Non-Foreign Affidavit NON-FOREIGN AFFIDAVIT
STATE OF INDIANA
) SS:
COUNTY OF t-AfPrc»L;6A
John F.Hays and Laurence Grabb(the"Transferors"),state that Transferors are transferring
to the City of Carmel Redevelopment Commission (the "Transferee") that certain real estate located in
Hamilton County, Indiana, as 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, Transferors
hereby certify the following:
1. Transferors are United States citizens;
2. John F. Hays' social security number is
3. Laurence Grabb's social security number is ;
(t aU
4. John F.Hays'home address is/??y /Vase?ise/love.T/Jp . AR45 74 -47 �';and
5. Laurence Grabb's home address is far 6k}iv0 ,er Rd, /Ye?t2LASC//LL E,, stA,
Transferors understand 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,Transferors certify that this Affidavit is true,correct,and complete.
�ev/Yti F. /740 y'S 15.
BY:
John . Hays
B
:
aurence Grabb
1
i,
ACKNOWLEDGMENTS
STATE OF INDIANA )
1111 11 ) SS:
COUNTY OF 40 ot/ )
Before me,a Notary Public in and for the State of Indiana,personally appeared John F. Hays,
who acknowledged the execution of the foregoing Non-Foreign Affidavit.
WITNESS my hand and Notarial Seal thisS—da .f c&R , 2000.
hr-
By: der.i-1:9-tinger
Printed Name:
Notary Public
I am a resident of County, Indiana. . P%'1 P°46'
(; WILLIAM B.OLSEN
My commission expires . * . , My Comm.Exp: 6.30-00
Res.of Hamilton Co.
• iyDI Al"
STATE OF INDIANA )
,,11 SS:
COUNTY OF MArtykT
Before me, a Notary Public in and for the State of Indiana, personally appeared Laurence
Grabb, who acknowledged the execution of the foregoing Nord-Foreign Affidavit.
WITNESS my hand and Notarial Seal this3 -d'.!'of , 2000.
rir*
0 PO I �� . WILLIAM B.OLSEN sr
My Comm.Exp: 6-30-00
Res. •of Hamilton co. Printed Name:
/ND I AkP
Notary Public
I am a resident of County, Indiana.
My commission expires .
(This document must be retained until the end of the fifth taxable year following the taxable year in which the
transfer takes place.)
-2-
2:\Docu,nenta\Sloop, Jenny\City of Carmel\Main Stteet Redeye lope,ent\G c H Ftopetty\NFA-G i H to CRC.epd
File No.: 99:;307
EXHIBIT A
That part of Lot Number Three (3) and Lot Number Four (4) in Carey's Addition (an unrecorded
addition) to the Town of Carmel, Indiana, and part of the Southeast Quarter of Section Twenty-
five (25), Township Eighteen (I8) North, Range Three (3) East more specifically and truly
described as follows:
Tract #1: Beginning Thirty-five (35) rods West and One hundred thirty-two (132) feet South of
the Northeast corner of said Quarter Section, thence South Twenty-four (24) feet, thence East
parallel with the North line of said Quarter Section Fifty-two (52) feet, thence North Twenty-four
(24) feet, thence East parallel with the North line of said Quarter Section Fifty-two (52) feet to
the place of beginning.
Tract #2: Beginning Thirty-five (35) rods West and One hundred Fifteen (115) feet South of the
Northeast corner of said Quarter Section, and run thence South Seventeen (17) feet, East Fifty-
two feet, North Seventeen (17) feet and West Fifty-two (52) feet to the place of beginning, in
Hamilton County, Indiana.
Tract #3: Beginning Thirty-five (35) rods West of the Northeast corner of said Southeast Quarter
and run thence South One hundred Fifteen (115) feet; thence East Fifty-two (52) feet; thence
North One hundred fifteen (1 15) feet; thence West Fifty-two (52) feet to the place of beginning,
Hamilton County, Indiana.
Tract #4: Beginning Twenty-eight rods (28) Eleven and One-half (11-1/2) feet West of the
Northeast corner of said Quarter Section, run West Fifty-two (52) feet, South One hundred fifty-
six (156) feet, East Fifty-two (52) feet, North One hundred fifty-six (156) feet to the place of
beginning.
Tract #5: A part of the Southeast Quarter of Section 25, Township 18 North, Range 3 East,
located in the Clay Township, Hamilton County, Indiana, being more specifically described as
follows:
Beginning at a point on the North line of the Southeast Quarter of Section 255 Township 18
North, Range 3 East, said place of beginning being South 89 degrees 01 minutes 00 seconds
West (assumed bearing) 406.50 feet from the Northeast corner of said Southeast Quarter; thence
South 00 degrees 00 minutes 00 seconds 156.17 feet parallel with the East line of said Southeast
Quarter; thence South 89 degrees 01 minute 00 seconds West 52.00 feet; thence North 00
degrees 00 minutes 00 seconds 156.17 feet to a point on the North line of said Southeast Quarter;
thence North 89 degrees 01 minute 00 seconds East 52.00 feet to the place of beginning.
Tract #6: A part of the Southeast Quarter of Section 25, Township 18 North, Range 3 East,
bounded and described as follows:
Commencing Thirty-Five rods West and ten rods and five feet South of the Northeast corner of
said Quarter Section, thence running South One Hundred Twenty-Eight feet, thence West One
Hundred and Four feet, to the place of beginning, and being known as Lots 5 and 6 Carey's
Addition to Carmel.
Tract #7: Part of the Southeast Quarter of Section 25, Township 18 North, Range 3 East in
Hamilton County, Indiana, and more particularly described as follows:
Beginning 24 rods, 10 '/2 feet West and 10 rods 9 feet South of the Northeast corner of the
Southeast Quarter of said Section 25, Township 18 North, Range 3 East, run thence South 126
feet, thence West 52 feet, thence North 126 feet, thence East 52 feet to the place of beginning,
except five feet off the entire East side thereof.
Also, alleys vacated as per Ordinance D-588, recorded as Instrument No. 88-11576.
•
Continued
Said real estate is now more specifically described as follows:
A part of the Southeast Quarter of Section 25, Township 18 North, Range 3 East, in Hamilton
County, Indiana, described as follows:
Beginning at a point on the North line of said Quarter Section being South 89 degrees 51 minutes
35 seconds West (assumed bearing) 406.50 feet from the Northeast corner of said Quarter
Section; thence South 00 degrees 51 minutes 36 seconds West, parallel with the East line of said
Quarter Section, 174.00 feet; thence South 89 degrees 51 minutes 35 seconds West, parallel with
said North line 5.00 feet; thence South 00 degrees 51 minutes 36 seconds West, parallel with said
East line, 126.00 feet; thence South 89 degrees 51 minutes 35 seconds West, parallel with said
North line, 47.00 feet; thence North 00 degrees 51 minutes 36 seconds East, parallel with said
East line, 2.00 feet; thence South 89 degrees 51 minutes 35 seconds West, parallel with said
North line 119.00 feet; thence North 00 degrees 51 minutes 36 seconds East, parallel with said
East line, 298.00 feet to a point on said North line; thence North 89 degrees 51 minutes 35
seconds East 171.00 feet to the point of beginning, and containing 1.158 acres, more or less.
NOTE: The acreage shown above is included for descriptive purposes only. The policies, when
issued, should not be construed as to insuring the amount of acreage included therein.