710 9th Street N - M & T Enterprises, Inc. Non-Foreign Taxpayer ID & GAP Affidavit PROJECT: CAT ADA EASEMENT
PARCEL: 11180040005
ADDRESS: 710 9`"Street N.
BUS STOP#: 12
GRANTOR'S NON-FOREIGN,TAXPAYER IDENTIFICATION&"GAP"AFFIDAVIT
The Undersigned, Dc zrr rt,A ,1�alt i tta't , ("Affiant") on behalf of M & T
Enterprises, Inc., a Florida corporation whose mailing address is 1Q4- St. T
Tampa, FL 33645("Grantor"),after being duly sworn,deposes and says: 12,40(..o rt "CD tI)-
a4
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: M&T Enterprises, 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
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.
Ise Pcsa`A
b. Grantor's address is: SG47,3-Str ez- leee-Tampa; FL 336
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: 2ro LO 101 3(p to
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
easement 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. Grantor acknowledges that the Lease Agreement between Grantor and Gray
Drug Fair, Inc., an Ohio corporation, dated June 1, 1983 and recorded November 15, 1983
in Official Records Book 1051, Page 858, of the Public Records of Collier County, Florida,
has expired,and is no longer in effect.
25. 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.
M&T Enterprises, Inc.
a Florida corporation
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STATE OF /A! ji 47
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SWORN TO •ND SUBSCT IBED be ore me this;' day of
2011'by ,,/
pe-y, / _ ,l i,IAL as_ e of M& Enterprises, Inc.
o . [ ] personally nown to me or o h [ ] produced as
iden ification.
WITNESS my hand and official s-. is ' da" y of o. , 01
(affix notarial seal) P Y, ,, ,/, ,Iff_ _1�
'!'n<' re o'' Nota 'u•lic)
A l I if 1
(Print Name o Notary 'u•lc)
NOTARY PUBLIC
I ,o p] SUSAN WHEAT Serial/Commission#:(if any) " I
d�oNotary Public-State of Florida, My Commission Expires: a/y&
N ;441-N*pq My Comm.Expires Nov 11,2017
J';.,.0,, e�. Commission # FF 069547
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A PARCEL NO. 11180040005
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4$ A PARCEL OF TRACT OF LAND LYING SECTION 34, TOWNSHIP
s 49SOUTH, RANGE 25 EAST, COLLIER COUNTY, FLORIDA, BEING MORE
41 PARTICULARLY DESCRIBED AS FOLLOWS:
m
COMMENCING AT THE NORTHWEST CORNER OF BLOCK A OF THE
PLAT OF LAKE PARK AS RECORDED IN PLAT BOOK 3, PAGE 35, LEGEND
g PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA THENCE C = CHORD LENGTH
ii S.09'36'55"E., ON THE WEST LINE OF SAID BLOCK A FOR 51.32 CB = CHORD BEARING
g FEET TO THE POINT OF BEGINNING OF THE HEREIN DESCRIBED DESC. = DESCRIPTION
PARCEL; INST. = INSTRUMENT NUMBER
1.
THENCE N.80'24'1 1"E., DEPARTING SAID WEST LINE FOR 2.00 FEET; L = ARC LENGTH
OR = OFFICIAL RECORDS BOOK
THENCE S.09'36'55"E., FOR 5.00 FEET; PG = PAGE
E THENCE S.80'24'1 1"W., FOR 2.00 FEET TO AN INTERSECTION WITH POB. = POINT OF BEGINNING
SAID WEST LINE; POC. = POINT OF COMMENCEMENT
n R = RADIUS
THENCE N.09'36'55"W. ON SAID WEST LINE FOR 5.00 FEET TO THE A = DELTA ANGLE
.- POINT OF BEGINNING OF THE PARCEL DESCRIBED HEREIN;
S CONTAINING 10 SQUARE FEET, MORE OR LESS.
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BEARINGS HEREINABOVE MENTIONED ARE BASED ON THE WEST LINE
8 OF SAID BLOCK A TO BEAR S.09'36'55"E.
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6
,V
3
TIMOTHY J. DEVRIES DATE
NOTES: PROFESSIONAL SURVEYOR AND MAPPER
1. THIS SKETCH DOES NOT MAKE ANY REPRESENTATION AS TO FLORIDA CERTIFICATE NO. LS 6758
ZONING OR DEVELOPMENT RESTRICTIONS ON THE SUBJECT NOT VALID WITHOUT THE SIGNATURE AND THE
PARCEL. ORIGINAL RAISED SEAL OF A FLORIDA LICENSED
SURVEYOR AND MAPPER. THIS IS NOT A SURVEY.
COLLIER AREA TRANSIT
6610 Willow Park Dr.,Suite 200
BUS STOP EASEMENT(ID 12) 4\ Naples,Florida 34109
LYING IN PFax:(239)597-05785
SECTION 34,TOWNSHIP 49 SOUTH, RANGE 25 EAST LB No.:6952
COLLIER, COUNTY, FLORIDA ENGINEERING
1 JOB NUMBER REVISION SECTION TOWNSHIP RANGE ,`.L E DATE_ DRAWN BY FILE NAME SHEET
150038.00.01 _ 0 34 _ 49 _ 25 1"=5' _ 06/17/16 TJD _150038.00.01 SD 1 OF 1
EXHIBIT B
1. Restrictions, conditions, reservations, easements and other matters contained on
the Plat of Naples Groves and Truck Co's Little Farms No. 2 as recorded in Plat
Book 1, Page 27, of the Public Records of Collier County, Florida: but deleting
any covenant, condition or restriction indicating a preference, limitation or
discrimination based on race, color, religion, sex, handicap, familial status, or
national orgin to the extent such covenants, conditions or restriction violate 42
USC 3604c.
