Tax Identification & GAP Affidavit - Folio #80400016465 PROJECT: Wilshire Lakes Loop
PARCEL: Village Walk ARV Easement Tract C
FOLIO: 80400016465
GRANTOR'S NON-FOREIGN, TAXPAYER IDENTIFICATION &"GAP" AFFIDAVIT
The Undersigned, r . 1 r v``�\;. v c �onrs s' (Name), V k u +;<r< i t��,M.+
(Title), ("Affiant") on behalf of VILLAGE WALK HOMEOWNERS ASSOCIATION OF NAPLES,
INC., a Florida not-for-profit corporation ("Grantor"), after being duly sworn, deposes
and says:
1. Grantor is the fee simple owner of the property located in Collier County and
described as follows:
SEE EXHIBIT "A" ATTACHED (THE "PROPERTY")
2. Grantor's Legal Name is: VILLAGE WALK HOMEOWNERS ASSOCIATION OF
NAPLES, INC.
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
purposes (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:
c. Grantor is not a disregarded entity as defined in Treas. Reg. §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:
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 XX 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. 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 actual notice has been received by Grantor 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 bankruptcy, except as shown on the exceptions reflected
in the Stewart Title Commitment for Title Insurance C-01206-11577.
15. To the best of Grantor's knowledge, the Property and all uses of the Property
have been and presently are in compliance in all material respects 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 actual 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. To the best of Grantor's knowledge, there are no unrecorded deeds,
judgments, liens, mortgages, easements (except as shown on the Village Walk
subdivision Plat and the exceptions reflected in the Stewart Title Commitment for Title
Insurance C-01206-11577), 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
easement interest 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. Grantor agrees to fully cooperate with Collier County when necessary to
correct any 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.
20. 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.
21. 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:
Witness ignature)
Name: �HY1btrip 1-1-r{nailitil VILLAGE WALK HOMEOWNERS
(Print or Type) ASSOCIATION OF NAPLES, INC., a
'� Florida not-for-profit corporation
Witness ( gn t rre)
Name: Mai Naafi{E'li By: ,ei./!,./i - - IL /4,1-
(Print or Type) / Prin : oil., ,J ii , / i p,
Title: _ P • _ -
STATE OF FLORIDA
COUNTY OF COLLIER
Sworn t and ubscribed before me this 4icit-n-r day_ f O\C'l V , 2015 by
Vileli I 1 L` (title), on behalf
of VILLAGE WALK HOMEOWNERS ASSOCA ION OF NAPLES, INC., who is personally
known to me or has produced as identification.
WITNESS my hand and official seal this aLJ lk day of 1\atir l lYi( , 2015.
(affix notarial seal) (,;j � Z12�� t=' (J �C ' C( C
(Signature f Notary Pu ic)
-�r��t��rll�t 61 7a /� 1rY
- rint Name of Notary Public}/
.• SAMANTHA GRACE HAGER
,1'' NOTARY PUBLIC
_. �!� ..': MY COMMISSION Y fF 155326
%.a EXPIRES:August 27,2018 Serial/Commission: E ;5�32(j
� 9f A Bonded Thro Notary Put*Undewriters
My Commission Expires:
Approved as to form and legality:
Jennifer A. B dio ( j
CD
Assistant County Attorney `�
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EXHIBIT A
° Page of
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EXHIBIT "B"
Easements and other matters affecting the land referred herein as shown on.the Plat as recorded in Plat Book 27,
Page(s) 64 through 69, inclusive, of Public Records of Collier County, Florida.
Covenants, conditions, easements and restrictions recorded in Official Records Book 2037. Page 1675; as
amended in Official Records Book 2071, Page 1129; as amended in Official Records book 2111, Page 2368; as
amended in Official Records Book 2154, Page 413; as amended in Official Records Book 2185. Page 1037; as
amended in Official Records Book 2278, Page 1; as amended in Official Records Book 2367. Page 1276; as
amended in Official Records Book 2409, Page 1519; as amended in Official Records Book 2463, Page 2237; as
amended in Official Records Book 3026. P-ge 559;Amended and'Restated in Official Records book 303'7. Page
2999; as amended in Official Records Book 3291, Page 338; as amended in Official Records Book 4077, Page
695; as amended in Official Records Book 4654, Page 325, of the Public Records of Collier County, Florida,
together with all amendments thereto, which may provide for association dues, fees and/or assessments, in
addition to any easements, reservations, covenants, building set back requirements, option to purchase, right of
first refusal and any special assessments which may come due but omitting any such covenant or restriction
based on race, color, religion, sex, familial status or national origin.
Oil, Gas and Mineral reservation recorded in Deed Book 30, Page 91, of the Public Records of Collier County,
Florida. The company makes no representation as to the present ownership of any such interest. There may be
leases, grants, exceptions or reservations of interest that are not listed.
Easement recorded in Official Records Book 400, Page 420, as affected by Easement recorded in Official
Records Book 523, Page 258, of the Public Records of Collier County, Florida. NOTE: Easement is along the
Southerly 40 feet of Tract C as shown on Plat recorded in Plat Book 27, pages 64 through 69, inclusive, Public
Records of Collier County, Florida.
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.
Resolution relating to the Establishment of the lmmokalee Area Planning District and the Coastal Area Planning
District as recorded in Official Records Book 649. P-ge 1239, of the Public Records of Collier County, Florida.
Easement recorded in Official Records Book 1193. Page 1126; as affected by Agreement recorded in Official
Records Book 1889, Page 1288 and Deed recorded in Official Records Book 1889, Page 1293, of the Public
Records of Collier County, Florida.
Agreement recorded in Official Records Book 1347. Page 545, of the Public Records of Collier County, Florida; as
affected by Agreement recorded in Official Records Book 1460, Page 16, of the Public Records of Collier County,
Florida.
Agreement recorded in Official Records Book 13851 Page 1279, of the Public Records of Collier County, Florida;
as affected by Agreement recorded in Official Records Book 1460, Page 16, of the Public Records of Collier
County, Florida
Easement recorded in Official Records Book 1971, Page 1196, of the Public Records of Collier County, Florida.
Easement recorded in Official Records Book 2295, Page 985; as affected by Subordination recorded in Official
Records Book 3493, Page 2771, of the Public Records of Collier County, Florida.
Easement recorded in Official Records Book 2295, Page 988; as affected by Subordination recorded in Official
Records Book 3493, Page 2771, of the Public Records of Collier County, Florida.
Easement recorded in Official Records Book 3552. Page 4080, of the Public Records of Collier County, Florida.
Resolution No. 2010-168 as recorded in Official Records Book 4610, Page 2307, of the Public Records of Collier
County, Florida.
Resolution No. 2011-150 as recorded in Official Records Book 4721. Page 1527, of the Public Records of Collier
County, Florida.
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