HomeMy WebLinkAboutPW 30 Joseph Court Purchase - Escrow DocumentsSELLER'S ESCROW INSTRUCTIONS (Sale)
TO: Tina Toe
First American Title Insurance Company
National Commercial Services
1850 Mt. Diablo Blvd., #530
Walnut Creek, CA 94596
Escrow No.: NCS -981325 -cc
Property: 30 Joseph Court, San Rafael, CA 94901
Prelim Ref: NCS -981325 -cc
Prelim Date: July 21, 2021
You are herewith handed, or will be handed prior to closing, all of the following documents for closing:
• Read and approved Preliminary title report
• The signed and notarized Grant Deed
• A completed 10995 form
■ A completed FIRPTA from
• A completed 593 form
• Signed and completed Owner's Affidavit
Which you are authorized and instructed to record, deliver or disburse, as needed to consummate this escrow,
when you have for delivery to the undersigned, or when you have accomplished, or are in position to accomplish
all of the following:
Our proceeds as shown on the Estimated Settlement Statement to: County of Marin, a political
subdivision of the State of California
Your Final Closing Statement
As of Close of Escrow prorate on the basis of actual days:
■ Taxes (based on the most recent information obtainable in the office of the proper taxing authorities)
• Any other miscellaneous charges that are required to be pro -rated in escrow
The parties to this escrow acknowledge that they have deposited a Purchase Agreement into this escrow which
contains, among other things, items which do not relate to this escrow. Escrow is not to be concerned with any
items contained in the Purchase Agreement and shall act only pursuant to the provisions set forth in these escrow
instructions.
Escrow Holder is hereby authorized and instructed to close escrow upon receipt of the fully, executed, faxed
instructions, if necessary, to expedite this closing. Said faxed copies shall be deemed to be originals for the
closing and may be executed in counterpart.
City of San Rafael, a municipal corporation
By:
Kate Colin, Mayor of the City of San Rafael
Order Number: NCS -981325 -CC
Page Number: 1
Updated July 28, 2021- Amended June 7, 2021
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First American Title Insurance Company
National Commercial Services
1850 Mt. Diablo Blvd., Suite 530
Walnut Creek, CA 94596
David Speer
County of Marin, Adminstrator
3501 Civic Center Drive, Room 325
San Rafael, CA 94903
Phone: (415)499-6061
Ncl
Read & Approves yla or Kate Colin
Customer Reference: 30 Joseph Court
Escrow Officer: Tina Toye
Phone: (925)927-2138
Email: TToye@firstam.com
Owner: City of San Rafael
Property: 30 Joseph Court, San Rafael, CA
PRELIMINARY REPORT
In response to the above referenced application for a policy of title insurance, this company hereby reports that it is prepared to
issue, or cause to be issued, as of the date hereof, a Policy or Policies of Title Insurance describing the land and the estate or
interest therein hereinafter set forth, insuring against loss which may be sustained by reason of any defect, lien or encumbrance not
shown or referred to as an Exception below or not excluded from coverage pursuant to the printed Schedules, Conditions and
Stipulations of said Policy forms.
The printed Exceptions and Exclusions from the coverage and Limitations on Covered Risks of said policy or policies are set forth in
Exhibit A attached. The policy to be issued may contain an arbitration clause. When the Amount oflnsurance is less than that set
forth in the arbitration clause, all 3rhit1-a61e matters shall be arbitrated at the option of either the Company or Me Insured as the
exclusive remedy of the p3dies. Limitations on Covered Risks applicable to the CLTA and ALTA Homeowner's Policies of Title
Insurance which establish a Deductible Amount and a Maximum Dollar Limit of Liability for certain coverages are also set forth in
Exhibit A. Copies of the policy forms should be read. They are available from the office which issued this report.
Please read the exceptions shown or referred to below and the exceptions and exclusions set forth in Exhibit A of
this report carefully. The exceptions and exclusions are meant to provide you with notice of matters which are not
covered under the terms of the title insurance policy and should be carefully considered.
It is important to note that this preliminary report is not a written representation as to the condition of title and
may not list all liens, defects, and encumbrances affecting title to the land.
First American Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 2
This report (and any supplements or amendments hereto) is issued solely for the purpose of facilitating the issuance of a policy of
title insurance and no liability is assumed hereby. If it is desired that liability be assumed prior to the issuance of a policy of title
insurance, a Binder or Commitment should be requested.
First Amencan Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 3
Dated as of July 21, 2021 at 7:30 A.M.
The form of Policy of title insurance contemplated by this report is:
ALTA Standard Owner's Policy 2006 with Western Regional Exceptions (6-17-06)
A specific request should be made if another form or additional coverage is desired.
Title to said estate or interest at the date hereof is vested in:
City of San Rafael, a municipal corporation
The estate or interest in the land hereinafter described or referred to covered by this Report is:
Fee Simple
The Land referred to herein is described as follows:
(See attached Legal Description)
At the date hereof exceptions to coverage in addition to the printed Exceptions and Exclusions in said
policy form would be as follows:
1. General and special taxes and assessments for the fiscal year 2021-2022, a lien not yet due or
payable.
2. General and special taxes and assessments for the fiscal year 2020-2021 are exempt. If the exempt
status is terminated an additional tax may be levied. A.P. No.: 155-081-08.
3. The lien of supplemental taxes, if any, assessed pursuant to Chapter 3.5 commencing with Section 75
of the California Revenue and Taxation Code.
4. An easement for public utilities and incidental purposes, recorded March 23, 1960 in Book 1353, Page
605 of Official Records.
In Favor of: Commonwealth Development Co., a limited partnership
Affects: As described therein
NOTE: Said easement is also shown on the map filed in Book 10 of Maps, Page 51.
5. This item has been intentionally deleted.
6. Any facts, rights, interests or claims that may exist or arise by reason of the following matters
disclosed by an ALTA/NSPS survey made by BKF on August 26, 2020 last revised
2021, designated Job No. 20201384:
(A) Concrete wall lies outside the northerly boundary by up to 0.4, ownership unknown; (B) Fence
lies across the northerly boundary by up to 3.2' north and up to 4.5' south, ownership unknown.
FirstAmencan Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 4
Rights of parties in possession.
FirstAmerican Title fnsurance Company
Order Number: NCS -981325 -CC
Page Number: 5
INFORMATIONAL NOTES
ALERT - CA Senate Bill 2 imposes an additional fee of $75 up to $225 at the time of
recording on certain transactions effective January 1, 2018. Please contact your First
American Title representative for more information on how this may affect your closing.
1. According to the latest available equalized assessment roll in the office of the county tax assessor,
there is located on the land a Fire Station known as 30 Joseph Court, San Rafael, California.
2. According to the public records, there has been no conveyance of the land within a period of twenty-
four months prior to the date of this report, except as follows:
None
3. This preliminary report/commitment was prepared based upon an application for a policy of title
insurance that identified land by street address or assessor's parcel number only. It is the
responsibility of the applicant to determine whether the land referred to herein is in fact the land that
is to be described in the policy or policies to be issued.
4. Should this report be used to facilitate your transaction, we must be provided with the following
prior to the issuance of the policy:
A. WITH RESPECT TO A CORPORATION:
1. A certificate of good standing of recent date issued by the Secretary of State of the corporation's
state of domicile.
2. A certificate copy of a resolution of the Board of Directors authorizing the contemplated
transaction and designating which corporate officers shall have the power to execute on behalf of
the corporation.
3. A certificate of revivor and a certificate of relief from contract voidability issued by the Franchise
Tax Board of the State of California.
4. Requirements which the Company may impose following its review of the above material and
other information which the Company may require.
B. WITH RESPECT TO A CALIFORNIA LIMITED PARTNERSHIP:
1. A certified copy of the certificate of limited partnership (form LP -1) and any amendments thereto
(form LP -2) to be recorded in the public records;
2. A full copy of the partnership agreement and any amendments;
3. Satisfactory evidence of the consent of a majority in interest of the limited partners to the
contemplated transaction;
4. A certificate of revivor and a certificate of relief from contract voidability issued by the Franchise
Tax Board of the State of California.
5. Requirements which the Company may impose following its review of the above material and
other information which the Company may require.
C. WITH RESPECT TO A FOREIGN LIMITED PARTNERSHIP:
1. A certified copy of the application for registration, foreign limited partnership (form LP -5) and any
amendments thereto (form LP -6) to be recorded in the public records;
2. A full copy of the partnership agreement and any amendment;
3. Satisfactory evidence of the consent of a majority in interest of the limited partners to the
contemplated transaction;
FirstAmencan Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 6
4. A certificate of revivor and a certificate of relief from contract voidability issued by the Franchise
Tax Board of the State of California.
5. Requirements which the Company may impose following its review of the above material and
other information which the Company may require.
D. WITH RESPECT TO A GENERAL PARTNERSHIP:
1. A certified copy of a statement of partnership authority pursuant to Section 16303 of the
California Corporation Code (form GP -I), executed by at least two partners, and a certified copy of
any amendments to such statement (form GP -7), to be recorded in the public records;
2. A full copy of the partnership agreement and any amendments;
3. Requirements which the Company may impose following its review of the above material required
herein and other information which the Company may require.
E. WITH RESPECT TO A LIMITED LIABILITY COMPANY:
1. A copy of its operating agreement and any amendments thereto;
2. If it is a California limited liability company, a certified copy of its articles of organization (LLC -1)
and any certificate of correction (LLC -11), certificate of amendment (LLC -2), or restatement of
articles of organization (LLC -10) to be recorded in the public records;
3. If it is a foreign limited liability company, a certified copy of its application for registration (LLC -5)
to be recorded in the public records;
4. With respect to any deed, deed of trust, lease, subordination agreement or other document or
instrument executed by such limited liability company and presented for recordation by the
Company or upon which the Company is asked to rely, such document or instrument must be
executed in accordance with one of the following, as appropriate:
(i) If the limited liability company properly operates through officers appointed or elected
pursuant to the terms of a written operating agreement, such documents must be executed by
at least two duly elected or appointed officers, as follows: the chairman of the board, the
president or any vice president, and any secretary, assistant secretary, the chief financial
officer or any assistant treasurer;
(ii) If the limited liability company properly operates through a manager or managers identified in
the articles of organization and/or duly elected pursuant to the terms of a written operating
agreement, such document must be executed by at least two such managers or by one
manager if the limited liability company properly operates with the existence of only one
manager.
5. A certificate of revivor and a certificate of relief from contract voidability issued by the Franchise
Tax Board of the State of California.
6. Requirements which the Company may impose following its review of the above material and
other information which the Company may require.
F. WITH RESPECT TO A TRUST:
1. A certification pursuant to Section 18100.5 of the California Probate Code in a form satisfactory to
the Company.
2. Copies of those excerpts from the original trust documents and amendments thereto which
designate the trustee and confer upon the trustee the power to act in the pending transaction.
3. Other requirements which the Company may impose following its review of the material require
herein and other information which the Company may require.
G. WITH RESPECT TO INDIVIDUALS:
1. A statement of information.
The map attached, if any, may or may not be a survey of the land depicted hereon. First American Title
Insurance Company expressly disclaims any liability for loss or damage which may result from reliance on
this map except to the extent coverage for such loss or damage is expressly provided by the terms and
provisions of the title insurance policy, if any, to which this map is attached.
FirstAmerican Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 7
LEGAL DESCRIPTION
Real property in the City of San Rafael, County of Marin, State of California, described as follows:
BEGINNING AT A POINT ON THE NORTHERLY LINE OF LOT 4, AS SHOWN ON THE MAP ENTITLED "MAP
OF MARIN PROFESSIONAL CENTER UNIT 1" FILED FOR RECORD MARCH 03, 1958 IN BOOK 9 OF MAPS,
PAGE 94, MARIN COUNTY RECORDS; SAID POINT BEING DISTANT THEREON NORTH 730 24' 28" EAST
24.27 FEET FROM THE INTERSECTION OF THE COURSES "NORTH 600 00' EAST 420.00 FEET AND
NORTH 730 24'28" EAST 340.44 FEET' AS SHOWN UPON THE ABOVE ENTITLED MAP; RUNNING
THENCE NORTH 120 13'00" WEST 61.23 FEET; THENCE SOUTH 890 51'00" WEST 186.60 FEET;
THENCE ON A CURVE TO THE RIGHT WHOSE CENTER BEARS SOUTH 890 51'00" WEST 45.00 FEET
THROUGH A CENTRAL ANGLE OF 510 22'00" AN ARC DISTANCE OF 40.34 FEET; THENCE SOUTH 400
08'39" EAST 123.44 FEET TO A POINT ON THE NORTHWESTERLY LINE OF LOT 4, MAP ABOVE
REFERRED TO; THENCE ALONG THE NORTHWESTERLY LINE OF SAID LOT 4, MAP ABOVE REFERRED
TO, NORTH 600 00' EAST 129.60 FEET AND NORTH 730 24' 28" EAST 24.27 FEET TO THE POINT OF
BEGINNING.
ALSO SHOWN AS LOT 8 ON THE MAP ENTITLED "MAP OF COMMONWEALTH LIGHT INDUSTRIAL
SUBDIVISION", FILED FEBRUARY 18, 1960 IN BOOK 10 OF MAPS, PAGE 51, MARIN COUNTY RECORD.
APN: 155-081-08
First American Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 8
NOTICEI
Section 12413.1 of the California Insurance Code, effective January 1, 1990, requires that any title insurance company, underwritten title
company, or controlled escrow company handling funds in an escrow or sub -escrow capacity, wait a specified number of days after depositing
funds, before recording any documents in connection with the transaction or disbursing funds. This statute allows for funds deposited by wire
transfer to be disbursed the same day as deposit. In the case of cashier's checks or certified checks, funds may be disbursed the next day after
deposit. In order to avoid unnecessary delays of three to seven days, or more, please use wire transfer, cashier's checks, or certified checks
whenever possible.
