108RDUE GAP Affidavit PROJECT: FOREST LAKES MSTU 162523
PARCEL No(s): 108RDUE
FOLIO No(s): 00263200207
GRANTOR'S NON-FOREIGN, TAXPAYER IDENTIFICATION &"GAP" AFFIDAVIT
The Undersigned, E. A C.a.rv'o 1 t , as Pre 5 Gl ,
on behalf of EMERALD GREENS CONDOMINIUM ASSOCIATION, INC. ("Grantor")
after being duly sworn, deposes and says:
1. Grantor is the fee simple owner and the only owner of the property located in
Collier County and described in Exhibit "A" attached hereto ("Property").
2. Grantor's Legal Name is: EMERALD GREENS CONDOMINIUM
ASSOCIATION, INC., a Florida non-profit corporation.
3. Section 1445 of the Internal Revenue Code ("IRC") requires a transferee of a
U.S. real property interest to withhold tax if the transferor is a foreign person. For U.S.
tax purpose (including IRC §1445), the owner of a disregarded entity having 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 Collier County, as transferee, that withholding of
tax is not required upon disposition the Property, Affiant affirms that the following is
true:
a. Grantor is not a non-resident alien (if individual) or a foreign corporation,
foreign partnership, foreign trust or foreign estate (as those terms are
defined by the Internal Revenue Code and Income Tax Regulations.) for
purposes of U.S. income taxation.
500-1-1',u p of Pe':, - cuck-5ervIltilt Corp
b. Grantor's address is: Io4y Ca5i-do Dr S+e ok) !kyle,5,11
34/13
c. Grantor is not a disregarded entity as defined in Treas. Req §1.1445-
2(b)(2)(iii). (NOTE: A disregarded entity for these purposes means an entity
that is disregarded as an entity separate from its owner under Treas. Reg.
§301.7701-3, a qualified REIT subsidiary as defined in IRC §856(i), or a
qualified subchapter S subsidiary under IRC §1361(b)(3)(B).
4. Grantor's Taxpayer Identification Number is: (4).q.; OO I 07
5. For purposes of reporting this Transaction to the Internal Revenue Service on
Form 1099-S, the Property is Grantor's (check one)
Principal Residence X Other real estate
Cq
6. Grantor is in sole constructive or actual possession of the Property, and there
is no other person or entity that has any possessory right in the Property.
7. Grantor has full authority to convey the Property.
8. There are no existing contracts for sale or mortgage commitments other than
those being closed affecting the Property.
9. Grantor knows of no defects in the Property's title and, except for real estate
taxes for the current year and those items identified on Exhibit "B" attached hereto,
there are no liens, encumbrances, mortgages, claims or demands on or against the
Property.
10. There are no unrecorded labor, mechanics', materialmen's liens or "Notices
of Commencement" against the Property; no material has been furnished to or labor
performed upon the Property within the past ninety (90) days which has not been paid
for in full; no notices to owner have been delivered to or received by the Grantor.
11. There are no bills, liens or assessments for sanitary sewers, paving or other
public utilities, or improvements made by any governmental instrumentality, which are
now unpaid, against the Property. Further, Grantor acknowledges responsibility for
water, sewer and electrical consumption charges through date of closing or occupancy
by Grantor, whichever first occurs. If any bills, liens or assessments are found which
relate to the period of Grantor's possession, Grantor will pay same upon demand.
Grantor shall obtain any release documents needed which relate to bills, liens or
assessments not paid at the time of closing.
12. No notice has been received of any public hearing regarding future or pending
zoning changes or assessments for improvements by any governmental instrumentality.
13. Grantor knows of no violations of local or state laws or private covenants,
restrictions or conditions which pertain to the Property.
14. There are no judgments, orders or decrees which have been entered in any
state or federal court against the Property or Grantor, and there are no civil or
administrative actions pending against Grantor or which involve the Property in any
way, including no action for dissolution of marriage or bankruptcy.
15. The Property and all uses of the Property have been and presently are in
compliance with all Federal, State and Local laws, regulations and ordinances,
including environmental laws, and that the Grantor has no knowledge of any spill or
environmental law violation on any property contiguous to or in the vicinity of the
Property; and that Grantor has not received notice and otherwise has no knowledge of
a) any spill on the Property, b) any existing or threatened environmental lien against the
Property or c) any lawsuit, proceeding or investigation regarding the generation,
storage, treatment, spill or transfer of hazardous substances on the Property. This
a
provision shall survive closing and/or acceptance and is not deemed satisfied by
conveyance of title.
