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HomeMy WebLinkAbout*Other - BOCC (004)Stewart Title Company ste �� 117E 4th Ave Moses Lake, WA 98837 TITLE (509) 765-3483 Phone (866) 356-9740 Fax Harmony.White@stewart.com CERTIFICATION UNDER THE FOREIGN INVESTMENTS IN Section 1445 of the U.S. Internal Revenue Code provides that a buyer of a U.S. real property interest must withhold tax if the seller is a foreign person, unless one of the exceptions of the act applies. The following will inform the buyer and closing agent whether or not tax withholding is required. Note: The above law applies to foreign corporation, partnerships, trusts, estates and other foreign entities, as well as, to foreign individuals. If the seller is a corporation, partnership, trust, estate or other entity, the terms 191" and "my" as used below means the corporation or other entity. A real property interest includes full or part ownership of land and/or improvements thereon; leaseholds; options to acquire any of the foregoing; and an interest in foreign corporations, partnerships, trusts or other entities holding U.S. Real Estate. SELLER CERTIFICATION: Seller hereby certifies the following: PROPERTY: I am the seller of the property located at: 0 0 SW 2nd Ave, Quincy, WA 98848 CITIZENSHIP STATUS: I am a non-resident alien (or foreign corporation, foreign partnership, foreign trust, foreign estate or other foreign business entity, for purposes of U.S. Income taxation. Yes No X TAXPAYER I.D. NUMBER OR SOCIAL SECURITY NUMBER: ADDRESS: My home address is: 35 C Street NW Ephrata, WA 98823 Under penalties of perjury, I declare that I have examined this certification and to the best of my knowledge and believe it is true and correct and complete. I understand that this certification may be disclosed to the Internal Revenue Service and that any false statement I have made here could be punished by fine, imprisonment or both. Date: 12/29/2021 Grant County DoauSigned by: By: Cindy Carter, Chair, oar 'of County Commissioners File No.: 1497515 Page 1 of 1 Certification Under FIRPTA . • , r / , . • File No.: 1497515 Subject Property: Lots 1, 21 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. 0 0 SW 2nd Ave, Quincy, WA 98848 State of Washington County of Grant BEFORE ME, the undersigned authority, on this day personally appeared: Cindy Carter as Board Chairperson of Grant County, a political subdivision of the State of Washington Seller(s) or Owner(s)- Borrower(s) [include middle name, if any] PLEASE NOTE: ANY BLANK SPACE IN THIS AFFIDAVIT SHALL BE DEEMED A STATEMENT BY THE UNDERSIGNED THAT THE RESPONSE IS "NO" OR "NONE". THIS AFFIDAVIT AND INDEMNITY is made in connection with the sale and/or mortgaging of the Property with the knowledge and intent that Stewart Title Guaranty Company, and its agent, if any (collectively, the "Title Company") will rely on it in issuing title insurance policy(ies). The undersigned, under oath, deposes and says: 1. NAME. My/Our full name(s) appear above. During the last ten (10) years, I/we have not been known by any other name except as stated above oras follows: The judgment(s) and/or other lien(s) appearing on the title commitment / preliminary report, is/are not against me/us, but rather is/are against someone else with a similar name. Initial if applicable: 2. POSSESSION AND OWNERSHIP. I/We have no knowledge of any challenge, claim or controversy relating to my/our ownership or possession of the Property. There are no tenants, occupants, or parties in possession of the Property, or leases or licenses affecting the Property, and no one is occupying, using or passing over the Property, other than me/us and my/our immediate family, except the following: 3. SURVEY. A. Except as may be shown on any survey, if any, of the Property, that has been provided to the Title Company, I/we have no knowledge of any easements, replattings, encroachments of my improvements (including fences and driveways) onto any easement or setback line or building line or onto my neighbors' property(ies), or of any encroachments of my neighbors' improvements (including fences and driveways) onto the Property, or of any boundary line disputes, except the following: B. If a survey of the Property has been provided to the Title Company, there have been no changes to the improvements (including fences and driveways) on the Property since the date of the survey, except the following: 4. RECENT IMPROVEMENTS. [Select one below] A. X No improvements (including but not limited to work, services, materials and equipment) have been made to the Property during the last 180 days. OR B. There has been no construction on the Property during the last 180 days. All work performed, services rendered, and materials and equipment furnished in connection with the improvements on the Property relate to routine repairs and replacements, and have been paid in full, and there are no unpaid bills, claims, demands or File No: 1497515 Page 1 of 3 amounts owed for services, labor, materials or equipment, except the following [Please insert description, amount, and name of unpaid claimant(s), if any]: I/We undertake to promptly pay the foregoing and to deliver proof of payment to the Title Company. 