Thank you for your transaction! - LoopNet · 2018-12-03 · transaction; they are designed such...
Transcript of Thank you for your transaction! - LoopNet · 2018-12-03 · transaction; they are designed such...
Andy Buskirk - Title Officer [email protected] Mike Mjelde - Senior Title Officer [email protected]
Marian Scott -Senior Title Officer [email protected] Lori Bullard -Senior Title Officer, Title Manager [email protected]
Thank you for your transaction!
We have generated an electronic copy of your file for you. Within you will findboth the preliminary title commitment and historical documents on yourtransaction; they are designed such that you can navigate between the commitmentand related documentation with greater ease.
The navigation bar along the left can be used to go directly to bookmarked pages inthe file. If you have questions or desire further information or clarification on yourfile, contact the title unit by clicking one of the links below.
Title Department Contacts:
Title Department Phone: (360) 307-6308 / Fax: (360) 307-6384
Julie Goodman - Chief Title Officer [email protected]
Shelley Hill - Recording/Title Technician [email protected]
We appreciate this opportunity to be of service to you!
E-Mail: <[email protected]>Web Site: <http://www.pnwtkitsap.com>
2021 NW Myhre Road, Suite 300, PO Box 3607, Silverdale, WA 98383
Title InsuranceEscrow ServiceReal Estate Resources
Silverdale Bainbridge Island360-692-4141 206-842-20822021 Myhre Road NW Suite 300 921 Hildebrand, Suite 200Silverdale, WA 98383 Bainbridge Island, WA 98110
Our Privacy Policy
We may collect nonpublic personal information about you from the following sources:
Information we receive from you such as on applications or other forms. Information about your transactions we secure from our files, or from others. Information we receive from a consumer reporting agency. Information that we receive from others involved in your transaction, such as the real estate agent or lender.
Unless it is specifically stated otherwise in an amended Privacy Policy Notice, no additional nonpublic personalinformation will be collected about you.
WE DO NOT DISCLOSE ANY NONPUBLIC PERSONAL INFORMATION ABOUT YOU WITH ANYONE FOR ANY PURPOSE.
We restrict access to nonpublic personal information about you to those employees who need to know thatinformation in order to provide products or services to you. We maintain physical, electronic, and proceduralsafeguards that comply with federal regulations to guard your nonpublic personal information.
Thank you for choosing Pacific Northwest Title. We value you as a customer and appreciate the opportunity to serveyou.
Commitment for Title Insurance
Issued By Old Republic National Title Insurance CompanyOld Republic NationalTitle Insurance Company, a Minnesota corporation (“Company”), for a valuable, consideration, commits to issue its policy or policies of titleinsurance, as identified in Schedule A, in favor of the Proposed Insured named in Schedule A, as owner or mortgagee of the estate or interest in the landdescribed or referred to in Schedule A, upon payment of the premiums and charges and compliance with the Requirements; all subject to the provisions ofSchedules A and B and to the Conditions of this Commitment.This Commitment shall be effective only when the identity of the Proposed Insured and the amount of the policy or policies committed for have beeninserted in Schedule A by the Company.All liability and obligation under this Commitment shall cease and terminate six (6) months after the Effective Date or when the policy or policiescommitted for shall issue, whichever first occurs, provided that the failure to issue the policy or policies is not the fault of the Company.The Company will provide a sample of the policy form upon request.IN WITNESS WHEREOF, Old Republic National Title Insurance Company has caused its corporate name and seal to be affixed by its duly authorizedofficers on the date shown in Schedule A.
Issued through the Office of
Pacific Northwest Title of KitsapPost Office Box 3607Silverdale, WA 98383
Continued on next pageOLD REPUBLIC NATIONAL TITLE INSURANCE COMPANYA Stock Company400 Second Avenue South, Minneapolis, Minnesota 55401(612) 371-111
ByAuthorized Signatory
President
ORT Form 4308ALTA Commitment for TitleInsurance 6/06
Attest
Secretary
CONDITIONS
1. The term mortgage, when used herein, shall include deed of trust, trust deed, or other security instrument.2. If the proposed Insured has or acquired actual knowledge of any defect, lien, encumbrance, adverse claim or other matter affecting the estate or
interest or mortgage thereon covered by this Commitment other than those shown in Schedule B hereof, and shall fail to disclose such know -edge to the Company in writing, the Company shall be relieved from liability for any loss or damage resulting from any act of reliance hereon tothe extent the Company is prejudiced by failure to so disclose such knowledge. If the proposed Insured shall disclose such knowledge to theCompany, or if the Company otherwise acquires actual knowledge of any such defect, lien, encumbrance, adverse claim or other matter, theCompany at its option may amend Schedule B of this Commitment accordingly, but such amendment shall not relieve the Company from liabilitypreviously incurred pursuant to paragraph 3 of these Conditions and Stipulations.
