Non-Foreign Affidavit - Marshall E. and Sandra Lee Andich NON-FOREIGN AFFIDAVIT
Marshall E. and Sandra Lee Andich
STATE OF INDIANA )
''tt _ ` ) SS:
COUNTY OF i'ii`- )
Marshall E.Andich and Sandra Lee Andich(jointly and severally,the"Transferor"),state that
they are transferring to The City of Carmel Redevelopment Commission (the "Transferee"), certain United
States real property located in Hamilton County, Indiana (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
withholding of tax is not required upon the disposition by Transferor of the Real Estate, Transferor hereby
certifies the following:
1. Transferor is neither:(a)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); nor(b)a nonresident alien for purposes of United States Income
Taxation;
2. The taxpayer identification number of Marshall E. Andich is 300'40-;1•-A q0
3. The taxpayer identification number of Sandra Lee Andich is/2.0-3a,gl1 d
4. Transferor's home address is 7S 4 ' s l i t,., _ h 7,,, cw-•4i ) yc a 3 A
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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,Transferor certifies that:(a)he has examined this Affidavit;
and (b) it is true, correct, and complete. �J
By: . .. __ __/
Mars all E.44,Andich
By: O%4-ZcX
Sandra Lee Andich
ACKNOWLEDGMENT
Before me, a Notary Public in and for the State of Indiana, personally appeared
Marshall E.Andich and Sandra Lee Andich, who, having been first duly sworn,A knowledged the execution
of the foregoing Non-Foreign Affidavit.
,.m=;� WITNESS my hand and Notarial Seal this day of (L, (r/Argltorw,�
�� WILLIAM B.OLSEIV B . �_�i1��►
,_ My Comm.Erp: 06-30 08 Y sue•:,:�
Res.of Hamilton Co. Notary PUb
Printed Name:
I am a resident of County, Indiana. �
My commission expires . .
AO(This document must be retained until the end of the fifth taxable year following the taxable -_�r'in which he `�
transfer takes place.) 0 RECEIVED
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