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Epic Land S3olutions,.lnc. <br />PULL ACQUISITION OFFSET STATFMFNT <br />(Conforms to CatTraas Exhibit 8 -EX-I SA) <br />PERSONAL INFORMATION NOTICE <br />Pursuant to lire Federal privacy Act (P.L. 95.579) and fire Information Practices Act of 1977 (Civil Code Sections 1789, at sec.), notice is hereby given for the regnsst <br />of personal information by this form, The requested personal infomrntion is voluntary. The principal purpose ofthe voluntary information is to facilitate the processing <br />of this Igrm. The failure to provide all or any part of the requested information may delay processing of this Corm. No disclosure of personal information will be made <br />unless pprmissible Linder Article 6, Section 1798.24 of lie IPA of 1977. Each individual has the right upon request end proper identification, to inspect all personal <br />information in any record maintained on the Individual by an identifying padicular, Direct any inquiries oft infornmtlonmaintaimnoR to your IPA Office._ <br />Cra Rte Post Parcel No. _ <br />—� e'T '�-e <br />Grantor <br />WHEREAS, The City of Santa And (City) seeks to acquire the fee - simple title to certain lands and buildings, <br />including that certain�buildingknownas: It <br />and, <br />(Address) <br />WHEREAS, the City and the owner of said building are negotiating a sale of said building. <br />NOW, THEREFORE, The undersigned makes the following statement of facts and represents to the City that <br />each of said facts are true and correct in every detail. <br />That the undersigned are the tenants in possession underthe terms of: <br />1. O An oral lease fiotn month -to -month <br />() written least) for a term ending `D' i C 2--011 at a monthly rental of <br />$ %0 and that the undersigned has paid all rents to and including the _ day of <br />year , and has paid no rents beyond said date except <br />2. That the last rental payment was made to and that the next rental payment of $ will be due and <br />payable an the day of year_ <br />3. ( ) That no offsets are claimed by the undersigned tenants and/or lessees against any rents which have been <br />paid or which may hereafter become due. <br />( ) That the following offsets are claimed by the undersigned tenants ( ), lessees ( ), against future rents: <br />25D -20 <br />