3. Liability of the Company under this Commitment shall be only to the named proposed Insured and such parties included under the definition ofInsured in the form of policy or policies committed for and only for actual loss incurred in reliance hereon in undertaking in good faith(a) to comply with the requirements hereof, or (b) to eliminate exceptions shown in Schedule B, or (c) to acquire or create the estate or interest ormortgage thereon covered by this Commitment. In no event shall such liability exceed the amount stated in Schedule A for the policy or policiescommitted for and such liability is subject to the insuring provisions and Conditions and Stipulations and the Exclusions from Coverage of theform of policy or policies committed for in favor of the proposed Insured which are hereby incorporated by reference and are made a part of thisCommitment except as expressly modified herein.
4. This Commitment is a contract to issue one or more title insurance policies and is not an abstract of title or a report of the condition of title. Anyaction or actions or rights of action that the proposed Insured may have or may bring against the Company arising out of the status of the title tothe estate or interest or the status of the mortgage thereon covered by this Commitment must be based on and are subject to the provisions ofthis Commitment.
5. The policy to be issued contains an arbitration clause. All arbitrable matters when the Amount of Insurance is $2,000,000 or less shall bearbitrated at the option of either the Company or the Insured as the exclusive remedy of the parties.You may review a copy of the arbitration rules at: http://www.alta.org/.
Page 2
rev. 07/2016
FACTS WHAT DOES OLD REPUBLIC TITLE DO WITH YOUR PERSONAL INFORMATION?
Why?
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.
What?
The types of personal information we collect and share depend on the product or service you have with us. This information can include:
• Social Security number and employment information • Mortgage rates and payments and account balances • Checking account information and wire transfer instructions
When you are no longer our customer, we continue to share your information as described in this notice.
How?
All financial companies need to share customers’ personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers’ personal information; the reasons Old Republic Title chooses to share; and whether you can limit this sharing.
Reasons we can share your personal information
Does Old Republic
Title share?
Can you limit
this sharing?
For our everyday business purposes — such as to process your
transactions, maintain your account(s), or respond to court orders and
legal investigations, or report to credit bureaus
Yes No
For our marketing purposes —
to offer our products and services to you No We don’t share
For joint marketing with other financial companies No We don’t share
For our affiliates’ everyday business purposes —
information about your transactions and experiences Yes No
For our affiliates’ everyday business purposes —
information about your creditworthiness No We don’t share
For our affiliates to market to you No We don’t share
For non-affiliates to market to you No We don’t share
Questions Go to www.oldrepublictitle.com (Contact Us)
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Who we are
Who is providing this notice? Companies with an Old Republic Title name and other affiliates. Please see below for a list of affiliates.
What we do
How does Old Republic Title protect my personal information?
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. For more information, visit http://www.OldRepublicTitle.com/newnational/Contact/privacy.
How does Old Republic Title collect my personal information?
We collect your personal information, for example, when you:
Give us your contact information or show your driver’s license
Show your government-issued ID or provide your mortgage information
Make a wire transfer
We also collect your personal information from others, such as credit bureaus, affiliates, or other companies.
Why can’t I limit all sharing? Federal law gives you the right to limit only:
Sharing for affiliates’ everyday business purposes - information about your creditworthiness
Affiliates from using your information to market to you
Sharing for non-affiliates to market to you
State laws and individual companies may give you additional rights to limit sharing. See the "Other important information" section below for your rights under state law.
Definitions
Affiliates Companies related by common ownership or control. They can be financial and nonfinancial companies.
• Our affiliates include companies with an Old Republic Title name, and financial companies such as Attorneys’ Title Fund Services, LLC, Lex Terrae National Title Services, Inc., Mississippi Valley Title Services Company, and The Title Company of North Carolina.
Non-affiliates Companies not related by common ownership or control. They can be financial and non-financial companies.