If you have any questions about the effect of this new law, please contact your local First American Office for more details.
NOTICE II
As of January 1, 1991, if the transaction which is the subject of this report will be a sale, you as a party to the transaction, may have certain tax
reporting and withholding obligations pursuant to the state law referred to below:
In accordance with Sections 18662 and 18668 of the Revenue and Taxation Code, a buyer may be required to withhold an amount equal to three
and one-third percent of the sales price in the case of the disposition of California real property interest by either:
A seller who is an individual with a last known street address outside of California or when the disbursement instructions authorize the
proceeds be sent to a financial intermediary of the seller, OR
A corporate seller which has no permanent place of business in California.
The buyer may become subject to penalty for failure to withhold an amount equal to the greater of 10 percent of the amount required to be
withheld or five hundred dollars ($500).
However, notwithstanding any other provision included in the California statutes referenced above, no buyer will be required to withhold any
amount or be subject to penalty for failure to withhold if:
The sales price of the California real property conveyed does not exceed one hundred thousand dollars ($100,000), OR
The seller executes a written certificate, under the penalty of perjury, certifying that the seller is a resident of California, or if a
corporation, has a permanent place of business in California, OR
The seller, who is an individual, executes a written certificate, under the penalty of perjury, that the California real property being
conveyed is the seller's principal residence (as defined in Section 1034 of the Internal Revenue Code).
The seller is subject to penalty for knowingly filing a fraudulent certificate for the purpose of avoiding the withholding requirement.
The California statutes referenced above include provisions which authorize the Franchise Tax Board to grant reduced withholding and waivers
from withholding on a case-by-case basis.
The parties to this transaction should seek an attorney's, accountant's, or other tax specialist's opinion concerning the effect of this law on this
transaction and should not act on any statements made or omitted by the escrow or closing officer.
The Seller May Request a Waiver by Contacting:
Franchise Tax Board
Withhold at Source Unit
P.O. Box 651
Sacramento, CA 95812-0651
(916) 845-4900
First American Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 9
Privacy Policy
We Are Committed to Safeguarding Customer Information
In order to better serve your needs now and in the future, we may ask you to provide us with certain
information. We understand that you may be concerned about what we will do with such information -
particularly any personal or financial information. We agree that you have a right to know how we will
utilize the personal information you provide to us. Therefore, together with our parent company, The
First American Corporation, we have adopted this Privacy Policy to govern the use and handling of your
personal information.
Applicability
This Privacy Policy governs our use of the information which you provide to us. It does not govern the
manner in which we may use information we have obtained from any other source, such as information
obtained from a public record or from another person or entity. First American has also adopted broader
guidelines that govern our use of personal information regardless of its source. First American calls these
guidelines its Fairinformation Values, a copy of which can be found on our website at www.firstam.com.
Types of Information
Depending upon which of our services you are utilizing, the types of nonpublic personal information that
we may collect include:
• Information we receive from you on applications, forms and in other communications to us, whether
in writing, in person, by telephone or any other means;
• Information about your transactions with us, our affiliated companies, or others; and
• Information we receive from a consumer reporting agency.
Use of Information
We request information from you for our own legitimate business purposes and not for the benefit of any
nonaffiliated party. Therefore, we will not release your information to nonaffiliated parties except: (1) as
necessary for us to provide the product or service you have requested of us; or (2) as permitted by law.
We may, however, store such information indefinitely, including the period after which any customer
relationship has ceased. Such information may be used for any internal purpose, such as quality control
efforts or customer analysis. We may also provide all of the types of nonpublic personal information
listed above to one or more of our affiliated companies. Such affiliated companies include financial
service providers, such as title insurers, property and casualty insurers, and trust and investment advisory
companies, or companies involved in real estate services, such as appraisal companies, home warranty
companies, and escrow companies. Furthermore, we may also provide all the information we collect, as
described above, to companies that perform marketing services on our behalf, on behalf of our affiliated
companies, or to other financial institutions with whom we or our affiliated companies have joint
marketing agreements.
Former Customers
Even if you are no longer our customer, our Privacy Policy will continue to apply to you.
Confidentiality and Security
We will use our best efforts to ensure that no unauthorized parties have access to any of your
information. We restrict access to nonpublic personal information about you to those individuals and
entities who need to know that information to provide products or services to you. We will use our best
efforts to train and oversee our employees and agents to ensure that your information will be handled
responsibly and in accordance with this Privacy Policy and First American's Fairinformation Values We
currently maintain physical, electronic, and procedural safeguards that comply with federal regulations to
guard your nonpublic personal information.
First American Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 10
CLTA/ALTA HOMEOWNER'S POLICY OF TITLE INSURANCE (02-03-10)
EXCLUSIONS
In addition to the Exceptions in Schedule B, You are not insured against loss, costs, attorneys' fees, and expenses resulting from:
1. Governmental police power, and the existence or violation of those portions of any law or government regulation concerning:
(a) building; (d) improvements on the Land;
(b) zoning; (e) land division; and
(c) land use; (f) environmental protection.
This Exclusion does not limit the coverage described in Covered Risk 8.a., 14, 15, 16, 18, 19, 20, 23 or 27.
2. The failure of Your existing structures, or any part of them, to be constructed in accordance with applicable building codes. This
Exclusion does not limit the coverage described in Covered Risk 14 or 15.
3. The right to take the Land by condemning it. This Exclusion does not limit the coverage described in Covered Risk 17.
4. Risks:
(a) that are created, allowed, or agreed to by You, whether or not they are recorded in the Public Records;
(b) that are Known to You at the Policy Date, but not to Us, unless they are recorded in the Public Records at the Policy Date;
(c) that result in no loss to You; or
(d) that first occur after the Policy Date - this does not limit the coverage described in Covered Risk 7, 8.e., 25, 26, 27 or 28.
5. Failure to pay value for Your Title.
6. Lack of a right:
(a) to any land outside the area specifically described and referred to in paragraph 3 of Schedule A; and
(b) in streets, alleys, or waterways that touch the Land.
This Exclusion does not limit the coverage described in Covered Risk 11 or 21.
7. The transfer of the Title to You is invalid as a preferential transfer or as a fraudulent transfer or conveyance under federal
bankruptcy, state insolvency, or similar creditors' rights laws.
LIMITATIONS ON COVERED RISKS
Your insurance for the following Covered Risks is limited on the Owners Coverage Statement as follows: For Covered Risk 16, 18, 19,
and 21 Your Deductible Amount and Our Maximum Dollar Limit of Liability shown in Schedule A.
Your Deductible Amount
Our Maximum Dollar
Limit of Liability
Covered Risk 16: 1% of Policy Amount or $2,500.00 (whichever is less)
$10,000.00
Covered Risk 18: 1% of Policy Amount or $5,000.00 (whichever is less)
$25,000.00
Covered Risk 19: 1% of Policy Amount or $5,000.00 (whichever is less)
$25,000.00
Covered Risk 21: 1% of Policy Amount or $2,500.00 (whichever is less)
$5,000.00
ALTA RESIDENTIAL TITLE INSURANCE
POLICY (6-1-87)
EXCLUSIONS
In addition to the Exceptions in Schedule B, you are not insured against loss, costs, attorneys' fees, and expenses resulting from:
Q
Icfl
Governmental police power, and the existence or violation of any law or government regulation. This includes building and
zoning ordinances and also laws and regulations concerning:
(a) and use
(b) improvements on the land
(c) and division
(d) environmental protection
This exclusion does not apply to violations or the enforcement of these matters which appear in the public records at Policy Date.
This exclusion does not limit the zoning coverage described in Items 12 and 13 of Covered Title Risks.
The right to take the land by condemning it, unless:
(a) a notice of exercising the right appears in the public records on the Policy Date
(b) the taking happened prior to the Policy Date and is binding on you if you bought the land without knowing of the taking
Titre Risks:
First American Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 11
(a) that are created, allowed, or agreed to by you
(b) that are known to you, but not to us, on the Policy Date -- unless they appeared in the public records
(c) that result in no loss to you
(d) that first affect your title after the Policy Date -- this does not limit the labor and material lien coverage in Item 8 of Covered
Title Risks
Failure to pay value for your title.
Lack of a right:
(a) to any land outside the area specifically described and referred to in Item 3 of Schedule A OR
(b) in streets, alleys, or waterways that touch your land
This exclusion does not limit the access coverage in Item 5 of Covered Title Risks.
2006 ALTA LOAN POLICY (06-17-06)
EXCLUSIONS FROM COVERAGE
The following matters are expressly excluded from the coverage of this policy, and the Company will not pay loss or damage, costs,
attorneys' fees, or expenses that arise by reason of:
a. Any law, ordinance, permit, or governmental regulation (including those relating to building and zoning) restricting, regulating,
prohibiting, or relating to
i. the occupancy, use, or enjoyment of the Land;
ii. the character, dimensions, or location of any improvement erected on the Land;
iii. the subdivision of land; or
iv. environmental protection;
or the effect of any violation of these laws, ordinances, or governmental regulations. This Exclusion 1(a) does not modify or
limit the coverage provided under Covered Risk 5.
b. Any governmental police power. This Exclusion 1(b) does not modify or limit the coverage provided under Covered Risk 6.
2. Rights of eminent domain. This Exclusion does not modify or limit the coverage provided under Covered Risk 7 or 8.
3. Defects, liens, encumbrances, adverse claims, or other matters
a. created, suffered, assumed, or agreed to by the Insured Claimant;
b. not Known to the Company, not recorded in the Public Records at Date of Policy, but Known to the Insured Claimant and not
disclosed in writing to the Company by the Insured Claimant prior to the date the Insured Claimant became an Insured under this
policy;
c. resulting in no loss or damage to the Insured Claimant;
d. attaching or created subsequent to Date of Policy (however, this does not modify or limit the coverage provided under Covered
Risk 11, 13, or 14); or
e. resulting in loss or damage that would not have been sustained if the Insured Claimant had paid value for the Insured Mortgage.
4. Unenforceability of the lien of the Insured Mortgage because of the inability or failure of an Insured to comply with applicable
doing -business laws of the state where the Land is situated.
5. Invalidity or unenforceability in whole or in part of the lien of the Insured Mortgage that arises out of the transaction evidenced by
the Insured Mortgage and is based upon usury or any consumer credit protection or truth -in -lending law.
6. Any claim, by reason of the operation of federal bankruptcy, state insolvency, or similar creditors' rights laws, that the transaction
creating the lien of the Insured Mortgage, is
a. a fraudulent conveyance or fraudulent transfer, or
b. a preferential transfer for any reason not stated in Covered Risk 13(b) of this policy.
7. Any lien on the Title for real estate taxes or assessments imposed by governmental authority and created or attaching between
Date of Policy and the date of recording of the insured Mortgage in the Public Records. This Exclusion does not modify or limit the
coverage provided under Covered Risk 11(b).
The above policy form may be issued to afford either Standard Coverage or Extended Coverage. In addition to the above Exclusions
from Coverage, the Exceptions from Coverage in a Standard Coverage policy will also include the following Exceptions from Coverage:
EXCEPTIONS FROM COVERAGE
This policy does not insure against loss or damage (and the Company will not pay costs, attorneys' fees or expenses) that arise by reason
of:
I. (a) Taxes or assessments that are not shown as existing liens by the records of any taxing authority that levies taxes or
assessments on real property or by the Public Records; (b) proceedings by a public agency that may result in taxes or assessments,
or notices of such proceedings, whether or not shown by the records of such agency or by the Public Records.
2. Any facts, rights, interests, or claims that are not shown by the Public Records but that could be ascertained by an inspection of the
Land or that may be asserted by persons in possession of the Land.
3. Easements, liens or encumbrances, or claims thereof, not shown by the Public Records.
4. Any encroachment, encumbrance, violation, variation, or adverse circumstance affecting the Title that would be disclosed by an
FirstAmencan Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 12
accurate and complete land survey of the Land and not shown by the Public Records.
(a) Unpatented mining claims; (b) reservations or exceptions in patents or in AcLs authorizing the issuance thereof; (c) water rights,
claims or title to water, whether or not the matters excepted under (a), (b), or (c) are shown by the Public Records.
Any lien or right to a lien for services, labor or material not shown by the public records.
2006 ALTA OWNER'S POLICY (06-17-06)
EXCLUSIONS FROM COVERAGE
The following matters are expressly excluded from the coverage of this policy, and the Company will not pay loss or damage, costs,
attorneys' fees, or expenses that arise by reason of:
1. a. Any law, ordinance, permit, or governmental regulation (including those relating to building and zoning) restricting, regulating,
prohibiting, or relating to
i. the occupancy, use, or enjoyment of the Land;
ii. the character, dimensions, or location of any improvement erected on the Land;
iii. the subdivision of land; or
iv. environmental protection;
or the effect of any violation of these laws, ordinances, or governmental regulations. This Exclusion 1(a) does not modify or
limit the coverage provided under Covered Risk 5.
b.Any governmental police power. This Exclusion 1(b) does not modify or limit the coverage provided under Covered Risk 6.
Rights of eminent domain. This Exclusion does not modiry or limit the coverage provided under Covered Risk 7 or 8.
