HomeMy WebLinkAboutNon-Foreign Affidavit - 2004 NON-FOREIGN AFFIDAVIT
STATE OF INDIANA
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COUNTY O F gid>L6rd1
ifoact E Ce(-ier(the "Affiant"), in his capacity as the l/-ccf,.,re5•1 del' f The City of
Carmel Redevelopment Commission(the"Transferor"),states thatTransferoris transferring to PedcorOffice,
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). 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.
3. Transferor's principal office address is c/o the City of Carmel, Indiana, One Civic
Square, Carmel, Indiana 46032, Facsimile: 317-844-3498.
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.
THE CJ._TY OF CARMEL
DE O"?V ENT COM ISSI N
Printed: n«-6i
Title: VC CL gre S(C{E'i1`I�
ACKNOWLEDGMENT
STATE OF INDIANA )
/ ) SS:
COUNTY OF /flM'i /1I
z Before me, a Notary Public in and for the State of Indiana, personally appeared
isoneto k.1.4i-y-ef, the Lice rv5td.e8 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/G day of December, 2004.
i
By
c •
PrintedName: C/G //-/S%ey
otary Public /
I am a resident of N/l/"/aoli County, Indiana.
My commission expires 7/ 5/? 7 .
(This document must be retained until the end of the fifth taxable year following the taxable year in which the
transfer takes place.)
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Z:\Documents\Shoup, Jenny\City of Carmel\Retail Parcel\Pedcor\Closing Documents\NFA.wpe
File No.: 2043428
EXHIBIT A
Tract 1
A part of the Northeast Quarter of Section 36, Township 18 North, Range 3 East, Hamilton
County, Indiana, described as follows:
Beginning at the brass plug found at the northeast corner of said quarter section, said corner
being North 00 degrees 13 minutes 54 seconds West 2,648.02 feet, measured along the east line
of said quarter section, from the brass plug found at the southeast corner of said quarter section;
thence South 89 degrees 12 minutes 13 seconds West 707.40 feet running on and along the north
line of said Northeast Quarter Section Line to a point on the east Right of Way line of the former
Monon Railway; thence south running on and along said east Right of Way line South 00 degrees
51 minutes 54 seconds East 284.25 feet to a point that is also on the south Right of Way line of
126`" Street (City Center Drive); thence North 77 degrees 00 minutes 25 seconds East and
running on and along said south Right of Way Line 96.48 feet to a point; thence continuing on
and along said south Right of Way line North 89 degrees 36 minutes 45 seconds East 140.00 feet
to the Point of Beginning of this description; thence continuing on and along said south Right of
Way line North 89 degrees 36 minutes 45 seconds East 27.49 feet to a point; thence continuing
on and along said south Right of Way line South 89 degrees 56 minutes 58 seconds East 387.00
feet to a point on the west Right of Way line of South Rangeline Road; thence south and running
on and along said west Right of Way line for the next three bearing calls, South 09 degrees 38
minutes 09 seconds West 77.92 feet; thence South 00 degrees 54 minutes 50 seconds West
150.03 feet; thence South 00 degrees 13 minutes 54 seconds East 640.59 feet to a point on the
north Right of Way line of Monon Green Blvd.; thence leaving said west Right of Way line and
running on and along said north Right of Way line South 89 degrees 12 minutes 13 seconds West
388.50 feet to a point; thence leaving said north Right of Way line North 00 degrees 51 minutes
54 seconds West 873.07 feet to the point of beginning, containing 7.880 acres, more or less.
Excepting therefrom:
Part of the North Half of the Northeast Quarter of Section 36, Township 18 North, Range 3 East
in Hamilton County, Indiana, described as follows:
Beginning at a point on the East line of the Northeast Quarter of Section 36, Township 18 North,
Range 3 East 628.97 feet South 00 degrees 00 minutes 00 seconds (assumed bearing) from the
Northeast corner of said Northeast Quarter; thence South 00 degrees 00 minutes 00 seconds on
said East line 175.26 feet; thence South 90 degrees 00 minutes 00 seconds West 239.11 feet;
thence North 00 degrees 00 minutes 00 seconds West parallel with the East line of said Quarter
173.00 feet to a point 628.97 feet South 00 degrees 00 minutes 00 seconds of the North line of
said Northeast Quarter; thence North 89 degrees 27 minutes 30 seconds East parallel with said
North line 239.12 feet to the place of beginning, containing 0.956 acres, more or less.