessor for more Total excise tax: state $ - information. This land ❑ does ❑ does not qualify for Local $ - continuance. *Delinquent interest: state Local Deputy assessor signature Date *Delinquent penalty (2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY) Subtotal $ - NEW OWNER(S): To continue special valuation as historic property, sign *State technology fee $ 5.00 (3) below. If the new owner(s) doesn't wish to continue, all additional tax *Affidavit processing fee $ 5.00 calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. Total due $ 10.00 (3) NEW OWNER(S) SIGNATURE A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX Signature Signature *SEE INSTRUCTIONS Print name Print name 8 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of grantor or agent Signature of grantee or agent_,. g g 9 9 g Name (print) Cindy Carter, Board Chair Name (print) Paul Worley, Mayor Date & city of signing: Date & city of signingl2/30/2021 Qui nay Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five years, or by a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021 (1)(c)). To ask about availability of this publication in an alternate format for the visually impaired, please call 360-705-6705. Teletype (TTY) users may use the WA Relay Service by calling 711. REV 84 0001a (9/17/21) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER American Land Title Association ALTA Settlement Statement - Borrower Adopted 05-01-2015 File No./Escrow No.: 1497515 Stewart Title Company Officer/Escrow Officer: Harmony White 117E 4th Ave Moses Lake, WA 98837 (509) 765-3483 Property Address: 0 0 SW 2ND AVE QUINCY, WA 98848 (GRANT) (040017000, 040018000, 040019000, 040020000) Borrower: CITY OF QUINCY P.O. Box 335 Quincy, WA 98848 Lender: Settlement Date: 12/31/2021 Disbursement Date: 12/31/2021 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. SELLER INSTRUCTIONS: If this real estate was your principal residence, file form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of form 4797, Form 6252 and/or Schedule D (Form 1040). This transaction does not need to be report on Form 1099-S if you sign a certification containing assurances that any capital gain from this transaction will be exempt from tax under new IRS Code Section 121. You are required by law to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Acknowledgement We/I have carefully reviewed the ALTA Settlement Statement and find it to be a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction and further certify that I have received a copy of the ALTA Settlement Statement. We/I authorize Stewart Title Company to cause the funds to be disbursed in accordance with this statement. BORROWER(S) City of Quin DocuSlgned by: By: v� Paul Wore , K8�30EONCB... SETTLEMENT COORDINATOR White File # 1497515 Page 1 of 1 Printed on 12/29/2021 at 3:25 PM 1, Sig] sir ;Certificate Of Com letion Envelope Id: B5E54695EF8541 F6BB5884FEB52A43C0 Status: Completed Subject: Please DocuSign: Closing Documents Quincy Holder: Harmony White G F#: 12/29/2021 5:26:23 PM Source Envelope: Document Pages: 10 Signatures: 4 Envelope Originator: Certificate Pages: 3 Initials: 1 Harmony White AutoNav: Enabled 1360 Post Oak Blvd #100 Envelopeld Stamping: Disabled Houston, TX 77056 Time Zone: (UTC -06:00) Central Time (US & Canada) Harmony.White@stewart.com Signature Adoption: Drawn on Device IP Address: 199.253.19.1 Record Tracking Status: Original Holder: Harmony White Location: DocuSign 12/29/2021 5:26:23 PM Harmony.White@stewart.com Si ner. Events I S� nature Timestam :,,:,:,� Paul Worley uinc ashin ton Yw g .us Docuftned by; f���pworleY@q ,Resent: Sent: 12/29/2021 5:28:03 PM 12/30/2021 9:19:50 AM Security Level: Email, Account Authentication 78'3°3E45C40B... Viewed: 12/30/2021 11:13:45 AM (None) Signature Adoption: Drawn on Device Signed: 12/30/2021 11:17:47 AM Using IP Address: 74.82.234.198 Electronic Record and Signature Disclosure: Accepted: 12/30/2021 11:13:45 AM ID: 66ca07de-b29e-4bd3-93a6-db9f6b08948f r In Person Si ne .Events . Si, nature :. :: . T �mestam Ed�to a vents. - r D l ever E Status Temestam p A'------ ent Deltve Events - g ry ::Status Times amp Intermedia a ove Events rY rY - . Status _ Timestam p. ' Certified De#Iver Events = Y Status = Timestam p Ca rbon -Co Events= Py Status Timestamp. Nancy Schanze ON&Sent: 12/29/2021 5:28:03 PM nschanze uinc ashin tous Pi r @q Yw gn�'' Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Stephanie BoormanSent: 12/29/2021 5:28:03 PM @q Ywashin skeller uinc ton.us P I E Eff)g Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events status Timestamps -- Envelope Sent Hashed/Encrypted 12/29/2021 5:28:04 PM Certified Delivered Security Checked 12/30/2021 11:13:45 AM Signing Complete Security Checked 12/30/2021 11:17:47 AM Completed Security Checked 12/30/2021 11:17:47 AM P--- a n Evens to u yme t t S t s Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 12/1/2017 2:25:32 PM Parties agreed to: Paul Worley All communications in either electronic or paper format from Stewart to you will be considered " in writing." If you prefer, you may receive information and sign Transaction documents by electronic means. To do this, Stewart requires your general consent to use Electronic Communications and Electronic Signatures in connection with Transaction. You can consent to receive these materials electronically using e-mails and Electronic Communications by signing below. Please know that you are not obligated to sign electronically; electronic signatures are for your convenience. You have the right to have any Transaction document and communication provided in paper form by contacting Stewart. You have the right to withdraw your consent by contacting Stewart. Further contact details are provided in the attached consent form. However, any documents ousi.gned electronically before you withdrew ,your consent will be considered legally valid and enforceable.