Defects, liens, encumbrances, adverse claims, or other matters
a. created, suffered, assumed, or agreed to by the Insured Claimant;
b. not Known to the Company, not recorded in the Public Records at Date of Policy, but known to the Insured Claimant and not
disclosed in writing to the Company by the Insured Claimant prior to the date the Insured Claimant became an Insured under this
policy;
c. resulting in no loss or damage to the Insured Claimant;
d. attaching or created subsequent to Date of Policy (however, this does not modify or limit the coverage provided under Covered
Risk 9 and 10); or
e. resulting in loss or damage that would not have been sustained if the Insured Claimant had paid value for the Title.
Any claim, by reason of the operation of federal bankruptcy, state insolvency, or similar creditors' rights laws, that the transaction
vesting the Title as shown in Schedule A, is
a. a fraudulent conveyance or fraudulent transfer; or
b. a preferential transfer for any reason not stated in Covered Risk 9 of this policy.
Any lien on the Title for real estate taxes or assessments imposed by governmental authority and created or attaching between
Date of Policy and the date of recording of the deed or other instrument of transfer in the Public Records that vests Title as shown
in Schedule A.
The above policy form may be issued to afford either Standard Coverage or Extended Coverage. In addition to the above Exclusions
from Coverage, the Exceptions from Coverage in a Standard Coverage policy will also include the following Exceptions from Coverage:
EXCEPTIONS FROM COVERAGE
This policy does not insure against loss or damage (and the Company will not pay costs, attorneys' fees or expenses) that arise by reason
of:
1. (a) Taxes or assessments that are not shown as existing liens by the records of any taxing authority that levies taxes or
assessments on real property or by the Public Records; (b) proceedings by a public agency that may result in taxes or assessments,
or notices of such proceedings, whether or not shown by the recards of such agency or by the Public Records.
2. Any facts, rights, interests, or claims that are not shown by the Public Records but that could be ascertained by an inspection of the
Land or that may be asserted by persons in possession of the Land.
3. Easements, liens or encumbrances, or claims thereof, not shown by the Public Records.
4. Any encroachment, encumbrance, violation, variation, or adverse circumstance affecting the Title that would be disclosed by an
accurate and complete land survey of the Land and not shown by the Public Records.
5. (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, whether or not the matters excepted under (a), (b), or (c) are shoivn by the Public Records.
6. Any lien or right to a lien for services, labor or material not shown by the public records.
ALTA EXPANDED COVERAGE RESIDENTIAL LOAN POLICY (07-26-10)
EXCLUSIONS FROM COVERAGE
First American Title Insurance Company
Order Number: NCS -981325 -CC
Page Number: 13
The following matters are expressly excluded from the coverage of this policy, and the Company will not pay loss or damage, costs,
attorneys' fees, or expenses that arise by reason of:
1. a. Any law, ordinance, permit, or governmental regulation (including those relating to building and zoning) restricting, regulating,
prohibiting, or relating to
i. the occupancy, use, or enjoyment of the Land;
ii. the character, dimensions, or location of any improvement erected on the Land;
iii. the subdivision of land; or
iv. environmental protection;
or the effect of any violation of these laws, ordinances, or governmental regulations. This Exclusion 1(a) does not modify or
limit the coverage provided under Covered Risk 5, 6, 13(c), 13(d), 14 or 16.
b. Any governmental police power. This Exclusion 1(b) does not modify or limit the coverage provided under Covered Risk 5, 6,
13(c), 13(d), 14 or 16.
Rights of eminent domain. This Exclusion does not modify or limit the coverage provided under Covered Risk 7 or 8.
Defects, liens, encumbrances, adverse claims, or other matters
a. created, suffered, assumed, or agreed to by the Insured Claimant;
b. not Known to the Company, not recorded in the Public Records at Date of Policy, but Known to the Insured Claimant and not
disclosed in writing to the Company by the Insured Claimant prior to the date the Insured Claimant became an Insured under this
policy;
c. resulting in no loss or damage to the Insured Claimant;
d. attaching or created subsequent to Date of Policy (however, this does not modify or limit the coverage provided under Covered
Risk 11, 16, 17, 18, 19, 20, 21, 22, 23, 24, 27 or 28); or
e. resulting in loss or damage that would not have been sustained if the Insured Claimant had paid value for the Insured Mortgage
4. Unenforceability of the lien of the Insured Mortgage because of the inability or failure of an Insured to comply with applicable
doing -business laws of the state where the Land is situated.
5. Invalidity or unenforceability in whole or in part of the lien of the Insured Mortgage that arises out of the transaction evidenced by
the Insured Mortgage and is based upon usury or any consumer credit protection or truth -in -lending law. This Exclusion does not
modify or limit the coverage provided in Covered Risk 26.
6. Any claim of invalidity, unenforceability or lack of priority of the lien of the Insured Mortgage as to Advances or modifications made
after the Insured has Knowledge that the vestee shown in Schedule A is no longer the owner of the estate or interest covered by
this policy. This Exclusion does not modify or limit the coverage provided in Covered Risk 11.
7. Any lien on the Title for real estate taxes or assessments imposed by governmental authority and created or attaching subsequent
to Date of Policy. This Exclusion does not modify or limit the coverage provided in Covered Risk 11(b) or 25.
8. The failure of the residential structure, or any portion of it, to have been constructed before, on or after Date of Policy in
accordance with applicable building codes. This Exclusion does not modify or limit the coverage provided in Covered Risk 5 or 6.
9. Any claim, by reason of the operation of federal bankruptcy, state insolvency, or similar creditors' rights laws, that the transaction
creating the lien of the Insured Mortgage, is
a. a fraudulent conveyance or fraudulent transfer, or
b. a preferential transfer for any reason not stated in Covered Risk 27(b) of this policy.
FlrstAmencan Title Insurance Company
RECORDING REQUESTED BY:
First American Title Insurance Company National
Commercial Services
MAIL TAX STATEMENT
AND WHEN RECORDED MAIL DOCUMENT TO:
COUNTY OF MARIN, a political subdivision of the
State of California
3501 Civic Center Drive, Room 325
San Rafael, CA 94903
A.P.N.: 155-081-08
Space Above This Line for Recorder's Use Only
GRANT DEED
File No.: NCS -981325 -CC (TT)
The Undersigned Grantor(s) Declare(s): DOCUMENTARY TRANSFER TAX $1,100.00; CITY TRANSFER TAX $2,000.00;
SURVEY MONUMENT FEE $N/A
X computed on the consideration or full value of property conveyed, OR
computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale,
unincorporated area; [ X ] City of San Rafael, and
D(EMPT FROSUIWING HOMES AND 3065 ACTS FEE PER GOVERNMENT COQF 27388. ] a 2
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, City of San Rafael, a municipal
corporation
hereby GRANTS to COUNTY OF MARIN, a political subdivision of the State of California
the following described property in the City of San Rafael, County of Marin, State of California:
BEGINNING AT A POINT ON THE NORTHERLY LINE OF LOT 4, AS SHOWN ON THE MAP
ENTITLED "MAP OF MARIN PROFESSIONAL CENTER UNIT 1" FILED FOR RECORD MARCH 03,
1958 IN BOOK 9 OF MAPS, PAGE 94, MARIN COUNTY RECORDS; SAID POINT BEING
DISTANT THEREON NORTH 730 24'28" EAST 24.27 FEET FROM THE INTERSECTION OF THE
COURSES "NORTH 600 00' EAST 420.00 FEET AND NORTH 730 24'28" EAST 340.44 FEET" AS
SHOWN UPON THE ABOVE ENTITLED MAP; RUNNING THENCE NORTH 120 13'00" WEST
61.23 FEET; THENCE SOUTH 89° 51' 00" WEST 186.60 FEET; THENCE ON A CURVE TO THE
RIGHT WHOSE CENTER BEARS SOUTH 890 51'00" WEST 45.00 FEET THROUGH A CENTRAL
ANGLE OF 510 22'00" AN ARC DISTANCE OF 40.34 FEET; THENCE SOUTH 40° 08-39'. EAST
123.44 FEET TO A POINT ON THE NORTHWESTERLY LINE OF LOT 4, MAP ABOVE REFERRED
TO; THENCE ALONG THE NORTHWESTERLY LINE OF SAID LOT 4, MAP ABOVE REFERRED TO,
NORTH 600 00' EAST 129.60 FEET AND NORTH 730 24' 28" EAST 24.27 FEET TO THE POINT
OF BEGINNING.
ALSO SHOWN AS LOT 8 ON THE MAP ENTITLED "MAP OF COMMONWEALTH LIGHT
INDUSTRIAL SUBDIVISION", FILED FEBRUARY 18, 1960 IN BOOK 10 OF MAPS, PAGE 51,
MARIN COUNTY RECORD.
Mail Tax Statements To: SAME AS ABOVE
Grant Deed - continued
Date: 08/12/2021
A.P.N.: 155-081-08 File No.: NCS -981325 -CC (TT)
Dated: August 12, 2021
City of San Rafael, a municipal corporation
By:k�fi ll
Kate Colin, Mayor
A notary public or other officer completing this certificate
verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
STATE OF caju /-�-u. )SS
COUNTY OF
On before rqe,e�� �fe '; Notary Public, personally appeared
who proved to me on the basis of Saflsfa'ct evidence to be the person w se name is X subscribed to the within
instrument and acknowledged to me that s eh t[i ecuted the same i er h authorized capacity�je�, and that by
tl,signature(on the 'instrument the person, or the entity upon eha of which the personXacted, executed the
{{{instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Notary Signature
Page 2
This area for official notarial seal.
BRENNA KATHLEEN NURMI
Notary Public • California
' Marin County
Commission 9 2297544
My Comm, Expires Jul 18, 2023
To: First American Title Insurance Company National Commercial
Services
Tina Toye, Escrow Officer
Re: 30 3oseph Court, San Rafael, CA 94903 ("Property'l
Seller: City of San Rafael, a municipal corporation
First American Title Insurance Company
National Commercial Services
1850 Mt. Diablo Blvd., Suite 530
Walnut Creek, CA 94596
(925)927-2138
Fax -(714)361-3565
File No.: NCS -981325 -CC (TT)
Date: August 12, 2021
INFORMATION REQUEST FORM — For IRS 1099-S Reporting For Real Estate Transactions
Name (as shown on your income tax return)
t3usiness name/disregarded entity name, if different from
City of San Rafael, a municipal corporation
Give form to
requestor. Do not
send to the IRS.
Check appropriate box: ❑ Individual / Sole proprietor ® Corporation (exempt from 1099-S reporting) ❑ Partnership ❑ Trustlestate
❑ Limited liability company. For LLC, enter the tax classification (D=disregarded entity, C=corporation, S=S Corporation, P=Partnership
❑ Other (i.e. Bankrupts, etc. - see instructions) Do -
Forwarding
Forwarding Street Address (your address after closing)
1400 Fifth Avenue, Room 203
City, State, and Zip code
San Rafael, CA 94901
,er Identification Number
Percentage Owned
® 100% ❑ Other: %
Number of sellers including you
1
Enter your taxpayer identification number ("TIN") in the appropriate box. The TIN provided must match the name Socialsecurity number
given on Line 1 to avoid the imposition, underthe Internal Revenue Code, of civil or criminal penalties forfailing to 1
furnish a correct TIN and to insure the TIN passes the IRS's NameITIN matching software's TIN matching process
which we utilize. For individuals, this is your social security number (SSN). However for a resident alien, sole or
proprietor, or disregarded entity, see "Specific Instructions" below. For other entities, it is your employer identification Employer identification number
number (EIN). Note: If multiple sellers are involved, see "General Instructions" below. 94 6000424
Person - "IMPORTANT— SIGN
Under penalties of perjury, I certify that:
1 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. lam a U.S. citizen or other U.S. person (defined befowl,
Sign Here
) U.S. person ► /<29.7 /- r,&/XA�1- Mavai Kate Colin Date ► Av"L1JT 01y, 7a.
Certification of Foreign Person -"IMPORTANT" SIGN HERE IF YOU ARE FOREIGN, SIGN ABOVE IF YOU AREA U.S. PERSON
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued tome), and
2. 1 am a Foreign Person defined below).
Sign Here
_ Foreign person ■ Date 0 -
GENERAL
GENERAL INSTRUCTIONS Multiple Sellers
Section references are to the Internal Revenue Code unless otherwise noted. Each seller must complete a separate form Spouses who hold title as
Purpose of Form
A person who is required to file an information return on real estate with the IRS must
obtain your correct taxpayer Identification number (TIN) which may be your social security
number (SSN), Individual taxpayer number (ITIN), adoptive taxpayer identification
number(ATIN) or employer identification number (EIN).
Definition of a US. Person. For federal tax purposes, you are considered a U.S. person
if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the United
States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Defrrri_fion of a Foreian Person.
A foreign person includes a nonresident alien individual, foreign corporation, foreign
partnership, foreign trust, foreign estate, and any other person that is not a U.S. person. It
also includes a foreign branch of a U.S. financial institution If the foreign branch is a
qualified intermediary. In most cases, the U.S. branch of a foreign corporation or
partnership is treated as a foreign person.
Requirement to Furnish TIN & Penalties for Failure
You are required by law to provide us with your correct taxpayer IdentificaGan number
("TIN'), If you do not provide us with your cared taxpayer identification number (-t IN').
you may be subject to civil or criminal penalties imposed by law. If we disclose or use your
TIN in violation of federal law, we may be subject to civil or criminal penalties imposed by
tenants in common, joint tenants, tenants by the entirety, or community property
will be treated as a single seller unless we are instructed otherwise.
SPECIFIC INSTRUCTIONS
Please review chart "What Name and Number to Give" on page 2.
fndividuafs. You must generally enter the name shown on your income tax
return. However, if you have changed your last name, for instance, due to
marriage without informing the Social Security Administration of the name
change, enter your first name, the last name shown on your social security card,
and your new last name.