16. Grantor shall indemnify, defend and hold Collier County harmless against and
from any and all damages, claims, liabilities, actions, expenses, penalties, fines and
costs (including attorney's fees and expenses) incurred by or asserted against Collier
County by reason of or arising out of the breach of Grantor's representations under
Paragraph 15 above, irrespective of whether the undersigned affiants were negligent in
the making of these representations. This provision shall survive closing.
17. There are no unrecorded deeds, judgments, liens, mortgages, easements or
rights of way for users, claims, boundary line or other disputes, or demands of any
nature asserted against or affecting the Property.
18. There are no matters pending against Grantor that could give rise to a lien
that would attach to the Property, or cause a loss of title, or impair title between the
effective date of the title insurance commitment (or title search showing ownership and
encumbrances) and the time of recording of the instruments evidencing the County's
fee simple or other interests in the Property; and that Grantor has not executed and will
not execute any instrument that would adversely affect the title to the Property from the
date of this Affidavit forward.
19. If the conveyance is of fee simple and by purchase, Grantor agrees that in
the event the current real and personal property taxes vary in amount from the figures
used in making the prorations used in closing the conveyance of the Property to
County, then a new proration and a correct and proper adjustment shall be made upon
demand. Grantor understands that all taxes, maintenance charges and assessments
due from Grantor for which a bill is rendered prior to closing will be charged against
Grantor on the closing statement.
20. If the Property is improved property, then Grantor is the owner of said
property, and there are no claims, liens, security interests, claims or demands of any
kind against the furniture, equipment, fixtures and personal property located on the
Property and being sold as part of this transaction.
21. If the Property is rental property, Grantor hereby represents that Grantor
has paid all sales taxes due to the State of Florida to date and will pay any remaining
taxes due in respect to said premises before due and will indemnify and hold harmless
Collier County from Grantor's failure to do so.
22. Grantor agrees to fully cooperate with Collier County when necessary to
correct an error discovered after closing and, in doing so, to execute, without delay, any
corrective instrument(s) needed in order to effectuate the intent of the parties to this
transaction. This provision shall survive closing.
23. Grantor understands that this certification may be disclosed to the Internal
Revenue Service by Collier County and that any false statements made here could be
punished by fine, imprisonment, or both. Grantor further authorizes the submission of
this affidavit if and when required.
24. Under penalties of perjury, I, the undersigned affiant, state that I have
examined this affidavit and to the best of my knowledge and belief it is true, correct and
complete as of the date of execution hereof; that I am authorized to execute this
affidavit as or on behalf of Grantor and to bind Grantor thereby; that I will immediately
notify Collier County of any change to the representations contained herein and that, in
the absence of such notification, Collier County may rely on the representations
contained herein on the day of closing; that Grantor intends for Collier County, its
agents and attorneys, the title company issuing the title policy (if title insurance is to be
issued), its underwriter and its employees, any escrow/settlement agent and other
parties and their attorneys participating in this transaction, to rely on these
representations, and Grantor will indemnify said parties for all damages, loss, liability,
claims, cost and expenses, including attorney fees, which arise out of or result from
their reliance upon these representations, irrespective of whether I was negligent in
making these representations or executing this Affidavit.
EMERALD GREENS CONDOMINIUM
ASSOCIATION, INC., a Florida non-profit corp.
itness (Signature) If By: J'7"
Print: :04 cr ' ' _ - ! i+Iq Print: +=
Title: • h-
JIM. 1Jv ' +11=11/x%
Witness (Signature)
Print: , t i • 1 e: G
STATE OF
COUNTY OF
SWORN TO AND SUBSCRIBED before me this %� day of £11 TZ'L e' , 2013 by
e,4/? d// , as 77f / 7 , on behalf of EMERALD
GREENS CONDOMINIUM ASSOCIATION, INC., w ho is personally known.to me or who has
produced as identification.
WITNESS my hand and official seal this 3 day of 0C 7i)heeL 2013.
affix notarial seal) ` u ��{ z
(affix
(Signature o Notary�Public)
M , l g /0-ft..'
(Print Name of Notary Public)
goo Notary Public State of Florida NOTARY PUBLIC
f- 71 Ruth M Pnor Serial/Commission #:(if any) r�
My Commission EE 839269
a^ Expires 12/01/2016 My Commission Expires: /�/1/ J/k
Approved as to form and legality
A:.;;i t.int Cc;,iltty�s torncy 0.