5. DEBTS AND LIENS. Except as described in the commitment / preliminary report, there are no debts, liens (including but not limited to federal or state Liens or judgment liens), loans (including but not limited to mortgages or deeds of trust), lawsuits, unpaid judgments, proceedings or legal obligations of any kind against me/us or encumbering or potentially affecting the Property except the following [Please insert name of creditor and amount, if any]: Creditor Approximate Amount 6. TAXES AND ASSESSMENTS. Except as described in the commitment / preliminary report, there are no unpaid taxes, charges, fees, fines or assessments of any kind (including but not limited to real property taxes and assessments imposed by a taxing authority, condominium association or homeowner's association fees and assessments, water or sewer charges) encumbering or potentially affecting the Property except the following [Please describe item and amount, if any]: I/We undertake to promptly pay the foregoing and to deliver proof of payment to the Title Company. 7. BANKRUPTCY. There are no current proceedings in bankruptcy or receivership affecting me/us. I/We do not intend to file bankruptcy. 8. PURCHASE RIGHTS. Except for the current transaction (if a sale), there are no contracts to sell the Property, or options or rights of first refusal to purchase the Property except the following: 9. MARITAL STATUS. If an individual (natural person), the following describes my/our current marital status (check and complete all that are applicable): A. I have never been married. Q am currently married to: [state] on married to each other, without interruption, since that date. C. I was married to to [date]. [name]. We were married in [date] and we have been continuously [name] from: [date] That marriage ended due to [describe: e.g., death, divorce]. D. We are married to each other. We were married in [state] on [date] and we have been continuously married to each other, without interruption, since that date. E. X Other: DOES NOT APPLY 10. INDEMNITY. I/We make this Affidavit to induce the Title Company to issue a policy/ies of title insurance and I/we understand that the Title Company is relying on the statements made herein in issuing such policy/ies. I/We agree to indemnify, defend and hold harmless the Title Company from and against all claims, costs, losses, liabilities, damages, expenses, fees and attorneys' fees, including attorneys' fees and expenses to enforce this indemnity, that the Title Company may incur, arising out of or relating to: A. any errors, omissions or inaccuracies in this Affidavit, B. all liens, encumbrances or other objectionable matters filed or recorded against the Premises between the last Effective Date of the commitment / preliminary report referenced above and the date and time of recording of the deed and/or mortgage/deed of trust, if applicable. I/We undertake to promptly remove, File No: 1497515 Page 2 of 3 release, bond or otherwise dispose of the such matters, to the satisfaction of the Title Company, in its sole discretion; and C. the failure to timely perform all undertakings, if any, described in this Affidavit. 11. OTHER. A. If the Seller or Borrower is an entity, I have authority to sign on its behalf, based upon Under penalties of perjury I/we declare that I/we have examined this affidavit and to the best of my knowledge and belief it is true, correct, and complete. Date: 12/29/2021 , 2021 Grant County DocuSigned by: By: Cindy Carter, air, oard of County Commissioners File No: 1497515 Page 3 of 3 SELLER CERTIFICATION FOR 1099 REPORTING ON THE SALE OR EXCHANGE OF COMMERCIAL REAL PROPERTY PART I - SELLER INFORMATION 1. Legal Individual Name: 2. Legal Entity Name: Grant County (Not DBA or AKA) SSN: (XXX-XX-XXXX) TIN/EIN: (XX-XXXXXXX) Type of Legal Entity ❑ Corporation ❑ Sub Corp ❑ Partnership ❑ Estate ❑ Trust ❑ Sole Owned or Disregarded LLC If an LLC, operates as: ❑ Corporation ❑ Sub Corp ❑ Other: 3. Name for 1099-S, if different: PERMANENT MAILING ADDRESS Street Address 35 C Street NW City/State/Zip Ephrata, WA 98823 PART II - TRANSACTION INFORMATION Closing Date (MM/DD/YY): File Number: 1497515 Contract Sales Price: $84,000.00 Description of Property: 0 0 SW 2nd Ave, Quincy, WA 98848 (Street Address or Brief Legal) County, City and School Taxes paid in advance by seller, charged to buyer If multiple Sellers, request is hereby made that you allocate the sales price amount among the sellers: Is this sale part of a 1031 Tax Deferred Exchange? ❑ Yes ❑ No PART III - FOREIGN PERSONS If checked, transferor is a foreign person (nonresident alien, foreign partnership, foreign estate or foreign trust) ❑ Stewart Title — Seller Certification For Information Reporting Page 1 of 2 © 2018 Stewart. All rights reserved. 