If more than one name is listed, list first, and then circle, the name of the
person or entity whose number you entered in Part I of the form.
Note. [TIN Applicant: Enter your individual name as it was entered on your form
W-7 application, line 1a. This should also be the same as the name you entered
on the Form 1040/104OAll040EZ you filed with your application.
Limited liability company tLI.Q. Check the "Limited liability company' box only
and enter the appropriate code for the tax classification ("D" for disregarded
entity, "C" for corporation, "P" for partnership) in the space provided and follow
the instructions on the next page.
(Specific Instructions Continued on Next Page)
For Escrow Use Only - Additional File Information
[] Change No. of 1099-S Fortes Is Name/Entity Party a'Non-Record' Seller? [] Is Property part of an Exchange?
[] Void I required for this file?
[] Add Contract Sales Price Buyees Part of Re at estate Tax Actuat Settlement Date
[] Change $1,000,000.00 $ May 17, 2021
n r�..i.,...
Region: National Commercial Services Division FAST Office: 0703 (1686) (TT)
i T •� �= r• h r`First American Title Insurance Company
4 National Commercial Services
r 1850 Mt. Diablo Blvd., Suite 530
Walnut Creek, CA 94596
(925)927-2138
Fax - (714)361-3565
INFORMATION REOIJEST FORM — For IRS 1099-S
Specific Instructions (Continued)
Limited liability company (LLC' (Continued)
For a single -member LLC (including a foreign LLC with a domestic owner) that is
disregarded as an entity separate from its owner under Regulations section
2301.7701-3, enter the owners name on the "Name" line. Enter the LLC's name
on the "Business name/disregarded entity name" line.
For an LLC classified as a partnership or a corporation, enter the LLC's name
on the "Name" line and enter "same" on the "Business name/disregarded entity
name' line.
Other entities. Enter the name as shown on required federal tax documents on
the "Name" line. This name should match the agreement, charter, order, or other
document creating the entity
Sole proprietor_ Enter your individual name as shown on your
1040/1040A/1040EZ on the "Name" line. You may enter your business, trade, or
"doing business" (DBA) name on the Business name/disregarded entity name
line
Note: Check the appropriate box for your status (Individual/Sole Proprietor,
Corporation, etc.)
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do
not have and are not eligible to get an SSN, your TIN is your IRS individual
taxpayer identification number (ITIN). Enter it in the social security number box.
If you do not have an ITIN. see "How to pet a TIN" below
Card," from the local Social Security Administration office, or online at
www.ssa.gov or by calling 1-800-772-1213. Use form W-7, "Application for IRS
Individual Taxpayer Identification Number', to apply for an ITIN,
or Form SS -4, "Application for Employer Identification Number," to apply for an
EIN. You can apply for an EIN online by accessing the IRS website at
www.irs.govIbusinesses and clicking on Employer Identification Number (EIN)
under "Starting a Business." You can get Forms W-7 and SS -4 from the IRS by
visiting www.irs.gov or by calling 1 -800 -TAX -FORM (1-800-829-3676.
If you are asked to comylet_e this Information Request Form but do not have a
TIN write "Applied For" in the spare for the TIN. sign and date the form, and
give it to us.
Note. Entering "Applied For' means that you have already applied for a TIN or
that you intend to apply for one soon. Note: A TIN is required if withholding is
required under FIRPTA.
Caution: A disregarded domestic entity that has a foreign owner must use the
appropriate Form W-8.
Part II. Certification
To establish to us that you are a U.S. person, or resident alien, sign this form.
For property owned by spouses as tenants in common, joint tenants, tenants by
the entirety, or community property, only the spouse whose TIN is shown first
on the Name line or is circled should sign.
Signature requirements: You must sign the certification.
If you are a single -member LLC that is disregarded as an entity separate from
its owner (see "Limited liability company (LLC)" on page 1), enter the owners
SSN (or EIN, if you have one). Do not enter the disregarded entity's EIN If the
LLC is classified as a corporation or partnership, enter the entity's EIN.
Note: Seethe chart below for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for a SSN, get Form SS -5, 'Application for a Social Security
What Name and
Number to Give
For this Type of Owner:
Give Name and Social Security Number SSN of:
i. Indi+rldual
The Individual
2. Spouses (who hold title as tenants in common, joint tenants, tenants by
Show both spouses, with the name of the spouse whose SSN is used shown
the entirety, or community property)
first and circled'
3. Custodian account of a minor (Uniform Gift to Minors Act)
The minorz
4. a. The usual revocable savings trust (grantor is also trustee)
The grantor -trustee'
b. So-called trust account that is not a legal or valid trust under state law
The actual owner'
5. Sole proprietorship or disregarded entity owned by an individual.
The owner'
6. Disregarded entity or Sole proprietorship owned by an individual
The owner'
For this Type of Owner:
Give Name and Em fo er Identification Number EINL01 L
7. Disregarded entity not owned by an individual
The owner
8. A valid trust, estate, or pension trust
Legal entity4
9. Corporate or LLC electing corporate status on Form 8832
The corporation or LLC electing corporate status
10. Association, club, religious, charitable, educational, or other tax-
The organization
exempt organization
11. Partnership or multi -member LLC
The partnership or multi -member LLC
12. A broker or registered nominee
The broker or nominee
13. Account with the Department of Agriculture in the name of a public entity
The public entity
(such as a state or local government, school district, or prison) that receives
agricultural program payments
14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form
The trust
1099 filing Method 2 See Regulations section 1.671-4 b 2 i B
'List first and circle the name of the person whose number you furnish. If only one person has an SSN, that person's number must be furnished
2Circle the minors name and fumish the minors SSN.
'You must show your individual name and you may also enter your business or "DBA" name on the "Business name/disregarded entity name" line. You may use either your SSN or EtN (if
you have one), but the IRS encourages you to use your SSN.
°List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account
title.)
Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed
Region: National Commercial Services Division FAST Office: 0703 (1686) (TT)
SELLER'S CERTIFICATION OF NON -FOREIGN STATUS UNDER FOREIGN
INVESTMENT IN REAL PROPERTY TAX ACT ("FIRPTA") (26 U.S.C. 1445)
File No: NCS -981325 -CC
For purposes of this form the following definitions shall apply:
1. Seller - the person(s) or entity(ies) that hold(s) the legal title to a U.S. real property interest under local law.
2. Transferor - the person(s) or entity(ies) that is/are the party(ies) treated as the transferor(s) under 26 USC
1445 (IRC Section 1445). The Seller may or may not be deemed to be the Transferor for purposes of
withholding under FIRPTA.
This form must be completed by each Seller or Transferor. All Sellers or Transferors providing this
certification must have a taxpayer identification number ("TIN"). A TIN is not an indication that the
Seller or Transferor is a resident alien or a U.S. citizen.
Section 1445 of the Internal Revenue Code provides that a transferee (buyer) of a U.S. real property interest
must withhold tax if the transferor is a foreign person.
I. THIS SECTION FOR ENTITY SELLERS:
For U.S. tax purposes (including Section 1445), the owner of a disregarded entity (which has legal title to a U.S.
real property interest under local law) will be the Transferor of the property and not the disregarded entity.
A. FOR ENTITY SELLERS THAT ARE NOT DISREGARDED ENTITIES:
To inform the transferee that withholding of tax is not required upon the disposition of a U.S. real
property interest by Seller, the undersigned Seller/Transferor hereby certifies:
1. Seller IS NOT a disregarded entity,
2. Seller/Transferor is NOT a foreign corporation, foreign partnership, foreign trust, or foreign estate
(as those terms are defined in the Internal Revenue Code and Income Tax Regulations),
3. Seller's/Transferor's Taxpayer Identification Number is 94-6000424 . and
4. Seller's/Transferor's office address is _UQQ Fifth Avenue San Rafael CA 94901
Seller/Transferor understands that this certification may be disclosed to the Internal Revenue Service by
transferee and that any false statement contained herein could be punished by fine, imprisonment, or both.
Under penalties of perjury I declare that I have examined this certification and to the best of my knowledge and
belief it is true, correct, and complete, and I further declare that I have authority to sign this document on behalf
of Seller/Transferor.
City of San Rafael, a municipal corporation
By: k" Ax,
Name: Kate Corin
Its: _ Mayor
B. FOR ENTITY SELLERS THAT ARE DISREGARDED ENTITIES.•
LR ►l
To inform the transferee that withholding of tax is not required upon the disposition of a U.S. real
property interest by Seller, the undersigned Transferor hereby certifies:
Seller, [insert name of Seller entity] IS a disregarded entity as
defined in 26 CFR 1.1445-2(b)(2)(iii), thus Seller's owner, [insert owner
name], is therefore the Transferor;
2. Transferor is NOT a foreign corporation, foreign partnership, foreign trust, or foreign estate, nor a
non-resident alien for purposes of U.S. income taxation (as those terms are defined in the Internal
Revenue Code and Income Tax Regulations),
3. Transferor's U.S. Taxpayer Identification number is ; and
4. Transferor's address is: [please complete address below]
[Insert home address if Transferor is an individual]:_
[Insert office address if Transferor is an entity:
Transferor understands that this certification may be disclosed to the Internal Revenue Service by transferee and
that any false statement contained herein could be punished by fine, imprisonment, or both.
Under penalties of perjury I declare that I have examined this certification and to the best of my knowledge and
belief it is true, correct, and complete, and I further declare that I have authority to sign this document on behalf
of Transferor.
City of San Rafael, a municipal corporation
By:
Name: Kaee Colin Date.
Its: Mayor
TAXABLE YEAR N CALIFORNIA FORM
2021 Real Estate Withholding Statement 593
AMEN DED: .
Escrow or Exchange No. NCS -981325 -CC
Part I Remitter Information CX ff REEP ❑ Qualified Intermediary ❑ Buyer/Transferee ❑ Other
Business name
First American Title Insurance Company National Commercial Services
First name
Initial I Last name
FEIN ❑ CA Corp no. ❑ CA SOS file no.
95-2566122
SSN or ITIN
Address (apt./ste., room, PO box, or PMB no.)
1850 Mt. Diablo Blvd., Suite 530
City (If you have a foreign address, see instructions.) State I ZIP code Telephone number
Walnut Creek CA 94596 (925)927-2100
Part II Seller/Transferor Information If a grantor or nongrantor trust, check the box that applies. e ❑ Grantor ❑ Nongrantor Trust
First name/Grantor
Initial I Last name/Grantor
SSN or ITIN
Spouse's/RDP's first name (if jointly owned) Initial Last name Spouse's/RDP's SSN or ITIN (if jointly owned)
Business/Nongrantor Trust name (if applicable) ® FEIN ❑ CA Carp no. ❑ CA SOS file no.
City of San Rafael. a municipal corporation 94-6000424
Address (apt./ste., room, PO box, or PMB no.)
1400 Fifth Avenue, Room 203
City (If you have a foreign address, see instructions.)
i San Rafael
Property address (provide street address, parcel number, and county)
30 Joseph Court, San Rafael, CA 94903
State ZIP code Telephone number
CA 94901 415-485-3070
Ownership percentage
100%
Part III Certifications which fully exempt the sale from withholding (See instructions)
Determine whether you qualify for a full withholding exemption. Check all boxes that apply to the property being sold or transferred.
1. OO ❑ The property qualifies as the seller's (or decedent's, if sold by the decedent's estate or trust) principal residence under Internal
Revenue Code (IRC) Section 121.
2. ❑ The seller (or decedent, if sold by the decedent's estate or trust) last used the property as the seller's (decedent's) principal residence
under IRC 121 without regard to the two-year time period.
3. Q. ❑ The seller has a loss or zero gain for California income tax purposes on this sale. Complete Part VI, Computation on Side 2.
4. ❑ The property is compulsorily or involuntarily converted, and the seller intends to acquire property that will qualify for nonrecognition of
gain under IRC Section 1033.
5. ❑ The transfer qualifies for nonrecognition treatment under IRC Section 351 (property transferred to a corporation controlled by the
transferor) or IRC Section 721 (property contributed to a partnership in exchange for a partnership interest).
6. OO ❑ The seller is a corporation (or a limited liability company (LLC) classified as a corporation for federal and California income tax
purposes) that is either qualified through the California Secretary of State or has a permanent place of business in California.
7. O ❑ The seller is a California partnership or qualified to do business in California (or an LLC that is classified as a partnership for federal
and California income tax purposes that is not a single member LLC that is disregarded for federal and California income tax
purposes).
8. OO ❑X The seller is a tax-exempt entity under California or federal law.
9. OO ❑ The seller is an insurance company, individual retirement account, qualified pension/profit sharing plan, or charitable remainder trust.
If you checked one or more boxes in line 1 through line 9, withholding is not required. Go to Side 3, complete the perjury statement and sign.
Provide Sides 1-3 to the remitter before the close of escrow or exchange transaction to submit to the Franchise Tax Board.
Part IV Certifications that may partially or fully exempt the sale from withholding or if no exemptions apply (See instructions)
Determine whether you qualify for a full, partial, or no withholding exemption. Check all boxes that apply to the property being sold or transferred.
10. O ❑ The transfer qualifies as either a simultaneous or deferred like -kind exchange under IRC Section 1031. See instructions for
Form 593, Part IV.
31. OO ❑ The transfer of this property is an installment sale where the buyer must withhold on the principal porton of each installment
payment. Copy of the promissory note is attached at the close of escrow. Complete Part V, Buyer/Transferee Information on Side 2.
Withholding may be required.