O.\ 0
1:
LEGAL DESCRIPTION
PARCEL 108RQUE
A PARCEL OF LAND LYING IN SECTION 14, TOWNSHIP 49 SOUTH, RANGE 25 EAST, COLLIER COUNTY. FLORIDA
BEING A PORTION OF EMERALD GREENS. A CONDOMINIUM PER OFFICIAL RECORDS BOOK 1418, PAGE 1831 OF
THE PUBLIC RECORDS OF COLLIER COUNTY FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE SOUTHEAST CORNER OF EMERALD GREENS, A CONDOMINIUM PER OFFICIAL RECORDS BOOK
1418 PAGE 1831 OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA: THENCE ALONG THE SOUTHERLY
BOUNDARY OF SAID EMERALD GREENS, S80'53'23"W FOR 75.45 FEET;
THENCE LEAVING THE SOUTHERLY BOUNDARY OF SAID EMERALD GREENS, NO3'56'13"W FOR 56.19 FEET TO THE
BEGINNING OF A TANGENTIAL CURVE;
THENCE 213.30 FEET ALONG A CURVE TO THE RIGHT, HAVING A RADIUS OF 772.00 FEET, THROUGH A CENTRAL
ANGLE OF 15'49'49", AND WHOSE LONG CHORD BEARS NO3'58'41"E FOR A DISTANCE OF 212.62 FEET, TO THE
BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 217.40 FEET ALONG A CURVE TO THE LEFT, HAVING A RADIUS OF 505.75 FEET, THROUGH A CENTRAL
ANGLE OF 24'37'46", AND WHOSE LONG CHORD BEARS N00'25"7"W FOR A DISTANCE OF 21573 FEET, TO
THE BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 176.90 FEET ALONG A CURVE TO THE RIGHT, HAVING A RADIUS OF 665.00 FEE-, THROUGH A CENTRAL
ANGLE OF 15'14'31". AND WHOSE LONG CHORD BEARS N05'06'55"W FOR A DISTANCE OF 176.38 FEET, TO
THE BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 187.64 FEET ALONG A CURVE TO THE RIGHT, HAVING A RADIUS OF 1894.23 FEET, THROUGH A
CENTRAL ANGLE OF 05'40'32", AND WHOSE LONG CHORD BEARS N05'20'37"E FOR A DISTANCE OF 187.56
FEET, TO THE BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 88.51 FEET ALONG A CURVE TO THE LEFT, HAVING A RADIUS OF 400.00 FEET, THROUGH A CENTRAL
ANGLE OF 1740'39", AND WHOSE LONG CHORD BEARS N01'50'33"E FOR A DISTANCE OF 88.33 FEET;
THENCE N04'29'46"W FOR 167.72 FEET TO THE BEGINNING OF A NON-TANGENTIAL CURVE:
THENCE 100.13 FEET ALONG A CURVE TO THE RIGHT, HAVING A RADIUS OF 227.88 FEET, THROUGH A CENTRAL
ANGLE OF 25'10'29", AND WHOSE LONG CHORD BEARS NO4'50'07"W FOR A DSTANCE OF 99.32 FEET, TO THE
BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 178.61 FEET ALONG A CURVE TO THE RIGHT, HAVING A RADIUS OF 110.00 FEET, THROUGH A CENTRAL
ANGLE OF 93'01'52", AND WHOSE LONG CHORD BEARS N54'16'04"E FOR A DISTANCE OF 159.62 FEET. TO THE
BEGINNING CF A NON-TANGENTIAL CURVE;
THENCE 81.74 FEET ALONG A CURVE TO THE RIGHT, HAV;NG A RADIUS OF 1057.04 FEE, THROUGH A CENTRAL
ANGLE OF 04'25'50", AND WHOSE LONG CHORD BEARS S77'00'05"E FOR A DISTANCE OF 8'.72 FEET, TO THE
BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 154.09 FEET ALONG A CURVE TO THE LEFT, HAVING A RADIUS OF L75.02 FEET, THROUGH A CENTRAL