• Old Republic Title does not share with non-affiliates so they can market to you
Joint marketing A formal agreement between non-affiliated financial companies that together market financial products or services to you.
• Old Republic Title doesn’t jointly market.
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Other Important Information
Oregon residents only: We are providing you this notice under state law. We may share your personal information (described on page one) obtained from you or others with non-affiliate service providers with whom we contract, such as notaries and delivery services, in order to process your transactions. You may see what personal information we have collected about you in connection with your transaction (other than personal information related to a claim or legal proceeding). To see your information, please click on "Contact Us" at www.oldrepublictitle.com and submit your written request to the Legal Department. You may see and copy the information at our office or ask us to mail you a copy for a reasonable fee. If you think any information is wrong, you may submit a written request online to correct or delete it. We will let you know what actions we take. If you do not agree with our actions, you may send us a statement.
Affiliates Who May be Delivering This Notice
American First Abstract, LLC American First Title & Trust Company
American Guaranty Title Insurance Company
Attorneys' Title Fund Services, LLC
Compass Abstract, Inc.
eRecording Partners Network, LLC
Genesis Abstract, LLC Kansas City Management Group, LLC
L.T. Service Corp. Lenders Inspection Company
Lex Terrae National Title Services, Inc.
Lex Terrae, Ltd. Mara Escrow Company Mississippi Valley Title Services Company
National Title Agent's Services Company
Old Republic Branch Information Services, Inc.
Old Republic Diversified Services, Inc.
Old Republic Exchange Company
Old Republic National Title Insurance Company
Old Republic Title and Escrow of Hawaii, Ltd.
Old Republic Title Co. Old Republic Title Company of Conroe
Old Republic Title Company of Indiana
Old Republic Title Company of Nevada
Old Republic Title Company of Oklahoma
Old Republic Title Company of Oregon
Old Republic Title Company of St. Louis
Old Republic Title Company of Tennessee
Old Republic Title Information Concepts
Old Republic Title Insurance Agency, Inc.
Old Republic Title, Ltd. Republic Abstract & Settlement , LLC
Sentry Abstract Company The Title Company of North Carolina
Title Services, LLC
Trident Land Transfer Company, LLC
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Pacific Northwest Title Agent for Old Republic National Title Insurance Company
2021 NW Myhre Road, Suite 300 · P.O. Box 3607
Silverdale, Washington 98383
(360) 692-4141 · Fax (360) 692-8001
http://www.pnwtkitsap.com
A.L.T.A. Commitment
Schedule A
Realogics Sotheby's International Realty Title Order No.: 32167419
240 Winslow Way East Title Officer: Andy Buskirk
Bainbridge Island, WA 98110 Sr. Title Officer: Lori Bullard
Attention: Georg Syvertsen & Arthur Mortell Sr. Title Officer: Mike Mjelde
Customer Ref: VWA-BI-Lots LLC Sr. Title Officer: Marian Scott
1. Effective Date: October 25, 2018 at 8:00 A.M.
2. Policy or Policies to be issued:
(X) ALTA 2006 Owner's Policy
(X) Standard Amount: TBD
Premium: $ 0.00
Tax: $ 0.00
Proposed Insured:
To Be Determined
**See Note 2 for Kitsap County recording charges, including E-record fees**
3. The estate or interest in the land described or referred to in the Commitment and covered herein is:
Fee Simple
4. Title to the said estate or interest in said land is at the effective date hereof vested in:
VWA-BI-Lots LLC, an Ohio limited liability company
5. The land referred to in this Commitment is in the State of Washington, County of Kitsap, and is
described as follows:
See Exhibit "A" Attached Hereto
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Exhibit “A”
Order No.: 32167419
Resultant Parcel D of Boundary Line Adjustment recorded under Auditor’s File No. 201607270165
and as depicted on Survey recorded under Auditor’s File No. 201607270166, in Volume 82, Page
209, being a portion of the Southeast quarter of the Southwest quarter, Section 23, Township 25
North, Range 2 East, W.M., in Kitsap County, Washington.
…End of Exhibit “A”…
Page 3
Pacific Northwest Title
A.L.T.A. Commitment
Schedule B
Order No.: 32167419
I. The following are the requirements to be complied with:
A. Instruments necessary to create the estate or interest to be insured must be properly executed,
delivered and duly filed for record.