12. 0 ❑ No exemptions apply. Complete Part VII, Escrow or Exchange Information, on Side 3 for amounts to withhold. Withholding is
required.
-� 8601213 F_ Form 593 2021 Side 1
Escrow or Exchange No.
NCS -981325 -CC
Remitter name SSN, ITIN, FEIN, CA corp no., or CA SOS file no.
First American Title Insurance Company National Commercial Services 95-2566122
Part V Buyer/Transferee Information
Complete this part if you checked box 11 in Part IV for an installment agreement.
First name/Grantor
Initial I Last name/Grantor
Spouse's/RDP's first name (if jointly purchased) Initial Last name
Business/Nongrantor Trust name (if applicable)
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.) State ZIP code
Principal Amount of Promissory Note I Installment Amount
Buyer's/Transferee's Acknowledgment to Withhold
Read the "Buyer/Transferee" Information below.
SSN or ITIN
Spouse's/RDP's SSN or ITIN
❑ FEIN F-] CA Corp no. ❑ CA SOS file no.
relephone number
Interest Rate Repayment Period-
0/0
Number of months
I acknowledge that I am required to withhold on the principal portion of each installment payment to the seller/transferor for the above shown
California real property either at the rate of 3 1/3% (.0333) of the sales price or the Alternative Withholding Calculation, as specified by the
seller/transferor on Form 593, Real Estate Withholding Statement, of the principal portion of each installment payment. I will complete Form 593 for
the principal portion of each installment payment and send one copy of each to the Franchise Tax Board along with Form 593-V, Payment Voucher
for Real Estate Withholding, the withholding payment, and give one copy of Form 593 to the seller/transferor. I will send each withholding payment
to the Franchise Tax Board by the 20th day of the month following the month of the installment payment. If the terms of the installment sale,
promissory note, or payment schedule change, I will promptly inform the Franchise Tax Board. I understand that the Franchise Tax Board may
review relevant escrow documents to ensure withholding compliance. I also understand that I am subject to withholding penalties if I do not
withhold on the principal portion of each installment payment and do not send the withholding along with Form 593 to the Franchise Tax Board by
the due date, or if I do not send one copy of Form 593 to the seller/transferor by the due date. Go to Side 3, complete the perjury statement
and sign.
Part VI Computation
Complete this part if you checked and certified box 3 in Part III, or to calculate an alternative withholding calculation amount.
13. Selling price........................................................................................................................................................................ Q. 13
14. Selling expenses........................................................................................................................................................................ 14
15. Amount realized. Subtract line 14 from line 13................................................................................................................... 15
16. Enter the price you paid to purchase the property (see instructions, How to Figure Your Basis.) ........... 16
17. Seller/Transferor-paid points....................................................................................... 17
18. Depreciation.................................................................................................................. 18
19. Other decreases to basis.............................................................................................. 19
20. Total decreases to basis. Add line 17 through line 19................................................................................. 20 _
21. Subtract line 20 from line 16........................................................................................................................ 21
22. Cost of additions and improvements...................................................................... * 22
23. Other increases to basis......................................................................................... O 23
24. Total increases to basis. Add line 22 and line 23....................................................................................... 24
25. Adjusted basis. Add line 21 and line 24.......................................................,..................................................................... Q. 25
26. Enter any suspended passive activity losses from this property ................................................................ 26
27. Add line 25 and line 26..................................................................................................................................................... 27
28. Estimated gain or loss on sale. Subtract line 27 from line 15 and enter the amount here.
If you have a loss or zero gain, skip lines 29 and 30. Certify on Side 3. Withholding is not required.
If you have a gain, go to line 29 to calculate your withholding .......... --- .................................. --- ........................ 28
Side 2 Form 593 2021 1 8602213 I -
Escrow or Exchange No.
NCS -981325 -CC
Remitter name SSN, ITIN, FEIN, CA corp no., or CA SOS file no.
First American Title Insurance Company National Commercial Services 95-2566122
29. Alternative withholding calculation amount. Check the applicable box for the filing type.
❑ Individual 12.3% ❑ Corporation 8.84% ❑ Bank and Financial Corporation 10.84% ❑ Trust 12.3%
❑ Non -California Partnership 12.3% ❑ S Corporation 13.8% ❑ Financial S Corporation 15.8%
Multiply the amount on line 28 by the tax rate for the filing type selected above and enter the amount here. This is the
alternative withholding calculation amount. If you elect the alternative withholding calculation amount, then check the
appropriate box on line 35, Boxes B-H, and enter the amount on line 36.............................................................................. 29
30. Sales price withholding amount. Multiply the selling price on line 13 by 31/3 % (.0333).
This is the sales price withholding amount. If you select the sales price withholding amount, check box A on
line 35 below and enter the amount on line 36. ...................................... ................ ................................ 30
Part VII Escrow or Exchange Information
31. Escrow or Exchange Number..........................................................................................e 31 NCS -981325 -CC
32. Date of Transfer, Exchange Completion, Failed Exchange, or Installment Payment ... ..................... (mm/dd/yyyy) . 32 _
33. Sales Price, Failed Exchange, or Boot Amount $ 1,000,000.00 x Ownership Percentage % e 33 _
34. Type of Transaction (Check One Only): e
A { Conventional Sale/Transfer C []Boot
B ❑ Installment Sale Payment D❑ Failed Exchange
35. Withholding Calculation (Check One Only): e
Sales Price Method
A ❑ 31/3 % (.0333) x Sales Price, Boot, or Installment Sale Payment
Alternative Withholding Calculation Election
B [] Individual 12.3% x Gain on Sale
C ❑I Non -California Partnership 12.3% x Gain on Sale
D ❑ Corporation 8.84% x Gain on Sale
E ❑ Bank and Financial Corp. 10.84% x Gain on Sale
36. Amount Withheld from this Seller/Transferor ....................
F ❑ S Corporation 13.8% x Gain on Sale
G ❑ Financial S Corporation 15.8% x Gain on Sale
H ❑ Trust 12.3% x Gain on Sale
............. ■ 36
Title and escrow persons, and exchange accommodators are not authorized to provide legal or accounting advice for purposes of
determining withholding amounts. Transferors are strongly encouraged to consult with a competent tax professional for this purpose.
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to
ftb.ca.gov/forms and search for 1131. To request this notice by mail, call 800.852.5711.
Perjury Statement
Under penalties of perjury, I hereby certify that the information provided above is, to the best of my knowledge, true and correct. I further certify that:
Check the applicable box(s):
❑X The sale is fully exempt from withholding as indicated by a check mark(s) in Part III.
❑ The sale is fully or partially exempt from withholding as indicated by a check mark in Part IV, box 10 or 11.
❑ The seller has elected the Alternative Withholding Calculation as indicated by a check mark in Part VII, line 35 (B-H).
❑ The buyer/transferee understands and accepts the withholding requirements as stated on the Buyer's/Transferee's Acknowledgment to
Withhold in Part V. The buyer/transferee should only check this box when involved in an installment sale.
Seller's/T
X
Kate Colin
Sign Seller's/fransfkrors spouse's /RDP's signature
X
Here Buyer's/Transferee'ssignature
X
It is unlawful to forge Buyer's/Transferee's spouse's/RDP's signature
a spouse's/RDP's X
signature Remitter's name and Title/Escrow business name
X Tina Toye, First American Title Insurance Company National Commercial
Services
1 8603213
Date
1&�
Date D
Date
Date
Telephone Number
(925)927-2138
Form 593 2021 Side 3 0
2021 Instructions for Form 593
Real Estate WithholdingStatement
General Information For more information about real estate The FTB will approve or deny the request within
In general, for taxable years beginning on or after withholding, get FTB Publication 1016, Real Estate 30 days from when received. The buyer must
Janua 1 2015 California la Al t th
Withholding Guidelines. continue to withhold until the FTB approves the
ry ,w con ms o e
Internal Revenue Code (IRC) as of January 1,
2015. However, there are continuing differences
between California and federal law. When
California conforms to federal tax law changes, we
do not always adopt all of the changes made at
the federal level. For more information, go to
ftb.ca.gov and search for conformity. Additional
information can be found in FTB Pub. 1001,
Supplemental Guidelines to California Adjustments,
the instructions for California Schedule CA (540 or
540NR), and the Business Entity tax booklets.
The instructions provided with California tax forms
are a summary of California tax law and are only
intended to aid taxpayers in preparing their state
income tax returns. We include information that is
most useful to the greatest number of taxpayers in
the limited space available. It is not possible to
include all requirements of the California Revenue
and Taxation Code (R&TC) in the instructions.
Taxpayers should not consider the instructions as
authoritative law.
New Form 593 - Effective January 1, 2020, the
following real estate withholding forms and
instructions have been consolidated into one new
Form 593, Real Estate Withholding
Statement:
• Form 593, Real Estate Withholding Tax
Statement
• Form 593-C, Real Estate Withholding Certificate
• Form 593-E, Real Estate Withholding —
Computation of Estimated Gain or Loss
• Form 593-I, Real Estate Withholding
Installment Sale Acknowledgment
All remitters are required to complete the
applicable part(s) of Form 593 and submit Sides I-
3 to the Franchise Tax Board (FTB) regardless of
real estate transaction.
Real Estate Withholding Requirement—
Withholding is required when California real estate
is sold or transferred. The real estate escrow
person (REEP) is required to notify buyers of
withholding requirements, unless the buyer is a
Qualified Intermediary (QI) in a deferred
exchange. The amount withheld from the seller or
transferor is sent to the FTB as required by RUC
Section 18662.
Real estate withholding is not required when any
of the following apply:
• The sales price is $100,000 or less.
• The property is in foreclosure.
• The transferor is a bank acting as a trustee
(except for a deed of trust).
• The seller or transferor certifies to an
exemption on Form 593, Part III.
Real Estate Escrow Person (REEP) - The
REEP is anyone involved in closing the real estate
transaction which includes any attorney, escrow
company, title company, QI, or anyone else who
receives and disburses payment for the sale of
real property.
Remitter - The person who will remit the
withheld tax on any disposition from the sale or
exchange of California real estate and file the
prescribed forms on the buyer's/transferee's
behalf with the FTB.
Seller — The term "seller" includes the seller or
any other transferor of real property. (i.e.
Seller/Transferor.)
Buyer — The term "buyer" includes the buyer or
any other transferee of real property. (i.e.
Buyer/Transferee.)
Like -Kind Exchanges - California requires
taxpayers who exchange property located in
California for like -kind property located outside of
California, and meet all of the requirements of the
IRC Section 1031, to file an annual information
return with the FTB. For more information, get
form FTB 3840, California Like -Kind Exchanges, or
go to ftb.ca.gov and search for like kind.
Installment Sales - The REEP reports the sale
or transfer as an installment sale if there will be at
least one payment made after the tax year of the
sale. The withholding is 3 1/3% (.0333) of the
down payment during escrow. Buyers/Transferees
are required to withhold on the principal portion of
all payments made following the close of the real
estate transaction, unless an approval letter for
elect -out method is received as described below.
See Specific Instructions for more information on
installment sales.
Elect Out of Subsequent Installment
Payment Withholding - Sellers or transferors
can elect to not report the sale on the installment
method. If the seller/transferor chooses not to use
the installment method, the seller/transferor
generally reports the entire gain in the year of
sale, even though the seller/transferor does not
receive all the sale proceeds in that year. To do
this, the seller/transferor must:
• File a California income tax return and report
the entire gain on Schedule D, California
Capital Gain or Loss Adjustment, or Schedule
D-1, Sale of Business Property.
• Submit to the FTB a written request to release
the buyer/transferee from withholding on
subsequent installment payments after filing
the income tax return and reporting the entire
gain.
request.
For more information, get FTB 4010, Withholding
on California Real Estate Installment Sales, or go
to ftb.ca.gov and search for installment sales.
Alternative Withholding Calculation —
This amount is calculated when the alternative
withholding calculation election has been made by
the seller/transferor. The withholding amount is
calculated by multiplying the seller's/transferor's
applicable tax rate by the estimated gain
determined in Part VI, Computation.
You may use estimates when you complete Part
VI, but the estimates must not result in the
calculation of a loss when you actually have a
gain. Any seller/transferor who, for the purpose of
avoiding the withholding requirements, knowingly
executes a false certificate is liable for a penalty of
$1,000 or 20% of the required withholding
amount, whichever is greater.
Registered Domestic Partners (RDP) - For
purposes of California income tax, references to a
spouse, husband, or wife also refer to a California
RDP, unless otherwise specified. When we use the
initials RDP, they refer to both a California
registered domestic "partner" and a California
registered domestic "partnership," as applicable.
For more information on RDPs, get FTB Pub. 737,
Tax Information for Registered Domestic Partners.
Important Information
Seller/Transferor filing requirement
Qualifying for an exemption from withholding or
being withheld upon does not relieve you of your
obligation to file a California income tax return and
pay any tax due on the sale of California real
estate.
You may be assessed penalties if:
• You do not file a tax return.
• You file your tax return late.
• The amount of withholding does not satisfy
your tax liability.
The seller/transferor must submit Form 593 before
the close of the real estate transaction to prevent
withholding on the transaction. After the real
estate transaction has closed, amounts withheld
may be recovered only by claiming the withholding
as a credit on the appropriate year's tax return.
How to Claim the Withholding
To claim the withholding credit you must file a
California tax return. Report the sale or transfer as
required. Enter the amount from Form 593, line
36, Amount Withheld from this Seller/Transferor,
on your California tax return as withholding from
Form(s) 592-B, Resident and Nonresident
Withholding Tax Statement, or 593.