ANGLE OF 18'35'07", AND WHOSE LONG CHORD BEARS N86'C3"1"E FOR A DISTANCE OF 153.41 FEET, TO THE
BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 324.66 FEET ALONG A CURVE TO THE RIGHT, HAVING A RADIUS OF 989.95 FEE-, THROUG- A CENTRAL
ANGLE OF 18'47'27", AND WHOSE LONG CHORD BEARS N89%74-9"E FOR A DISTANCE 0= 323.21 FEET, TO THE
BEGINNING 0= A NON-TANGENTIAL CURVE;
THENCE 168.85 FEET ALONG A CURVE TO THE LEFT, HAVING A RADIUS OF 521.00 FEET, THROUGH A CENTRAL
ANGLE OF 18'34'10", AND WHOSE LONG CHORD BEARS N89'40'57"E FOR A DISTANCE OF 168.12 FEET, TO THE
BEGINNING OF A NON-TANGENTIAL CURVE;
THENCE 93.11 FEET ALONG A CURVE TO THE RIGHT. ;-AVING A RAD:'.-S OF 1318.64 FEET, THROUGH A CENTRAL
ANGLE OF 04'02'44", AND WHOSE LONG CHORD BEARS N80'47'06"E FOR A DISTANCE OF 93.09 FEE", "C A
POINT ON THE EASTERLY BOUNDARY OF SAID EMERALD GREENS;
THENCE ALONG THE EASTERLY BOUNDARY OF SAID EMERALD GREENS, HE FOLLOWING FIVE (5) DESCRIBED
COURSES:
1) THENCE 526'52'07"E FOR 62.43 FEET TO THE BEGINNING OF A NON-TANGENTIAL CURVE;
2) THENCE 48.75 FEET ALONG A CURVE TO 7 HE RIGHT, HAV'N'G A RADIUS Of 511.51 FEE1, THROUGH A
CENTRAL ANGLE OF 05'23'55", AND WHOSE LONG CHORD BEARS S8C'53'38"W FOR A DISTANCE OF 48.74 FEET,
TO THE BEGINNING OF A NON-TANGENTIAL CURVE;
3) THENCE 48.77 FEET ALONG A CURVE TO THE RIGHT. HAVING A RADIUS OF 513.53 FEET, THROUGH A
CENTRAL ANGLE OF 05'26'30", AND WHOSE LONG CHORD BEARS S86'2C'06"W FOR A DISTANCE OF 48.75 FEET;
4) THENCE S89'03'13"W FOR 811.38 FEET;
5) 'HENCE SDO'L6'49"E FOR 11212.67 FEET, TO THE POINT OF BEGINNING OF THE PARCEL DESCRIBED HEREIN.
CONTAINING 129,955 SQUARE FEET OR 2.98 ACRES MORE OR LESS. SUBJECT TO EASEMENTS AND
RESTRICTIONS OF RECORD.
EXHIBIT
page_--of
/07/9/2vN
MICHAEL-A. V,g'RD_ • DATE SIGNED
FLORIDA PROFESSIC;NA._ SURVEYOR CERTIFICATE No. LS# 5301
NOT VALID-WITHOUT :■E'St3NATURE AND THE ORIG NAL RAISED SEAL OT A
FLORIDA LICEN) ED_SLiR .R AND MAPPER. (ECM - ROW
THIS IS NOT r--SUR' EY OCT 2 0 2011
,10P[r,:.zo!,2516-"3\2GGa,o7Jrg7.05'.0D r"re„Lake.e51u\000I Stet.AM DAM wr \xe.0G\070195e6AO_;9ee0UE.a.q
PROJECT: FOREST LAKES MSTU 1 IXM
Maxim
Viaadiatkra
LEGAL DESCRIPTION j ts`
TA. A.
PARCEL 108RDUE (ROAD, DRAINAGE AND UTILITY EASEMENT) 8810 Willow Park Orika.Suite 200
Naples.Florida 64109
PREPARED FOR: COLLIER COUNTY Plane:(239)5974675 FAX 1239)597-0578
LB No.:6952
JOB ( REVISION I SECTION I T0LIP I RANGE ( SCALE DATE
I DRAWN FILE , SHEET
14 9S 25E N/A 10/ 1/ RA.N. O8RDUE ' OF 2
N
W E
S
0100 OODSHIRE
GRAPHIC SCALE PHASE II O.R.
r'-200• 1180, PG. 834
EMERALD GREENS,
QUAIL RUN L=154.09' A CONDOMINIUM
L=81.74' O.R. 1418, PG.
