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SA FULL PACKET_2017-10-17
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SA FULL PACKET_2017-10-17
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Last modified
10/16/2017 3:31:59 PM
Creation date
10/16/2017 3:31:12 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Community Development
Item #
SA4
Date
10/17/2017
Destruction Year
2022
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EXHIBIT A TO EXHIBIT 4 <br />taK1111HY1[y <br />FIRPTA CERTIFICATE <br />TRANSFEROR'S CERTIFICATE OF NON -FOREIGN STATUS <br />To inform Marianne P. Covington, Ridley J. Politiski and Michael P. Politiski, as Trustees of the <br />Marital Trust of the Politiski Trust dated December 4, 2000 ("Transferee"), that withholding of tax under <br />Section 1445 of the Internal Revenue Code of 1986, as amended ("Code") will not be required upon the <br />transfer of certain real property to the Transferee by the Successor Agency to the former Community <br />Redevelopment Agency of the City of Santa Ana (the, "Transferor"), the undersigned hereby certifies the <br />following: <br />1. The Transferor is not a foreign person or citizen, foreign corporation, foreign partnership, <br />foreign trust, or foreign estate (as those terms are defined in the Code and the Income Tax Regulations <br />promulgated thereunder); <br />2. The Transferor's social security number or U.S, employer identification number is as <br />follows: 95-6000785. <br />The Transferor's home or office address is: <br />20 Civic Center Plaza, M-25 <br />City of Santa Ana, CA 92701 <br />The Transferor understands that this certification may be disclosed to the Internal Revenue Service <br />by the Transferee and that any false statement contained herein could be punished by fine, imprisonment <br />or both. Under penalty of perjury, I declare that I have examined this certification and to the best of my <br />knowledge and belief it is true, correct and complete, and I further declare that I have authority to sign this <br />document. <br />Successor Agency to the former Community <br />Redevelopment Agency of the City of Santa Ana <br />C-1 <br />SA4-130 <br />
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