Form 593 Instructions 2021 Page 1
If your filing status changed after escrow closed
and before filing your California tax return, please
call Withholding Services and Compliance at
888.792.4900 or 916.845.4900 prior to filing your
tax return for instructions on how to claim your
withholding credit. Claim your withholding credit
on one of the following:
• Form 540, California Resident Income Tax
Return
• Form 540NR, California Nonresident or Part -
Year Resident Income Tax Return
• Form 541, California Fiduciary Income Tax
Return
• Form 100, California Corporation Franchise or
Income Tax Return
• Form 1005, California S Corporation Franchise
or Income Tax Return
• Form 100W, California Corporation Franchise or
Income Tax Return — Water's -Edge Filers
• Form 109, California Exempt Organization
Business Income Tax Return
• Form 565, Partnership Return of Income
• Form 568, Limited Liability Company Return of
Income
Attach a copy of Form(s) 593 to the lower front of
your California tax return. Make a copy for your
records.
If withholding was done for a failed exchange or
on boot in the year following the year the property
was sold, the withholding is shown as a credit for
the taxable year the withholding occurred since
you qualify for installment sale reporting. If you
elect to report the gain in the year the property
was sold, instead of in the year you received the
payment, contact Withholding Services and
Compliance at 888.792.4900 or 916.845.4900
prior to filing your California tax return for
instructions to have the credit transferred to the
prior year.
A Purpose
Use Form 593, Real Estate Withholding
Statement to:
• Certify the seller/transferor qualifies for a full,
partial, or no withholding exemption.
• Estimate the amount of the seller's/transferor's
loss or zero gain for withholding purposes and
to calculate an alternative withholding
calculation amount.
• Report real estate withholding on sales closing
in 2021, installment payments made in 2021,
or exchanges that were completed or failed in
2021.
Use a separate Form 593 to report the amount
withheld from each seller/transferor. If the
sellers/transferors are married or RDPs and they
plan to file a joint return, include both
spouses/RDPs on the same Form 593.
If the sellers/transferors are married or RDPs and
they are entered as one seller/transferor, we treat
them as having equal ownership interest. If the
ownership interest is not equal, file separate
Forms 593 for each seller/ transferor to represent
the correct ownership interest percentage. If the
Page 2 Form 593 Instructions 2021
information submitted is incorrect, an amended
Form 593 must be filed with the FTB. See
Important Information E, Amending Form 593, for
more information.
Use Form 593-V, Payment Voucher for Real Estate
Withholding, to remit real estate withholding
payments to the FTB. Submit Form 593-V when
Form(s) 593 is submitted electronically or by mail.
The remitter must use Form 593-V when remitting
a payment by check or money order.
B Who Must File
A seller/transferor that qualifies for a full, partial,
or no withholding exemption must file Form 593.
Any remitter (individual, business entity, trust,
estate, or REEP) who withheld on the sale/transfer
of California real property must file Form 593 to
report the amount withheld. If this is an
installment sale payment after escrow closed, the
buyer/transferee is the responsible person. See
instructions for Part V, Buyer/Transferee
information.
All remitters are required to complete the
applicable part(s) of Form 593 and submit Sides 1-
3 to the FTB regardless of the real estate
transaction.
C When and Where to File
If the seller/transferor is exempt from withholding,
this form must be sent to the real estate escrow
person or QI prior to the close of the real estate
transaction. The form must be sent to the FTB
by the 20th day of the calendar month
following the month in which escrow closes.
For withholding on a sale, the remitter will need
the original completed Form 593 and two copies:
• File the original Form 593, along with
completed Form 593-V and the withholding
payment. Mail to FTB using the address shown
in this section within 20 days following the end
of the month in which the transaction closed.
• Provide one copy to the seller/transferor within
20 days following the end of the month in
which the transaction closed.
• Retain one copy for the remitter records for a
minimum of five years.
For installment sales, submit the following at the
close of the real estate transaction:
• Form 593.
• Form 593-V with the amount withheld on the
down payment.
• A copy of the promissory note.
When making installment payments following the
close of the real estate transaction, withhold either
3 1/3% (.0333) of the sales price, or the
alternative withholding calculation percentage
on the principal portion of each installment
payment, as specified by the seller/transferor on
Form 593. A copy of the promissory note, and the
seller's/transferor's signature are not required with
any subsequent installment payments.
File only a completed current year Form 593 and
Form 593-V with each withholding payment.
For example, if the buyer withholds on a payment
to a seller on June 1, 2021, then use a 2021 Form
593 and Form 593-V.
Mail to:
WITHHOLDING SERVICES AND
COMPLIANCE MS F182
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0651
D Electronic Filing Requirements
Form 593 information may be filed with the FTB
electronically, using FTB's Secure Web Internet
File Transfer (SWIFT). However, the REEP must
provide the seller/transferor with a copy of
Form 593.
For installment sales, the REEP must also mail a
copy of the promissory note to the FTB with the
down payment only.
For electronic filing, the REEP can submit the file
using the SWIFT process as outlined in FTB Pub.
923, Secure Web Internet File Transfer (SWIFT)
Guide for Resident, Nonresident, and Real Estate
Withholding.
For the required file format and record layout for
electronic filing, get FTB Pub. 1023R, Real Estate
Withholding Electronic Submission Requirements.
If you are the remitter for more than one REEP,
provide a separate electronic file for each REEP.
For electronic filing of Form 593, mail your
payment along with Form 593-V.
Electronic signatures, for example Docusign and
scanned copies of Form 593, shall be considered
as valid as the originals.
E Amending Form 593
If an error is discovered after the remitter files
Form 593, the REEP files an amended Form 593
with the FTB to correct the error. An amended
Form 593 can only be filed by the REEP. If a
seller/transferor notices an error, contact the
REEP.
Important: For assistance to correct error(s),
prepare, and file amended forms, call Withholding
Services and Compliance at 888.792.4900 or
916.845.4900.
If you previously filed with a correct taxable year
form, but reported incorrect information, follow
the steps below:
1. Complete a new Form 593 with the same
taxable year form as originally filed.
• Check the "Amended" box at the top left
corner of the form.
• Enter all the correct withholding and
seller/transferor information. Do not enter
negative numbers.
• Attach a letter to the back of the form to
explain your reasons for the corrections.
• Keep the original Form 593 for your records.
2. Mail the amended form and attached letter to
the address shown under Important Information C,
When and Where to File.
If you previously filed a Form 593 using an
incorrect year form, call us for assistance.
Whenever an amended Form 593 is filed with the
FTB, provide a copy to the seller/transferor. Do
not file an amended Form 593 to cancel the
withholding amount after the close of the real
estate transaction. After escrow has closed,
amounts withheld may be recovered only by
claiming the withholding as a credit on the
appropriate year's tax return.
F Interest and Penalties
Interest will be assessed on late withholding
payments and is computed from the due date to
the date paid. If the REEP does not notify the
buyer/transferee, other than a QI, of the
withholding requirements in writing, the penalty is
the greater of $500 or 10% of the required
withholding.
If after notification, the buyer/transferee, unless
the buyer is a QI in a deferred exchange, does not
withhold, the penalty is the greater of $500 or
10% of the required withholding.
If the buyer/transferee or REEP does not furnish
complete and correct copies of Form 593 to the
seller/transferor by the due date, the penalty is
up to $270 per Form 593. If the failure is due to
an intentional disregard of the requirement, the
penalty is the greater of $550 or 10% of the
required withholding.
We assess a penalty for failure to file complete,
correct, and timely information returns. The
penalty is calculated per seller:
• $50 if filed 1 to 30 days after the due date.
• $110 if filed 31 days to 6 months after the due
date.
• $270 if filed more than 6 months after the due
date.
(R&TC Section 19183)
If the failure is due to an intentional disregard of
the requirement, the penalty is the greater of $550
or 10% of the required withholding.
For more information, get FTB 1150, Withhold at
Source Penalty Information.
Penalties referenced in this section will be
assessed unless it is shown that the failure to
notify, withhold, or timely furnish returns was due
to reasonable cause.
G Helpful Hints
Taxable Year - The taxable year at the top of
Form 593 must match the taxable year on line 32.
See instructions for Part VII, line 32. We cannot
process a Form 593 with an incorrect taxable year.
To avoid processing delays, go to
ftb.ca.gov/forms to get the correct taxable year
Form 593.
Identification Numbers - Check to see that the
remitter and seller's/transferor's identification
numbers are correct and listed in the same order
as the names. If both a husband/RDP and
wife/RDP are listed, make sure both social security
numbers (SSNs) or individual taxpayer
identification numbers (ITINs) are listed in the
same order as their names.
Trusts and Trustees - It is important to report
the correct name and identification number when
title is held in the name of a trust. If the
seller/transferor is a trust, see the Specific
Instructions for Part II, Seller/Transferor
Information.
Specific Instructions
Private Mail Box (PMB) - Include the PMB in
the address field. Write "PMB" first, then the box
number. Example: 111 Main Street PMB 123.
Foreign Address - Follow the country's practice
for entering the city, county, province, state,
country, and postal code, as applicable, in the
appropriate boxes. Do not abbreviate the country
name.
Complete fields applicable to your transaction.
Part I - Remitter Information
Check the box for the type of remitter that applies
to your transaction.
Enter the business or individual name (not both),
escrow or exchange number, identification
number, and address of the party responsible for
closing the transaction or any other party who
receives and disburses payment and remits
withholding to the FTB for the sale of real
property.
Enter either a business name or individual name. If
the party is an escrow company, title company,
exchange company, corporation, partnership,
limited liability company, nongrantor trust, or
estate, enter the business name and business
identification number (FEIN, CA Corp no., CA SOS
file no.). If the business name is not applicable,
include the individual's or grantor's first name,
initial, last name, and identification number (SSN
or ITIN).
Part II - Seller/Transferor
Information
Enter only business or individual name, not both,
mailing address, and identification number of the
seller/transferor. If the seller/transferor does not
provide a tax identification number,
withholding is still required. If you do not have an
SSN because you are a nonresident or a resident
alien for federal tax purposes, and the Internal
Revenue Service (IRS) issued you an ITIN, enter
the ITIN in the space provided for the SSN. An
ITIN is a tax processing number issued by the IRS
to individuals who have a federal tax filing
requirement and do not qualify for an SSN. It is a
nine -digit number that always starts with the
number 9. If the seller/transferor has applied for
an identification number, but it has not been
received, enter, "Applied For" in the space for the
seller/transferor identification number and attach a
copy of the federal application behind Form 593.
After the identification number is received, call
Withholding Services and Compliance at
888.792.4900 or 916.845.4900.
Note: If you choose to provide a copy of Form
593 to the buyer/transferee, delete the
seller/transferor tax identification number on the
buyer/transferee copy.
If the seller/transferor is an/a:
• Individual, enter the SSN or ITIN. If the
sellers/transferors are husband/RDP and
wife/RDP and plan to file a joint return, enter
the name and SSN or ITIN for each
spouse/RDP. Otherwise, do not enter
information for more than one seller/transferor.
Instead, complete a separate Form 593 for
each seller/transferor.
• Business, enter the business name in the
business name field along with the federal
employer identification number (FEIN),
California Corporation number (CA Corp no.), or
California Secretary of State (CA SOS) file
number.
• Grantor trust, enter the individual name and
SSN or ITIN of the grantor that is required to
file a tax return and report the income. Do not
enter the name of the grantor trust or trustee
information. The grantor trust is disregarded
for tax purposes and the individual
seller/transferor must report the sale and claim
the withholding on the grantor's individual tax
return. If the trust was a grantor trust that
became irrevocable upon the grantor's death,
enter the name of the trust and the trust's
FEIN. Do not enter the decedent's or trustee's
name or SSN.
• Nongrantor trust, enter the name of the
nongrantor trust and the nongrantor trust's
FEIN. If the nongrantor trust has not applied
for a FEIN, leave the identification number
blank. Do not enter the trustee information.
When the nongrantor trust receives their FEIN,
contact Withholding Services and Compliance
at 888.792.4900 or 916.845.4900.
• Single member limited liability company
(SMLLC), enter the name and identification
number of the single member.
For all other non -individual sellers/transferors,
enter the FEIN, CA Corp number, or CA SOS file
number.
Property Address - Enter the address of the CA
real property transferred. Include the street
address, parcel number, and county.
Conventional Sale/Transfer and Installment
Sale - Enter the address of the CA real property
transferred.
Exchange - Enter the address of the relinquished
property.
Ownership Percentage
Enter your ownership percentage rounded to two
decimal places (e.g. 66.67%). If you are on the
title for incidental purposes and you have no
financial ownership, enter 0.00 and skip to
Seller/Transferor signature. You will not be
withheld upon.
Form 593 Instructions 2021 Page 3
Examples of sellers/transferors who are on title for
incidental purposes are:
• Co-signers on title (e.g., parents co-signed to
help their child qualify for the loan).
• Family members on title to receive property
upon the owner's death.
Part III - Certifications Which
Fully Exempt the Sale From
Withholding
Line 1 through Line 9
Check all boxes that apply to the property being
sold or transferred. Seller/Transferor must
complete the perjury statement, sign and date on
Side 3 of Form 593. Buyer/Transferee is not
required to sign for a traditional sale.
Line 1 - Principal residence
To qualify as your principal residence under IRC
Section 121, you (or the decedent, if sold by the
decedent's estate or trust) generally must have
owned and lived in the property as your main
home for at least two years during the five-year
period ending on the date of sale. Military and
Foreign Service, get FTB Pub. 1032, Tax
Information for Military Personnel.
You can have only one main home at a time. If
you have two homes and live in both of them, the
main home is the one you lived in most of the
time.
