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nk Fq,r <br />d ' Y <br />" First American Tithe <br />FirstAmerican Title Company <br />4 First American Way, Santa Ana, CA 92707 <br />(714)250 -3000 Fax - (714)913 -6770 <br />To: First American Title Company <br />Erin Reardon, Escrow Officer <br />Re: 510 East Second Street, Santa Ana, CA 92701 ( "Property") <br />Seller: City of Santa Ana <br />File No.: OSA- 5013727 (EDR) <br />Date: October 08, 2015 <br />1099 -S INPUT FORM for IRS Reporting <br />Why is this form required? Seller(s) of real property are required by law to provide the real estate reporting entity with your correct Social <br />Security/Taxpayer Identification Number ( "SSN /TIN "). By not providing your real estate reporting entity with your correct SSN/TIN, you may be subject to civil <br />or criminal penalties imposed by law under the Tax Reform Act of 1986 under Internal Revenue (IRS) Code Section 6045(E), 6676, 6722, 6723 and 7203. <br />Each Seller must complete a separate 1099 -S Input Form. Domestic corporations are exempt from reporting, <br />Husband and wife who file a ioint tax return should complete only one 1099 -S Input Form with one social security number. <br />Social Security Number <br /> <br />Name /Entity (for IRS Reporting of SSN or TIN) <br />Forwarding Street Address (after closing): Attn: Executive Director, CDA 20 Civic Center Plaza <br />City Santa Ana State CA Zip Code 92702 Country USA <br />1. What is your percentage or amount of ownership /sales price in the property? <br />19100% ❑ Other % or $ (If other than 100% - see question #2 to name other owners) <br />2. If your answer to question #1 is not 100%, you must provide the Name /Entity for IRS Reporting of other owners and their Ownership <br />Percentage or Amount. <br />• Name /Entity for reporting Ownership % or $ <br />• Name /Entity for reporting Ownership % or $ <br />• Name /Entity for reporting Ownership % or $ <br />Under penalties of perr tff Lfy tha •the above information is correct, <br />YourSignatur / <br />PL FASFNOTFTHATPOOP- CTNP/LTFnPM4mtiCTRF6lLRMTTTFn FnP All CFF/FPC <br />For Escrow Use Only — Additional File Information <br />[ ] Change <br />[ ] Void <br />[ ] Delete <br />No. of 1099 -5 Farms <br />required for this fie? <br />[ j <br />Is Name /Entity Party .'N.,- Recard' Seller? [ ] <br />Type Is'. [ ] H/W or Indlvidual [ ] Tmst/ausiness <br />Is Property part of an Exchange? <br />[ ] YES [ ] NO <br />For Escrow Use Only — Required for Y099 -S Ei Entry Only (No entry in FAST) <br />[ j Add <br />Contract Sales Price <br />Buyer's Part of Real Estate Tax <br />Actual Settlement Date <br />Change <br />Delete <br />nn .'o"— <br />Region: California FAST Office: 3002 (545) (EDR) <br />