B. Payment to or for the account of the grantors or mortgagors of the full consideration for the estate
or interest to be Insured.
II. Schedule B of the policy or policies to be issued will contain exceptions to the following matters unless the
same are disposed of to the satisfaction of the Company:
A. Defects, liens, encumbrances, adverse claims or other matters, if any, created, first appearing in
the public records, or attaching subsequent to the effective date hereof but prior to the date the
proposed Insured acquires of record for value the estate or interest or mortgage thereon covered by
this commitment.
B. General Exceptions:
1. Rights or claims of parties in possession not shown by the public records.
2. Public or private easements, or claims of easements, not shown by the public records.
3. Encroachments, overlaps, boundary line disputes, or other matters which would be
disclosed by an accurate survey or inspection of the premises.
4. Any lien, or right to a lien, for services, labor or material heretofore or hereafter
furnished, imposed by law and not shown by the public records, or liens under the
Workmen's Compensation Act not shown by the public records.
5. Any title or rights asserted by anyone including but not limited to persons, corporations,
governments or other entities, to tide lands, or lands comprising the shores or bottoms of
navigable rivers, lakes, bays, ocean or sound, or lands beyond the line of the harbor lines
as established or changed by the United States Government.
6. (a)Unpatented mining claims; (b) reservations or exceptions in patents or in Acts
authorizing the issuance thereof; (c) water rights, claims or title to water.
7. Indian tribal codes or regulations, Indian treaty or aboriginal rights, including, but not
limited to, easements or equitable servitudes.
8. Any service, installation, connection, maintenance, capacity, or construction charges for
sewer, water, electricity or garbage removal.
9. General taxes not now payable or matters relating to special assessments and special
levies, if any, preceding the same becoming a lien.
C. Special Exceptions:
As on Schedule B, attached.
Continued on Next Page
Schedule B - continued
Order No.: 32167419
Page 4
Special Exceptions:
1. Relinquishment of all existing, future or potential easements for access, light, view and air, and all
rights of ingress, egress to, from the between said premises and the highway or highways to be
constructed on lands conveyed by Deed recorded January 28, 1954, under Kitsap County Auditor's
File No. 589328.
To: The State of Washington
2. Relinquishment of all existing, future or potential easements for access, light, view and air, and all
rights of ingress, egress to, from the between said premises and the highway or highways to be
constructed on lands conveyed by Deed recorded January 28, 1954, under Kitsap County Auditor's
File No. 589335.
To: The State of Washington
3. Easement, and the terms and conditions thereof, affecting a portion of said premises and for the
purposes hereinafter stated, as disclosed by instrument recorded on March 19, 1993, under Kitsap
County Auditor's File No. 9305190189.
In favor of: The City of Bainbridge Island, Washington, a Municipal Corporation
For: The purpose of constructing, repairing, altering or reconstructing said
sidewalk
Affects: A portion of said premises
4. Easement, and terms and conditions thereof, affecting a portion of said premises and for the
purposes hereinafter stated, as disclosed by instrument recorded on October 3, 2003, under Kitsap
County Auditor's File No. 200310030063.
For: Vehicular, pedestrian and utilities
Affects: A portion of said premises
Said instrument is a re-recording of instrument recorded September 19, 2003 under Auditor’s File
No. 200309190195.
Amendment and termination of Easement Rights recorded under Auditor’s File Nos.
201410090109 and 201608030171.
5. Road, Sidewalk and Plater Strip Area Cost and Maintenance Agreement and the terms and
conditions thereof:
Recorded: October 3, 2003
Auditor’s File No.: 200310030062
6. Easement for utility systems, and the terms and conditions thereof, together with necessary
appurtenances, as granted by instrument recorded on November 12, 2014, under Kitsap County
Auditor's File No. 201411120375.
To: Puget Sound Energy, Inc.
Affects: A portion of said premises
7. Easement, agreement and terms and conditions thereof, affecting a portion of said premises and for
the purposes hereinafter stated, as disclosed by instrument recorded on November 19, 2015, under
Kitsap County Auditor's File No. 201511190164.
For: Underground water and sanitary sewer utilities facilities
Affects: A portion of said premises
Schedule B - continued
Order No.: 32167419
Page 5
8. Easement, agreement and terms and conditions thereof, affecting a portion of said premises and for
the purposes hereinafter stated, as disclosed by instrument recorded on June 18, 2014, under Kitsap
County Auditor's File No. 201406180126.