There are exceptions to the two-year rule if the
primary reason you are selling the home is for a
change in the place of employment, health, or
unforeseen circumstances such as death, divorce
or termination of registered domestic partnership,
or loss of job, etc. For more information about
what qualifies as your principal residence or
exceptions to the two- year rule, get federal
Publication 523, Selling Your Home. To get federal
publications, go to irs.gov, or call 800.829.3676.
If only a portion of the property qualifies as your
principal residence, a second Form 593 will need
to be completed to certify an exemption on the
portion not used as a principal residence.
The allocation method should be the same as the
seller/transferor used to determine depreciation.
Line 2 - Property last used as your principal
residence
If the property was last used as the
seller's/transferor's (or decedent's, if sold by the
decedent's estate or trust) principal residence
within the meaning of IRC Section 121 without
regard to the two-year time period, no withholding
is required. If the last use of the property was as a
vacation home, second home, or rental, you do
not qualify for the exemption. You must have lived
in the property as your main home.
If you have two homes and live in both of them,
the main home is the one you lived in most of the
time.
Page 4 Form 593 Instructions 2021
Line 3 - Loss or Zero Gain
You have a loss or zero gain for California income
tax purposes when the amount realized is less
than or equal to your adjusted basis. You must
complete Part VI and have a loss or zero gain on
line 28 to certify that the transaction is fully
exempt from withholding.
You may not certify that you have a net loss or
zero gain just because you do not receive any
proceeds from the sale or because you feel you
are selling the property for less than what it is
worth.
Line 4 - Involuntary Conversion
The property is being involuntarily or compulsorily
converted when both of the following apply:
• The California real property is transferred
because it was (or threatened to be) seized,
destroyed, or condemned within the meaning
of IRC Section 1033.
• The seller/transferor intends to acquire
property that is similar or related in service or
use in order to be eligible for nonrecognition of
gain for California income tax purposes.
Get federal Publication 544, Sales and Other
Dispositions of Assets, for more information about
involuntary conversions.
Line 5 - Non -recognition Under IRC Section
351 or 721
The transfer must qualify for nonrecognition
treatment under IRC Section 351 (transfer to a
corporation controlled by transferor) or IRC
Section 721 (contribution to a partnership in
exchange for a partnership interest).
Line 6 - Corporation
A corporation has a permanent place of business in
California when it is organized and existing under
the laws of California or it has qualified through
the CA SOS to transact intrastate business. A
corporation not qualified to transact intrastate
business (such as a corporation engaged
exclusively in interstate commerce) will be
considered as having a permanent place of
business in California only if it maintains an office
in California that is permanently staffed by its
employees after the sale.
S corporations must withhold on nonresident S
corporation shareholders. Get FTB Pub. 1017,
Resident and Nonresident Withholding Guidelines,
for more information.
Line 7 - Partnership or Limited Liability
Company (LLC)
Partnerships and LLCs are required to withhold on
nonresident partners and members.
Withholding is not required if the title to the
property transferred is recorded in the name of a
California partnership or it is qualified to do
business in California.
Withholding is not required if the title to the
property transferred is in the name of an LLC, and
the LLC meets both of the following:
• It is classified as a partnership for federal and
California income tax purposes.
• It is not an SMLLC that is disregarded for
federal and California income tax purposes.
If the LLC meets these conditions, the LLC must
still withhold on nonresident members. Get FTB
Pub. 1017 for more information.
If the SMLLC is classified as a corporation for
federal and California income tax purposes, then
the seller/transferor is considered a corporation for
withholding purposes. Refer to Line 6.
If the LLC is an SMLLC that is disregarded for
federal and California income tax purposes, then
that single member is considered the
seller/transferor and title to the property is
considered to be in the name of the single
member for withholding purposes.
When completing Form 593 as the single member
of a disregarded LLC, write on the bottom of Side
1 of Form 593 that the information on the form is
for the single member of the LLC, so the REEP will
understand why it is different from the recorded
title holder.
If the single
Complete Form 593
member is:
using -
An individual
The individual's
information
A corporation
The corporation's
information
A partnership
The partnership's
information
An LLC
The single member's
information
Line 8 - Tax -Exempt Entity
Withholding is not required if the seller/transferor
is tax-exempt under either California or federal law
(e.g., religious, charitable, educational, not for
profit organizations, etc.).
Line 9 - Insurance Company, Individual
Retirement Account, Qualified Pension or
Profit -Sharing Plan, or Charitable Remainder
Trust
Withholding is not required when the
seller/transferor is an insurance company,
individual retirement account, qualified pension or
profit sharing plan, or a charitable remainder trust.
Part IV - Certifications That May
Partially or Fully Exempt the Sale
From Withholding or if No
Exemptions Apply
Complete Part IV only if the seller/transferor did
not meet any of the exemptions in Part III. Check
all boxes that apply to the property being sold.
Line 10 - Simultaneous or Deferred
Exchange
If the California real property is part of a
simultaneous like -kind exchange within the
meaning of IRC Section 1031, the transfer is
exempt from withholding. However, if the
seller/transferor receives money or other property
(in addition to property that is a part of the like -
kind exchange) exceeding $1,500 from the sale,
the REEP must withhold.
If the California real property is part of a deferred
like -kind exchange within the meaning of IRC
Section 1031, the sale is exempt from withholding
at the time of the initial transfer. However, if the
seller/transferor receives money or other property
(in addition to property that is a part of the like -
kind exchange) exceeding $1,500 from the sale,
the QI must withhold.
If the exchange does not take place or if the
exchange does not qualify for nonrecognition
treatment, the intermediary or accommodator
must withhold 3 1/3% (.0333) of the sales price.
Seller/Transferor must complete the perjury
statement, sign and date on Side 3 of Form 593.
Buyer/Transferee is not required to sign the form
on an exchange transaction.
Line 11 - Installment Sale
The REEP reports the sale or transfer as an
installment sale if there will be at least one
payment made after the tax year of the sale. The
withholding is 3 1/3% (.0333) of the down
payment during escrow. Buyers/Transferees are
required to withhold on the principal portion of all
payments made following the close of the real
estate transaction unless an approval letter for the
elect -out method is received.
When the initial sale occurs, the withholding
amount on the down payment is sent to the FTB.
The FTB must also receive a Form 593 with
Buyer/Transferee Information section in Part V
completed, along with a copy of the promissory
note. Seller/Transferor and Buyer/Transferee must
complete the perjury statement, sign and date on
Side 3 of Form 593 when the initial sale occurs.
For the remaining installment payments, the
Buyer/Transferee must sign all subsequent Form
593s. Seller/Transferor is not required to sign for
subsequent payments.
Line 12 - No Exemptions Apply
Check this box if the exemptions in Part III or Part
IV, line 10 and line 11, do not apply.
This form is signed under penalty of perjury. The
seller/transferor must provide this form to the
REEP or remitter to provide to the FTB.
The seller/transferor must complete and sign this
form and return it to your REEP or remitter by the
close of the real estate transaction for it to be
valid. The buyer/transferee is not required to sign
Form 593 when no exemptions apply. Otherwise,
the REEP must withhold the full 3 1/3% (.0333) of
the sales price or the alternative withholding
calculation amount shown on line 36, Amount
Withheld from this Seller/Transferor.
Penalty - Any seller/transferor who, for the
purpose of avoiding the withholding requirements,
knowingly executes a false certificate is liable for a
penalty of $1,000 or 20% of the required
withholding amount, whichever is greater.
Part V -Buyer/Transferee
Information
Buyer/Transferee Instructions
If the sale or transaction is an installment sale,
the buyer/transferee must complete the
Buyer/Transferee Information section in Part V of
Form 593 for the correct taxable year. The
buyer/transferee must withhold on the principal
portion of each installment payment. However,
the buyer/transferee may authorize the REEP to
withhold on the down payment. In this case the
buyer/transferee withholds on the principal
portion of all subsequent payments (including
payoff or balloon payments).
After the form is complete and signed, the
buyer/transferee copies all pages to keep the
instructions for withholding on subsequent
payments.
The buyer/transferee submits the following to the
REEP:
• Form 593.
• Form 593-V, with the amount withheld on the
down payment.
A copy of the promissory note.
At the close of the real estate transaction, if no
down payment is received, submit Form 593 with
Part VII, Line 34, Box B, Installment Sale Payment
checked and $0 reported on Line 36, Amount
Withheld from this Seller/Transferor. The REEP
will mail the documents to the FTB with the
withholding on the down payment to the address
shown under Important Information C, When and
Where to File.
When making installment payments following the
close of the real estate transaction, withhold
either 3 1/3% (.0333) of the sales price, or the
alternative withholding calculation percentage
on the principal portion of each installment
payment, as specified by the seller/transferor on
Form 593. A copy of the promissory note and the
seller's/transferor's signature are not required with
any subsequent installment payments.
File only a completed current year Form 593 and
Form 593-V with each withholding payment.
For example, if you withhold on a payment to a
seller on June 1, 2021, then use a 2021 Form 593
and Form 593-V.
When the buyer/transferee sends the withholding
on the final installment payment, write "Final
Installment Payment" on the bottom of Side 1 of
Form 593.
For more information on withholding on
installment payments, call Withholding Services
and Compliance at 888.792.4900 or
916.845.4900.
Buyer/Transferee Information
Enter the buyers/transferee's name as it is shown
on the escrow instructions. Each buyer/transferee
is required to withhold on individual payments and
must complete a separate Form 593. However, if
the buyers/transferees are spouses/RDPs and both
of them will be on the promissory note, then
include both names, social security numbers
(SSNs) or individual taxpayer identification
numbers (ITINs), and signatures on one form. If
the buyer/transferee is a business, enter the
business name in the business name field.
The buyer's/transferee's identification number
(SSN, ITIN, federal employer identification number
(FEIN), CA corporation (CA Corp no.), or CA
Secretary of State (CA SOS) file number) is
required on each form to be valid.
Installment Sale Terms - Enter the terms of the
promissory note and include the principal amount,
installment amount, interest rate, and the number
of months of the repayment period. Attach a copy
of the signed promissory note to Form 593.
Buyer's/Transferee's Acknowledgement to
Withhold
By signing the perjury statement, you
acknowledge that you will:
• Withhold on the principal portion of each
installment payment.
• Authorize the REEP to withhold the required
amount only on the down payment.
• Withhold 3 1/3% (.0333) of the sales price or
the Alternative Withholding Calculation, as
specified by the seller/transferor on Form 593,
on the principal portion of all subsequent
installment payments.
• Give one copy of Form 593 to the
seller/transferor by the 20th day of the month
following the month of the installment
payments.
• Send each withholding payment, with Form
593-V, and the completed Form 593 to the FTB
by the 20th day of the month following the
month of the installment payment.
• Inform the FTB within 60 days if the terms of
the installment sale, promissory note, or
payment schedule change.
• Be subject to penalties if you do not:
— Withhold on the principal portion of each
installment payment.
— Send the withholding payment with Form
593 to the FTB by the due date.
— Send one copy of Form 593 to the
seller/transferor by the due date.
Part VI - Computation
Line 13 - Selling Price
The selling price is the total amount you will
receive for your property. It includes money, as
well as, all notes, mortgages, or other debts
assumed by the buyer/transferee as part of the
sale, plus the fair market value of any other
property or any services you receive.
Form 593 Instructions 2021 Page 5
Line 14 - Selling Expenses
Selling expenses include commissions, advertising
fees, legal fees, and loan charges that will be paid
by the seller/transferor, such as loan placement
fees or points.
Line 15 - Amount Realized
The amount realized is the selling price minus the
selling expenses.
Line 16 - Purchase Price
If you acquired this property by purchase, enter
your purchase price. Your purchase price includes
the down payment and any debt you incurred;
such as a first or second mortgage or promissory
notes you gave the seller/transferor in payment for
the property. If you acquired the property by gift,
inheritance, exchange, or any way other than
purchase, see How to Figure Your Basis in these
instructions.
Line 17 - Seller/Transferor-Paid Points
Points are charges paid to obtain a loan. They may
also be called loan origination fees, maximum loan
charges, loan discount, or discount points. If the
seller/transferor paid points for you when you
acquired the property, enter the amount paid by
the seller/transferor on your behalf on line 17,
unless you already subtracted this item to arrive at
the amount for line 16.
Line 18 - Depreciation
Enter the amount of depreciation you deducted, or
could have deducted, on your California income
tax return for business or investment use of the
property under the method of depreciation you
chose. If you took less depreciation on your tax
return than you could have under the method
chosen, you must enter the amount you could
have taken under that method. If you did not take
a depreciation deduction, enter the full amount of
depreciation you could have taken. Get federal
Publication 946, How to Depreciate Property, for
more information.
If you do not know how much depreciation you
deducted or were allowed, you can make an
estimate of the amount of depreciation (for
withholding purposes only), To estimate the
depreciation, divide the purchase price plus the
cost of additions and improvements by 27.5 and
multiply that by the number of years you used the
property for business use (up to 27.5 years). Do
not include the cost of land in the purchase price.
Example: Mary bought a house 20 years ago for
$150,000 and has used it as a rental property for
the last 18 years. Prior to renting the house, she
added a pool which cost her $25,000. Mary's
depreciation is estimated as follows:
Cost $150,000
Plus additions 25,000
Total 175,000
Divided by 27.5 = 6,364
Multiply by 18 years = $114,552
Mary's estimated depreciation to enter on line 18
is $114,552.
Page 6 Form 593 Instructions 2021
Line 19 - Other Decreases to Basis
Include any other amounts that decrease your
basis, such as:
• Casualty or theft loss deductions and insurance
reimbursements.
