JL South Properties Grantor's Taxpayer ID & GAP Affidavit PROJECT:HAYNES CORPORATION SEWER EASEMENT
FOLIO 00276120002
GRANTOR'S NON-FOREIGN, TAXPAYER IDENTIFICATION &"GAP" AFFIDAVIT
The Undersigned, James S. Dixon, Manager, on behalf of JL SOUTH
PROPERTIES LLC, a Florida limited liability company, ("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: JL South Properties LLC, a Florida limited liability
company.
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.
b. Grantor's address is: 3581 Mercantile Avenue
Naples, FL 34104-3309
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: 20-2561272.
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
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
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.
WITNESSES:
outh Properties LLC, a Florida
Wi ness(Signature) limi d liability company l
Name 1� LC.6 ( S
t 1-5
(Print) -
�►�_ By .PPP_IWAIIIMPPr
Witness(Signature) J.mes"'I ixon, 1 a► .ger
Name: �RG1r/4" 4 lx_ati
(Print)
STATE OF F-LORJBA 1 l-1
COUNTY OF 210 lV
Sworn to and subscribed before me this / —14k day of du L y , 2015, by
James S. Dixon, Manager. on behalf of JL South Properties LLC, a Florida limited liability
company, who did take an oath, and who is personally known to me or who has produced
as identification. �
(affix notarial seal) ���t���set qf_�i .
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.�. ,gTMp .,v: (Print Name of Notary Public)
W `or 0!
A P , Serial / Commission # (if any): 5?.3 7,2
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Or 0*111r My Commission Expires: 7-// —a or
''age of
HOLE MONTES
ENGINEERS PLANNERS SURVEYORS
950 Encore Way•Naples,Florida 34110•Phone 239.254.2000•Fax;239.254 2099
HM PROJECT#2012.015
1/26/2015
REF. DWG.#B-7026
Page 1 of 1
LEGAL DESCRIPTION:
A PARCEL OF LAND LOCATED IN A PORTION OF PARCEL 9, BLOCK"A", NAPLES INDUSTRIAL
PARK, LTD, UNIT NO. 1,AN UNRECORDED PLAT ALSO BEING LOCATED IN A PORTION OF
SECTION 36, TOWNSHIP 49 SOUTH, RANGE 25 EAST, COLLIER COUNTY, FLORIDA, BEING MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
COMMENCE AT THE NORTH QUARTER CORNER OF SECTION 36, TOWNSHIP 49 SOUTH, RANGE
25 EAST, COLLIER COUNTY, FLORIDA; THENCE RUN S.00°05'36"E FOR A DISTANCE OF 628.55
FEET TO A POINT ON THE NORTH LINE OF THE SOUTH 2005.80 FEET OF THE NORTHWEST 1/4 OF
SAID SECTION 36; THENCE RUN S.89°21'02"W., ALONG THE SAID NORTH LINE FOR A DISTANCE
OF 989.97 FEET; THENCE RUN N.00°38'58"W., FOR A DISTANCE OF 30.00 FEET TO A POINT ON
THE NORTH RIGHT-OF-WAY LINE OF MERCANTILE AVENUE, A 60 FOOT WIDE PUBLIC RIGHT-OF-
WAY, THE SAME BEING THE POINT OF BEGINNING OF THE PARCEL OF LAND HEREIN
DESCRIBED; THENCE RUN S.89°21'02"W., ALONG THE NORTH RIGHT-OF-WAY LINE OF
MERCANTILE AVENUE FOR A DISTANCE OF 40.00 FEET; THENCE RUN N.00°38'58"W., FOR A
DISTANCE OF 40.00 FEET; THENCE RUN N.89°21'02"E FOR A DISTANCE OF 40.00 FEET; THENCE
RUN S.00°38'58"E., FOR A DISTANCE OF 40.00 FEET TO THE POINT OF BEGINNING: CONTAINING
1600 SQUARE FEET, MORE OR LESS.
BEARINGS REFER TO THE NORTH RIGHT-OF-WAY LINE OF MERCANTILE AVENUE, COLLIER
COUNTY, FLORIDA AS BEING S.89°21'02"W.
HOLE MONTES, INC.
CERTIFICATE OF AUTHORIZATION NUMBER LB 1772
BY acLa.A,.... / 1446 «., ".S.M. #5628
THOMAS M. MURPHY ' ' STATE OF FLORIDA
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Naples•Fort Myers
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PARCEL 9 •
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NAPLES INDUSTRIAL PARK, LTD, UNIT NO. 1
PARCEL NO. 00276120002
GRAPHIC SCALE
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MERCANTILE AVE S 8921 '02" W 989.97'
(60' PUBLIC R-O-W) N. LINE. S. 2005.80 OF N.W. 1/4 SEC 36-49-25
SEC-TWN-RGE: 950 Encore Way PROJECT NO.
35-+9-25 Naples, FL. 34110 SKETCH TO ACCOMPANY
DRAWN BY: DATE 2,0 5
AAI 10/1+ Phone: (239) 254-2000
HOLE MONIES Florida Certificate of DESCRIPTION REFERENCE NO. I
IjCHECKED 8Y: DRAWING N206. pufhorizatlon No.1 772 A LEGAL DES.RIPTION 30915 1
CHECKED 8-7026
EXHIBIT "B"
1. Grant of Easement recorded April 5, 1983, in Official Records Book 1014 Page 918,
of the Public Records of Collier County, Florida.
2. Grant of Easement recorded October 11, 1983, in Official Records Book 1046, Page
679 of the Public Records of Collier County, Florida.
3. Utility Easement recorded May 11, 1992, in Official Records Book 1713, Page 2359,
of the Public Records of Collier County, Florida.
4. Right of Entry recorded December 11, 2014, in Official Records Book 5102, Page
3099, of the Public Records of Collier County, Florida.
5. Resolution No. 2010-168, as recorded in Official Records Book 4610, Page 2307, of
the Public Records of Collier County, Florida.
6. Resolution No. 2011-150, as recorded in Official Records Book 4721, Page 1527, of
the Public Records of Collier County, Florida.
7. Resolution No. 2013-183, as recorded in Official Records Book 4965, Page 1660, of
the Public Records of Collier County, Florida.
8. Collier County Ordinance Number 75-20 which regulates the installation of water
distribution and waste water collection systems; Ordinance Number 75-21 which
protects certain trees within Collier County; and Ordinance Number 75-24 which is
known as the Collier County Zoning Ordinance for the Coastal Area Planning District;
all of which were recorded May 19, 1975, in Official Records Book 619, Pages 1177
through 1381, inclusive, of the Public Records of collier county, Florida.
9. Resolution pursuant to Chapter 67-1246, as recorded in Official Records Book 649,
Page 1239, of the Public Records of Collier County, Florida.