1 (800) STEWART I stewart.com 104/18 File No.: 1497515 Part IV. SELLER CERTIFICATION Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number. I also certify that the other information shown herein is correct. Grant County1r=1 DocuSigned by: By: 44:7 45-130634011e. Cindy Carter, Chair, Board of County Commissioners SETTLEMENT AGENT INFORMATION (to be completed by settlement agent) Name: Stewart Title Company Address: 117E 4th Ave Moses Lake, WA 98837 Tax ID: 74-0923770 12/29/2021 Date Phone: (509) 765-3483 SUBSTITUTE FORM 1099 SELLER STATEMENT. Upon completion of this form, if the transaction is deemed reportable the information contained herein will be furnished to the Internal Revenue Service. This form is being provided to you in lieu of a formal tax statement, and if you are required to file a return and the IRS determines that the transaction has not been reported, a negligence penalty or other sanction will be imposed upon you for failure to report accordingly. You are required by law to provide the Settlement Agent with your correct taxpayer identification number and if you fail to provide them with the correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Stewart Title — Seller Certification For Information Reporting Page 2 of 2 © 2018 Stewart. All rights reserved. 1 (800) STEWART ( stewart.com 104/18 File No.: 1497515 Certificate Of Completion Envelope Id: 24C5492583B94398906288E873E6CF49 Status: Completed Subject: Please DocuSign: Closing Documents County GF#: Source Envelope: Document Pages: 17 Signatures: 8 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 IP Address: 199.253.19.1 Record cor Trackin g Status: Original Holder: Harmony White Location: DocuSign 12/29/2021 5:28:08 PM Harmony.White@stewart.com Signer Events Si nature Timestam g p Cindy Carter DocuSigned by: Sent: 12/29/2021 5:34:26 PM ccarter@grantcountywa.gov Resent: 12/29/2021 5:50:04 PM Cindy Carter BOCC Chairperson F1447A5130634CB... Resent: 12/29/2021 5:56:33 PM Grant county, Washington Viewed: 12/29/2021 6:12:56 PM Signature Adoption: Drawn on Device Security Level: Email, Account Authentication Signed: 12/29/2021 6:14:45 PM (None) Using IP Address: 141.164.124.220 Signed using mobile Electronic Record and Signature Disclosure: Accepted: 12/29/2021 6:12:56 PM D: d5696689-6146-488d-9d56-d6fc2424c99b In Person St ner-Events Si nature g g Timestamp tv Ev Editor Del e_ . Status Timestam ry ants ...:.:.:. . . _ n D I ve Ev n t A e t e e _ts 5 atus TImestam p Intermediary Delivery Events ;`- Status Timesta' Mp - ified Delive Event��tatu pert ry s s _ Times, am Carbon Copy Events Status Timestamp Barb Vasquezcf% Sent: 12/29/2021 5:34:25 PM q @g Y.g uez rantcount wa bvas ov F� E Viewed: 12/29/2021 5:40:13 PM Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Ruth Mina rimina@grantcountywa.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Samuel Castro samcastro@grantcountywa.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Sent: 12/29/2021 5:34:26 PM Sent: 12/29/2021 5:34:26 PM iit Carbon Copy Everts - Status Timestamp Not Offered via DocuSign Samuel DarkSent: 12/29/2021 5:34:27 PM @grantcount wag sdart ov IL PI E Y. Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Wetness Events Si nature Timestam g p. . INota Events Sr nature T�mestam �/. g p Envelo a Summa Events Status - Tim m s p rY esta p Envelope Sent Hashed/Encrypted 12/29/2021 5:34:27 PM Certified Delivered Security Checked 12/29/2021 6:12:56 PM Signing Complete Completed Security Checked Security Checked 12/29/2021 6:14:45 PM 12/29/2021 6:14:45 PM tat Pa m Events s _ e t , ,_ := _ S u ;. Timestam s Electr�- cor onec:Red and Si aturur e Disclos e Electronic Record and Signature Disclosure created on: 12/1/2017 2:25:32 PM Parties agreed to: Cindy Carter 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 you signed electronically before you withdrew your consent will be considered legally valid and enforceable. American Land Title Association ALTA Settlement Statement - Seller 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) Seller: GRANT COUNTY 35 C Street NW Ephrata, WA 98823 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. SELLER(S) DocuSigned by: Grant County By: Cindy Carter, Chair, Board of County Commissioners