PROJECT: CAT ADA EASEMENT
PARCEL: 11180040005
ADDRESS: 710 9m Street N.
BUS STOP#: 12
PUBLIC DISCLOSURE ACT— DISCLOSURE AFFIDAVIT
B• E• 'E M the undersigned authority in said County and State, personally appeared
r u/ie'11/ / x._ , who being first duly sworn, deposes and says that:
I1 /A:,i I, t a . to r of M & T Enterprises, Inc., a
Flori a corps .•tion aut or'zed to do business under t = laws of Florida.
2. M & T Enterprises, Inc. holds title to real property described in Exhibit "A" attached
hereto and by this reference made a part hereof(the "Property").
3. M & T Enterprises, Inc. hereby certifies that the names and addresses listed on Exhibit
"B" attached hereto, and by this reference made a part hereof, are the names and addresses
of every person having a beneficial interest in the Property, however small or minimal.
4. M & T Enterprises, Inc. files this Affidavit for the purpose of complying with the
provisions of 286.23 of the Florida Statutes.
M & T Enterprises, Inc.
a Florida corporation
By: j7 &.1t 91 -1
110Firs Yv gess Print: lb,. . _r i alai 6L5),1
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Print Name:
Second Witness Signature
Print Name: Tr S 4 vi V.-(e
(NOTARY JURAT ON FOLLOWING PAGE)
PUBLIC DISCLOSURE ACT-DISCLOSURE AFFIDAVIT-Page 2
i
STATE OF ' A.' 1 )
gimpy )
COUNTY OF it _AI 0 4 )
The,fgre.frgoing Public t isclosure Act— Disclosur; Affiia it w- sworn and sylatscribet to befor
me this X. 441day of , ,i, 20 . b I' ,h,,i, ' A itLS oi as 5-rcire,
of M & T Enterprises, Inc , w o is personally known ,or ' as produ ed as
identification. ._
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1 7 ature o' ot.r
(Affix Notary Seal)
40 t6-0A, lit MeCif
NotaryyL/ /Hrpr VI/
Commission #
--,:, Nutary Public-State of Florida
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my uomm.Expires Nov 11,2017 Li My Commission Expires:
ii Commission # FF 069547 v
j.‘77:.441T;j::;;.115!gt.flirnugh,Nationotary,,,57,.. 3
Approved as to form and legality:
By: Nemm..............-.....,
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Print Name: Jennifer A.Bel, • • 04, ...,-...
Assistant County Attom 1 oNN
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PARCEL NO. 11180040005
0 OR 966, PG 1680
o SITE OF BUS STOP
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A PARCEL OF TRACT OF LAND LYING SECTION 34, TOWNSHIP 1"=5'
1J 49SOUTH, RANGE 25 EAST, COLLIER COUNTY, FLORIDA, BEING MORE
A PARTICULARLY DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHWEST CORNER OF BLOCK A OF THE
E
PLAT OF LAKE PARK AS RECORDED IN PLAT BOOK 3, PAGE 35, LEGEND
PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA THENCE C = CHORD LENGTH
S.09'36'55"E., ON THE WEST LINE OF SAID BLOCK A FOR 51.32 CB = CHORD BEARING
8 FEET TO THE POINT OF BEGINNING OF THE HEREIN DESCRIBED DESC. = DESCRIPTION
o PARCEL; INST. = INSTRUMENT NUMBER
o THENCE N.80'24'I 1"E., DEPARTING SAID WEST LINE FOR 2.00 FEET; L = ARC LENGTH
E THENCE S.09'36'55"E., FOR 5.00 FEET; OR = OFFICIAL RECORDS BOOK
PG = PAGE
E THENCE S.80'24'1 1"W., FOR 2.00 FEET TO AN INTERSECTION WITH POB. = POINT OF BEGINNING
SAID WEST LINE; POC. = POINT OF COMMENCEMENT
N R = RADIUS
S THENCE N.09'36'55"W. ON SAID WEST LINE FOR 5.00 FEET TO THE = DELTA ANGLE
POINT OF BEGINNING OF THE PARCEL DESCRIBED HEREIN;
. G CONTAINING 10 SQUARE FEET, MORE OR LESS.
8
BEARINGS HEREINABOVE MENTIONED ARE BASED ON THE WEST LINE
OF SAID BLOCK A TO BEAR S.09'36'55"E.
e
F
f
NOTES: TIMOTHY J. DEVRIES DATE
PROFESSIONAL SURVEYOR AND MAPPER
1. THIS SKETCH DOES NOT MAKE ANY REPRESENTATION AS TO FLORIDA CERTIFICATE NO. LS 6758
ZONING OR DEVELOPMENT RESTRICTIONS ON THE SUBJECT NOT VALID WITHOUT THE SIGNATURE AND THE
PARCEL. ORIGINAL RAISED SEAL OF A FLORIDA LICENSED
SURVEYOR AND MAPPER. THIS IS NOT A SURVEY.
COLLIER AREA TRANSIT
IA/
BUS STOP EASEMENT(ID 12) 6610 Willow Park Dr.,Suite 200
LYING IN Naples,Florida 34109
Phone(239)597-0575
SECTION 34,TOWNSHIP 49 SOUTH, RANGE 25 EAST Fax:(239)597-0576
COLLIER, COUNTY, FLORIDA LB No.:6952
ENGINEERING
JOB NUMBER i REVISION I SECTION TOWNSHIP I RANGE I SC v,'N R`r ,-
NAME SHEET
1150038.00.01 0 34 49 25 5' 0:-5/17/15' TJD 15003n 00.01 50 1 OF 1
EXHIBIT"B"
Name: Name:
Address: Address:
Name: Name:
Address: Address: