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HomeMy WebLinkAbout101414 - Non Foreign AffidavitSTATE OF INDIANA COUNTY OF //a ∎"Pei SS: NON - FOREIGN AFFIDAVIT Each of: (a) William Hammer, in his capacity as the President of The City of Carmel Redevelopment Commission (the "Transferor "); and (b) DcaL,t &wle_rs in his capacity as the V lc° _1l of Transferor; (collectively, the "Affiant "), states that Transferor is transferring to CCC Market, LLC (the "Transferee "), the United States real property interest more particularly described on Exhibit A, attached hereto and incorporated herein by reference (the "Real Estate "). Section 1445 of the Internal Revenue Code of 1986, as amended (the "Code "), provides that a transferee (buyer) of a United States real property interest must withhold tax if the transferor (seller) is a "foreign person" (as that term is defined in Section 1445(0(3) of the Code). For United States tax purposes (including Section 1445 of the Code), the owner of a disregarded entity that has legal title to a United States real property interest (and not the disregarded entity itself) will be deemed to be the transferor of such United States real property interest. To inform Transferee that Transferee is not required to withhold tax upon disposition by Transferor of the Real Estate, Affiant hereby certifies the following on behalf of Transferor: 1. Transferor is not a "foreign corporation ", "foreign partnership ", "foreign trust", or "foreign estate" (as those terms are defined in the Code and the Income Tax Regulations promulgated thereunder). 2. Transferor's United States employer identification number is 35- 6000972 4. Transferor's principal office address is 30 West Main Street, Suite 220, Carmel, Indiana 46032. Transferor understands that: (a) Transferee may disclose this Affidavit to the Internal Revenue Service; and (b) any false statement contained in this Affidavit may be punished by fine, imprisonment, or both. Under penalties of perjury, Affiant certifies that: (a) Affiant has examined this Affidavit on behalf of Transferor; and (b) to the best of the knowledge and belief of Affiant, this Affidavit is true, correct, and complete. Affiant further certifies that Affiant has authority to sign this Affidavit on behalf of Transferor. T H E C I T Y O F REDEV Lc PMENT CO � By: C . / iii i/L7 �% 1Ii J C A R M E L MISSION 0 William Hamm r President T H E C I T Y O F C A R M E L REDEVELOPMENT COMMISSION By: Printed: Title: STATE OF INDIANA COUNTY OF S5: NON - FOREIGN AFFIDAVIT Each of: (a) William Hammer, in his capacity as the President of The City of Carmel Redevelopmen t om mission (the "Transferor'); and (b) AVIA 6Qt✓C/s, in his capacity as the mile Prekde of Transferor; (collectively, the "Affiant "), states that Transferor is transferring to CCC Market, LLC (the "Transferee "), the United States real property interest more particularly described on Exhibit A, attached hereto and incorporated herein by reference (the "Real Estate "). Section 1445 of the Internal Revenue Code of 1986, as amended (the "Code "), provides that a transferee (buyer) of a United States real property interest must withhold tax if the transferor (seller) is a "foreign person" (as that term is defined in Section 1445(f)(3) of the Code). For United States tax purposes (including Section 1445 of the Code), the owner of a disregarded entity that has legal title to a United States real property interest (and not the disregarded entity itself) will be deemed to be the transferor of such United States real property interest. To inform Transferee that Transferee is not required to withhold tax upon disposition by Transferor of the Real Estate, Affiant hereby certifies the following on behalf of Transferor: 1. Transferor is not a "foreign corporation ", "foreign partnership ", "foreign trust ", or "foreign estate" (as those terms are defined in the Code and the Income Tax Regulations promulgated thereunder). 2. Transferor's United States employer identification number is 35- 6000972 4. Transferor's principal office address is 30 West Main Street, Suite 220, Carmel, Indiana 46032. Transferor understands that: (a) Transferee may disclose this Affidavit to the Internal Revenue Service; and (b) any false statement contained in this Affidavit may be punished by fine, imprisonment, or both. Under penalties of perjury, Affiant certifies that: (a) Affiant has examined this Affidavit on behalf of Transferor; and (b) to the best of the knowledge and belief of Affiant, this Affidavit is true, correct, and complete. Affiant further certifies that Affiant has authority to sign this Affidavit on behalf of Transferor. T H E C I T Y O F CARMEL REDEVELOPMENT COMMISSION By: William Hammer, President T H E C I T Y O F CARMEL REDEVELOP ENT Ge SION By:�. Y C• �� e Printed:: autci C - vuA.Q5 Title: V • • ACKNOWLEDGMENT Before me, a Notary Public in and for the State of Indiana, personally appeared William Hammer, the President of The City of Carmel Redevelopment Commission, who acknowledged the execution of the foregoing Non - Foreign Affidavit on behalf of such entity. WITNESS my hand and Notarial Seal thisl3 day of October, 2014. By: Printed Nam ARIA J. ARNOLD kyb puSpc. Staie mUIdl. n Counq My Commission Expires May 14, 2015 v I am a resident of 72%k(r& ) County, Indiana. My commission expires )) CC Before me, a Notary Public in and for the State of Indiana, personally appeared , the of The City of Carmel Redevelopment Commission, who acknowledged the execution of the foregoing Non - Foreign Affidavit on behalf of such entity. WITNESS my hand and Notarial Seal this __ day of October, 2014. By: Printed Name I am a resident of County, Indiana. My commission expires . Notary Public (This document must be retained until the end of the fifth taxable year following the taxable year in which the transfer takes place.) v0:acumens vC 0: pd ACKNOWLEDGMENT Before me, a Notary Public in and for the State of Indiana, personally appeared William Hammer, the President of The City of Carmel Redevelopment Commission, who acknowledged the execution of the foregoing Non- Foreign Affidavit on behalf of such entity. WITNESS my hand and Notarial Seal this _ day of October, 2014. By: Printed Name: I am a resident of County, Indiana. My commission expires Notary Public Before me, a Notary Pubic in and for the State of Indiana, personally appeared Davy %YerG the _the Ptcj dCn7'of The City of Carmel Redevelopment Commission, who acknowledged the execution of the foregoing Non - Foreign Affidavit on behalf of such entity. WITNESS my hand and Notarial Seal this a day of October, 2014. I am a resident of _i{4mi (Jon_ County, Indiana. My commission expires 1-17-11 By: • - -� Printed Name: Mr (tide ( Lee Notary Public (This document must be retained until the end of the fifth taxable year following the taxable year in which the transfer takes place.) oID. JennoSCrry ct Czemel,Pa u.el I0 door Furchas C NFA..Pd