For: Reciprocal easement agreement
Affects: A portion of said premises
Confirmation and Grant of Easement Rights, recorded under Auditor’s File Nos. 201509020080,
201602180063 and 201701300037.
Release of Easement Rights recorded under Auditor’s File Nos. 201509020081, 201602290139
and 201704250189.
First Amendment to Reciprocal Easement Agreement recorded under Auditor’s File No.
201802090191.
9. Covenants, conditions, restrictions, easements and matters delineated, described and noted, if any,
in short plat:
Recorded: September 7, 1983
Auditor’s File No.: 8309070094
10. Covenants, conditions, restrictions and easements in declaration of restrictions:
Recorded: June 18, 2014
Auditor’s File No.: 201406180127
Amendment and/or modification of said restrictions:
Recorded: January 30, 2017
Auditor’s File No.: 201701300038
11. Boundary Line Adjustment and the terms and conditions thereof:
Recorded: June 18, 2014
Auditor’s File Nos.: 201406180124 and 201406180125
Affidavit of Correction recorded under Auditor’s File Nos. 201409030042 and 201612150194.
12. Boundary Line Adjustment and the terms and conditions thereof:
Recorded: July 27, 2016
Auditor’s File No.: 201607270164 and 201607270166
13. Local improvement assessments, and/or special assessment, if any, levied by the City of
Bainbridge Island.
Investigation should be made with the city for any amounts due or past due, if any at (206) 842-
7633.
14. Notice of possible (present and future) tap or connection charges levied, or to be levied, by the City
of Winslow, notice of which is given by instrument recorded July 10, 1979, under Kitsap County
Auditor's File No. 7907100114.
Schedule B - continued
Order No.: 32167419
Page 6
15. Lease dated June 13, 2014, upon the terms, covenants and conditions therein provided;
memorandum thereof dated June 13, 2014, recorded June 18, 2014, in the office of the recording
officer of Kitsap County, Washington, under Auditor’s File No. 201406180128:
Lessor: VWA – Bainbridge Island, LLC, an Ohio limited liability company
Lessee: Keybank National Association
Term: 15 years
Affects: Said premises and other property
16. Financing Statement and the terms and conditions thereof:
Secured Party: The Huntington National Bank
Debtor: VWA – Bainbridge Island, LLC
Covers: Personal Property And Fixtures Located On Said Premises
Filed: July 28, 2016
Auditor's File No.: 201607280069
Affects: Said premises and other property
17. Matters delineated, described and noted on Survey recorded November 1, 2007, in Volume 69,
Pages 181 and 182, under Auditor’s File No. 200711190171.
18. Evidence of the corporate existence of VWA-BI-Lots, LLC, an Ohio limited liability company, and
any amendments thereto, must be submitted, together with evidence of the identity and authority of
the members or managers thereof to execute the forthcoming instrument.
19. Unrecorded Leasehold, if any; rights of vendors and holders of security interest on personal
property installed upon said property and rights of tenants to remove trade fixtures at the
expiration of the term.
20. Title is to vest in persons not yet revealed and when so vested will be subject to matters disclosed
by a search of the records against their names.
21. Until the amount of the policy to be issued is provided to us, and entered on the commitment as
the amount of the policy to be issued, it is agreed by every person relying on this commitment
that we will not be required to approve any policy amount over $1,000.00, and our total liability
under this commitment shall not exceed that amount.
22. Lien of real estate excise tax upon any sale of said premises, if unpaid. Real estate excise tax on
said property is subject to tax at the rate of .0178, effective July 1, 2005, an additional $5.00
processing fee is required.
Note: If your transaction includes recording of tax exempt documents there is a $10.00
processing fee to the County Treasurer.
Note 1: Abbreviated Legal Description:
Resultant Parcel D, BLA, AF Nos. 201607270165 and 201607270166, Ptn SE/SW, Section
23, Township 25 North, Range 2 East
Schedule B - continued
Order No.: 32167419
Page 7
Note 2: Pacific Northwest Title electronically records documents, when possible. All checks for
excise and recording fees should be made payable to Pacific Northwest Title. Kitsap County
recording fees are as follows:
E-recording fee: $5.45 per document
Deeds: $99.00 1st page and $1 each additional page
Deeds of Trust: $100.00 1st page and $1 each additional page
Note 3: General and Special Taxes and Charges for the year 2018 have been paid in full:
In the Amount of: $14,629.28
Tax Account Number: 232502-3-094-2009
Levy Code: 0215
Assessed Value: $1,353,570.00
Note 4: Please be aware that should this transaction cancel, there will be a minimum cancellation fee of
$50.00 plus tax of $4.50.
