Parcel 264FEE Liebig NFTI & GAP AffidavitPROJECT: Misc. #99999
PARCEL: 264FEE
FOLIO: Portion of 70720400101
STATE OF V-IOriGOA
COUNTY OF 00 \tP f—
GRANTOR'S NON - FOREIGN TAXPAYER IDENTIFICATION & "GAP" AFFIDAVIT
The undersigned, PATRICK T. LIEBIG, after being duly swom, deposes and says:
1. Affiant is the President of LIEBIG MANAGEMENT, INC., a Florida Corporation.
2. 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 ").
3. Grantors Legal Name is: LIEBIG MANAGEMENT, INC., a Florida Corporation
332.5
4. Grantor's address is: -34WWestview Drive, Naples, Florida 34104
PARAGRAPHS 5,6 & 7 (BELOW) ARE NOT APPLICABLE TO GRATIS TRANSFERS.
5. Section 1445 of the Internal Revenue Code 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 Section 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 of 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 is not a disregarded entity as defined in s.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 s.301.7701 -3, a qualified REIT
subsidiary as defined in s. 856(i), or a qualified subchapter S subsidiary
under s. 1361(b)((3)(B).
6. For purposes of reporting this Transaction to the Internal Revenue Service on
Form 1099 -S, the Property is Grantor's (check one)
Principal Residence Other real estate
7. 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.
8. Grantor has full authority to convey the Property.
9 There are no existing contracts for sale or mortgage commitments other than
those being closed affecting the Property.
10. 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.
11. There are no unrecorded labor, mechanics', material men'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.
12. 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.
13. No notice has been received of any public hearing regarding future or pending
zoning changes or assessments for improvements by any governmental
instrumentality.
14. Grantor knows of no violations of local or state laws or private covenants,
restrictions or conditions which pertain to the Property.
15. 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.
16. 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.
17. 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 16 above, irrespective of whether Affiant was
negligent in the making of these representations.
18. 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.
19. 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.
20. 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.
21. If the Property is improved property, then Affiant 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.
22. If the subject Property hereto 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 Grantors failure to do so.
23. 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.
24. 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.
25. Under penalties of pedury, 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.
STATE OF: 1A V6d
COUNTY OF:
By: /ww
Patrick T. Lie g, President
LIEBIG MANAGEMENT, INC.
A Florida Corporation
Sworn to and subscribed before me this �h day of r LA 201
by PATRICK T. LIEBIG, President of Liebig Management, Inc., a Florldh corporation,
on behalf of the corporation, and who is:
personally known to me,
OR,
who has produced as proof of
identity.
TS a �m
(affix notarial seal)S ,(
i ture of Notary � u i c)
�Lza a %awn_ .
(Print Name of Notary Public)
,
k " SIRMINA NAY
Serial / Commission # (if any): « runt r ssioN r E 84W
My Commission Expires: EXPIRES: January , 2017
. Bonded Thru Notary Pubk
Last Revised: 5/15/12
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EXHIBIT "B"
Notice of Commencement recorded 4/10/2012 at O.R. Book 4783, Page 1163,
Public Records of Collier County, Florida.