GOLF CLUB R=1057.04' R=475.02' 1831-1946 L=93.11'
O.R. 1086 A=4'25'50"-- A=18'35'07" R-1318.64'
PG. 1013 CB=S7T00•05"E CB=N86 03'1 1"E A=4'02'44"
C=81.72' C=153.41' CB=N80'4T06"E
L=324.66' C=93.09'
�6� R=989.95' L°��� S26'52'07"E
t`� A=18'47'27" R=521.00' likAr62.43'
<0. S2 "
r----
qdg ..,„0 4 E CB=N89'34'19"E �9N89 40 57 E
L=100.13' ace/Z''/�'//,'"/�ii //'// ..
R=227.88' / S89'03'13'YV 811.38' L=48.77'
A=25'10'29. R=513.53'
CB=N04'50'07"W A=5'26'30"
C=99.32' / CB=S86'20'06"W SE'LY
I
/ CORNER OF
0=48.75' EMERALD
1=48.76' GREENS
N04'29'46"W R=517.51'
1 167.72' EASTERLY BOUNDARY A=523'55`
L=88.51' OF EMERALD GREENS CB=S80'53'38`W
R=400.00' / C=48.74'
A=12'40'39" 60' ROADWAY EASEMENT O.R.
CB=N01'50'33"E BOOK 517 PG 865-869
C=88.33' 108RDUE A.K.A. (WOODSHIRE LANE)
L=187.64' 129,955 SF
R=1894.23'
A=540'32" o
CB=N05'20'37'E /° QUAIL RUN GOLF CLUB
C=187.56' /A MAINTENANCE FACILITY
40
L=176.90' (^
R=665.00'
A=1514'31" N NAPLES BATH &
CB=Np506'55"W o TENNIS CLUB
C=176.38' /
L= 7.40'
R=505.75'
A=24'37'46'
CB=N00 2 15.73
C=215.73'
/
L=213.30'
R=772.00' P08
EXHIBIT A
A=15'49'49" / SOUTHEAST CORNER OF
CB=NO3'58'41"E EMERALD GREENS. A
C=212.62' 4 CONDOMINIUM PER O.R. 1418 Page of L _____®
NO3 56'13"W
PG. 1831
56.19'
S80'53'23"W
75.45' LEGEND
FAIRWAYS AT POB = POINT OF BEGINNING
EMERALD GREENS, O.R. = OFFICIAL RECORDS BOOK
A CONDOMINIUM PER PG. = PAGE
SF = SQUARE FEET
O.R. 1644, PG. L = LANE
\ 1368-1495 A = DELTA S
CB = CHORD BEARING
C = CHORD
Dame.,IT.2011 ice PIY S\2007\070,$006.00 tors Wm.1671.1\000t SI*And D...,pe.,\D..00\0107400600_!DEM EA.0
PROJECT: FOREST LAKES MSTU TYM�IIdC
SKETCH OF LEGAL DESCRIPTION C N iNIIN a e
PARCEL I08RDUE (ROAD, DRAINAGE AND UTILITY EASEMENT) 6610 Wimv Peak Drive.0.05020D
PREPARED FOR COLLIER COUNTY Na Flon°a 34109
Phone:(239)597-0575 FAX(239)597-0570
LB No.:6952 /
JOB NUMBER REVISION SEC-ON TOWNSHIP RANGE SCALE DATE DRAWN By FIFE NAME SPED"
J
070190.06.00 _ 0 14 I 49S _ 25E 1" = 200' 10/11/11 R.A.K. 10BRDUE 2 O. 2
EXHIBIT "B"
Grant of Easement from Forest Lakes Estates, Inc., a Florida corporation, to Fidelity
Service Corporation, a Florida corporation, dated April 3, 1973 and recorded April 5, 1973
in Official Records Book 517, Page 865, of the Public Records of Collier County, Florida.
Declaration of Condominium of Emerald Greens, dated October 31, 1988 and recorded
February 22, 1989 in Official Records Book 1418, Page 1831, of the Public Records of
Collier County, Florida.
Resolution No. 2010-168 approving the preliminary assessment roll for the purpose of
providing and regulating Solid Waste Collection and Disposal Services, dated September
14, 2010 and recorded October 1, 2010 in Official Records Book 4610, Page 2307, of the
Public Records of Collier County, Florida.
Resolution No. 2011-150 approving the preliminary assessment roll for the purpose of
providing and regulating Solid Waste Collection and Disposal Services, dated September
13, 2011 and recorded September 22, 2011 in Official Records Book 4721, Page 1527, of
the Public Records of Collier County, Florida.
Rights of tenant(s) in possession, if any, under lease(s) not recorded in the Public
Records.
Terms and conditions of the Easements creating the interest insured hereunder.