Note 5: The deed under which title was acquired was recorded under Kitsap County Auditor's File
No. 201802090190. There have been no other conveyances during the last 24 months except
the following:
Instrument: Special Warranty Deed
Grantor: Deschamps Partnership, L.P.
Grantee: VWA-Bainbridge Island, LLC, an Ohio Limited Liability Company
Recorded: June 18, 2014
Auditor’s File No.: 201406180123
…End of Schedule B…
cc: Realogics Sotheby's International Realty
Attn: Marilyn Tuner (Email only)
Page 1
Owner/Seller Affidavit State of Washington }
County of Kitsap } SS:
The undersigned, _______________________, the authorized signatory of ________________________
(the Owner), has personal knowledge of the facts sworn to in this Affidavit and has the power and
authority to execute this Affidavit on behalf of the Owner, being first duly sworn on oath, deposes and
says;
That the Owner is the fee simple owner and is in possession of the property described in Pacific
Northwest Title Company Order No. 32167419, and also attached hereto, and made a part hereof.
That no proceedings in Bankruptcy or receivership have been instituted by or against the Owner and the
Owner has never made an assignment for the benefit of creditors.
That there is no action or proceeding now pending in any state or federal court in the United States to
which the Owner is a party and which affects the Premises; nor is there any state or federal court judgment,
state or federal tax lien, or any other state or federal lien of any nature against the Owner which may
constitute a lien charge upon the Premises.
That the Owner’s possession of the Premises has been peaceable and undisturbed, and that title to the
premises has never been disputed or questioned.
That there is no pending litigation or dispute regarding the lines and corners of the Premises.
That there are no delinquent real estate taxes or unpaid current real estate taxes; nor any pending or levied
assessments on the Premises, including but not limited to those for sidewalks, streets, sewers and water
lines, that the Owner has knowledge of.
That the Owner has not caused any work, services, or labor to be done, or any fixtures, apparatus or
materials to be furnished, in connection with, or to, the said premises, except such materials, fixtures, work,
apparatus, labor or services as have been fully and completely paid for; that there is no claim or
indebtedness to anyone for any labor, fixtures, apparatus, materials, services or work done to, upon, or in
connection with the said premises; that there is no mechanics lien claim against the premises, whether of
record or otherwise.
Except as set forth in the aforesaid Commitment, there are no unrecorded mortgages, improvement loans,
chattel mortgages, conditional bills of sale, contracts of sale, (except that in connection with which this
affidavit is given), security agreements, agreements not to sell or encumber, financing statements which
affect the Premises or which affect any fixtures, appliances, or equipment now installed in or on the
Premises.
Order No.: 32167419
Page 2
That all tenants or parties who have leasehold or tenancy rights to occupy any portion of the Premises are
those listed below and none of such parties has any right to the Premises other than its right as Lessee, or
any right of first refusal or option to purchase the Premises.
Please complete the following by checking the appropriate number below. (If number 2 is checked,
please attach a copy of the lease.)
__________ 1. Residential Tenant Leases only with a term of one year or less.
__________ 2. The following commercial leases affect the subject property:
__________ 3. None
That all charges for water or sewer services provided to the Premises by the county and/or city in which the
Premises is located which are currently due have been paid.
That (if a survey has been provided) the survey depicts all of the improvements located on the Premises as
of the date of the survey, and there have been no structural changes to the exterior of the buildings shown on
said survey since the date of the survey.
That the Owner is not a foreign person, foreign trust or other foreign entity as those terms are defined in or
contemplated by Section 1445 of the Internal Revenue Code of 1986, as amended, and regulations
promulgated pursuant thereto.
Owner:
____________________________
Its Authorized Signatory
STATE OF }
COUNTY OF } SS:
Subscribed and sworn to before me this ____ day of _____________, 20 .
____________________________
Notary Public in and for the
State of Washington
Residing at __________________
My Commission Expires:_______
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