• Energy credits claimed for the cost of energy
improvements added to your basis.
• Payments received for granting an easement or
right-of-way.
Line 22 - Additions and Improvements
These add to the value of your property, prolong
its useful life, or adapt it to new uses. Examples
include room additions, landscaping, new roof,
insulation, new furnace or air conditioner,
remodeling, restoration project, etc. The cost of
repairs are not included. Do not include any
additions or improvements on line 22 that were
included on line 16.
Line 23 - Other Increases to Basis
Include the amounts paid for any other items that
increase the basis of the property, such as:
• Settlement fees and closing costs you incurred
when you bought the property.
• The amount you paid for special assessments
for items such as water connections, paving
roads, and building ditches.
• The cost of restoring damaged property from a
casualty loss, or cost of extending utility service
lines to the property.
Line 26 - Passive Activity Losses
You may only use suspended passive activity
losses that directly relate to the property sold.
Other losses such as net operating losses, capital
loss carry forwards, stock losses, and passive
activity losses from other properties cannot be
used.
Line 28 - Estimated Gain or Loss on Sale
If you have a zero gain or loss, check the box for
line 3 in Part III. Complete and sign Form 593 and
give it to your REEP. You will not be subject to
withholding on this sale.
Note: A loss or zero gain can only be claimed on
Form 593 if the taxpayer has a tax identification
number.
If you have a gain, this is your estimated amount
of gain on the sale of your California property. Go
to line 29.
Line 29 - Alternative Withholding Calculation
Amount
Check the applicable box for the filing type and
multiply the amount on line 28 by the tax rate for
the filing type selected. Enter the result on line 29.
Compare this amount to the withholding amount
on the sales price shown on line 30. If you elect
the alternative withholding calculation amount on
line 29, check the appropriate box in Part VII, line
35 (Boxes B-H), Alternative Withholding
Calculation Election, then transfer the amount on
line 29 to line 36.
Sign Form 593 to certify the election. Keep Form
593 for five years to document your calculations.
Line 30 - Sales Price Withholding Amount
Multiply the selling price on line 13 by 3 1/3%
(.0333) and enter the amount on line 30. If you
select the standard withholding amount on line 30,
check Box A on line 35 in Part VII, and transfer the
amount on line 30 to line 36.
Part VII - Escrow or Exchange
Information
Line 31 - Escrow or Exchange Number
Enter the escrow or exchange number for the
property transferred. Do not include dashes and/or
spaces in the escrow or exchange number.
Line 32 - Date of Transfer, Exchange
Completion, Failed Exchange, or Installment
Payment
If the date is left blank, we will use a default date
of January 1 of the tax year in which the Form 593
is received. Penalties may apply for failure to file a
complete, correct, and timely information return.
For additional information, see Important
Information F, Interest and Penalties.
Conventional Sale/Transfer: Enter the date
escrow closed.
Exchange: For completed exchanges, enter the
date that the boot (cash or cash equivalent) was
distributed to the exchanger. For failed exchanges,
enter the date when it was determined that the
exchange would not meet the deferred exchange
requirements and any cash was distributed to the
seller/transferor.
When withholding on boot or a failed exchange, be
sure to use the forms for the year that you
entered on line 32 (rather than the year of the
sale), since the seller/transferor will be able to use
installment sale reporting for the gain.
Installment Sale: For withholding on the down
payment, enter the date escrow closed. For
withholding on the principal portion of each
installment payment, enter the due date of the
installment payment.
Line 33 - Enter the sales price, failed exchange
amount, or boot amount, and the ownership
percentage. Multiply the two amounts and enter
the result on this line.
Line 34 - Type of Transaction
Check one box that represents the type of real
estate transaction for which the withholding is
being calculated.
Conventional Sale/Transfer: Check this box if
the conventional sale/transfer represents the close
of the real estate transaction. This sale/ transfer
does not contain any conditions such as an
installment sale, boot, or failed exchange.
Installment Sale Payment: Check this box to
report the sale or transfer as an installment sale if
there will be at least one payment made after the
tax year of the sale or transfer, or if you are
withholding on the down payment or principal
portion of any installment payment. Attach a copy
of the promissory note with the down payment
only. At the close of the real estate transaction, if
no down payment is received, submit Form 593
with Part VII, Line 34, Box B, Installment Sale
Payment checked and $0 reported on Line 36,
Amount Withheld from this Seller/Transferor.
Boot: Check this box if the seller/transferor
intends to complete a deferred exchange, but
receives boot (cash or cash equivalent) out of
escrow.
Failed Exchange: Check this box for any failed
exchange, including if a failed deferred exchange
had boot withheld upon in the original relinquished
property.
Line 35 - Withholding Calculation
Check one box that represents the method to be
used to calculate the withholding amount on line
36. Either the Sales Price Method (3 1/3% (.0333)
of the sales price, boot, or installment sale
payment) or the Alternative Withholding
Calculation Election based on the applicable tax
rate as applied to the gain on sale. Check only one
box, A -H.
Line 36 - Amount Withheld from this
Seller/Transferor
Enter the amount withheld from this transaction or
installment payment based upon the appropriate
calculation for either the Sales Price Method or the
Alternative Withholding Calculation Election,
below.
Withholding Calculation Using
Sales Price Method
Conventional Sale/Transfer:
a. Sales Price ....................................$
b. Enter the seller's/transferor's
ownership percentage ................... _ _ _ ._ _%
c. Amount Subject to Withholding.
Multiply line a by line b and enter
theresult ........ ... .....................$
d. Withholding Amount. Multiply line
c by 3 1/3% (.0333) and enter the
result here and on Form 593, line
36.. ..............................$
Installment Sale:
a. Amount Subject to Withholding. If
you are withholding on the down
payment in escrow, enter the
required amount of the down
payment. If you are withholding
on installment payments received
after the close of the real estate
transaction or the final payoff in
escrow, enter the principal portion
of the payment ............................$
b. Withholding Amount. Multiply line
a by 3 1/3% (.0333) and enter the
result here and on Form 593, line
36......... ... ................................$
Exchange:
a. Amount Subject to Withholding.
For completed deferred exchanges, enter the
amount of boot (cash or cash equivalent)
received by the seller/transferor...$
b. Withholding Amount. Multiply line a by 3 1/3%
(.0333) and enter the result here and on Form
593, line 36 .................. .........$
Failed Exchange:
a. Sales Price. If a deferred exchange
is not completed or does not meet
the deferred requirements, enter
the sales price ..............................$
b. Ownership Percentage. If multiple
sellers/transferors attempted to
exchange this property, enter this
seller's/transferor's ownership
percentage. Otherwise, enter
100,00%.., ...................................
c. Amount Subject to Withholding.
Multiply line a by line b ...............$
d. Withholding Amount. Multiply line c
by 3 1/3% (.0333) and enter the
result here and on Form 593, line
36-- ... ... - ........ -- .... - .......... $
Withholding Calculation Using
Alternative Withholding
Calculation Election
Conventional Sale/Transfer: Enter the amount
from line 29 on line 36.
Installment Sale: The alternative withholding
calculation amount for an installment sale is
calculated in two steps.
Step 1: Calculate the installment sale withholding
percent that will be applied to all installment
payments, including any deposits, down payments,
or amounts paid for the seller/transferor received
during escrow:
a. Estimated Gain On Sale. Gain on
sale from Form 593, line 28..........$
b. Sale Price. Selling price from
Form 593, line 13 ........................$
c. Installment sale withholding
percent, divide line a by line b........
Step 2: Calculate the alternative withholding
amount:
a. Installment payment or
down payment .............................$
b. Multiply line a by installment sale
withholding percent calculated in
Step1 ..........................................$
c. Withholding amount. Multiply
line b by the applicable tax rate*
and enter the result here and
on Form 593, line 36 ....................$
When withholding on the principal portion of each
installment payment using the Alternative
Withholding Calculation Election, the seller/
transferor must provide the buyer/transferee with
the Installment Sale Withholding percent.
Send the original Form 593, the required
withholding payment on the down payment, and a
copy of the promissory note to the FTB. Do not
attach a copy of the promissory note with
withholding on installment payments sent in after
the close of the real estate transaction.
Exchange:
a. Boot Amount. Not to exceed
recognized gain ............................$
b. Withholding Amount. Multiply
line a by the applicable tax rate*
and enter the result here and on
Form 593, line 36 ..........................$
Failed Exchange:
a. Gain on Sale from Form 593,
line28 .........................................$
b.Ownership Percentage. If multiple
sellers/transferors attempted to
exchange this property, enter this
seller's/transferor's ownership
percentage. Otherwise,
enter 100.00% ..............................
c. Amount Subject to Withholding.
Multiply line a by line b .................$
d. Withholding Amount. Multiply line
c by the applicable tax rate* and
enter the result here and on Form
593, line 36 ....................................$
If a failed deferred exchange had boot withheld
upon in the original relinquished property, reduce
the withholding amount by the amount previously
remitted to the FTB.
Form 593 Instructions 2021 Page 7
*Tax Rates
Individual .................................................
12.3%
Non -California Partnership ............................
12.3%
Corporation ................................ ................
.... 8.84%
Bank and Financial Corporation ..................
10.84%
S Corporation ................................................
13.8%
Financial S Corporation .................................
15.8%
Trusts (Grantor and Nongrantor)..................
12.3%
How to Figure Your Basis
Perjury Statement
The perjury statement must be completed for all
real estate transactions. Check the applicable
box(s) and include all required signatures.
The seller/transferor is required to sign during all
real estate transactions. The seller/ transferor is
not required to sign Form 593 for withholding on
subsequent installment payments.
The buyer/transferee is only required to sign Form
593 on the principal portion (e.g., down payment)
received in escrow upon closing. Following the
close of escrow, the buyer/ transferee is required
to sign Form 593 for withholding on all subsequent
installment payments.
Seller's/Transferor's and
Buyer's/Transferee's Signatures
If the seller's/transferor's and/or
buyer's/transferee's are married or RDPs and they
plan to file a joint return, then your signature and
your spouse's/RDP's signature are both required.
For information on electronic signatures, see
Important Information D, Electronic Filing
Requirement.
Remitter's Name and
Title/Escrow Business Name
Provide the remitter's name and title/escrow's
business name and phone number.
The cost or purchase price of property is usually its basas for figuring gain or loss from its sale or other disposition. However, if you acquired the property by gift,
inheritance, exchange, or in some way other than purchase, you must use a basis other than its cost. The following instruC:,ons only reflect the general rules.
Exceptions may apply. Get federal Publication 551, Basis of Assets, for more information. Sellers/transferors are strongly encouraged to consult with a tax
professional for this purpose.
How Property Was Received
Property was received as a gift
Property was inherited from someone other than your
spouse/RDP
You owned the property as community property with
your spouse/RDP who died
You owned the property in joint tenancy with your
spouse/RDP who died
Property received from your spouse/RDP in connection
your divorce/termination of registered domestic
partnership
Property received in exchange for other property
You built the house (or other improvements) on the
property being sold
You received the property in a foreclosure
Page 8 Form 593 Instructions 2021
How to Figure Your Basis
Usually, your basis is the donor's adjusted basis at the time of the gift. Enter the donor's adjusted basis
on line 16. Then complete the rest of Part VI (except line 17) with your information after you received
the property.
If the fair market value (FMV) of the property at the time of the gift was less than the donor's adjusted
basis, get federal Publication 551 to determine vour basis.
Usually, your basis is the FMV at the date of the individual's death. You can get that valuation from the
probate documents, or if there was no probate, use the appraised value at the date of death. Enter the
FMV on line 16. Then complete the rest of Part VI (except line 17) with your information after you
received the property.
If you or your spouse/RDP originally gave the property to the decedent within one year of the
decedent's death, get federal Publication 551 to determine vour basis.
Your basis is the FMV of the total property at the date of your spouse's/RDP's death. Enter the FMV on
line 16. Then complete the rest of Part VI (except line 17) with your information after the date of
basis is the sum of: 1) the FMV of your spouse's/RDP's half of the property at the date of your
se's/RDP's death; and, 2) the existing basis of your half of the property at the date of your
se's/RDP's death. Enter the sum on line 16. Then complete the rest of Part VI (except line 17) with
information after the date of death.
Usually, your basis is the same as it would have been without this transfer. Complete Part VI as if you
had been the only owner before and after the transfer.
If your spouse/RDP transferred the property to you before July 18, 1984, get federal Publication 551 to
determine your basis.
Your basis will depend on whether you received the property in a nontaxable, taxable, or partially
taxable exchange. Get federal Publication 551 to determine your basis. Enter your basis on line 16.
Then complete the rest of Part VI. However, do not include any amounts on line 17 through line 22
that you included on line 16.
Add the purchase price of the land and the cost of the building. Enter the total on line 16 and complete
the rest of Part VI.
If you deferred the gain from a previous home to this orovertv, net federal Publication 551
Enter your basis in the property after the foreclosure on line 16. (You may need to get a tax
professional to help you with this calculation). Then complete the rest of Part VI (except for line 17)
with your information after the foreclosure.
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WITH F'
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Public Works
Project Manager: Faby Guillen Extension: 3435
Contractor Name: First American Title Insurance Company - 30 Joseph Ct Purchase- Escrow Documents
i Contractor's Contact: Tina Toye Contact's Email: ttoye@firstam.com
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
a. Email PINS Introductory Notice to Contractor
DATE
Check/Initial
1
Project Manager
Clic` here to
❑
enter a date.
b. Email contract (in Word) and attachments to City
8/16/2021
Attorney c/o Laraine.Gittens@cityofsanrafael.org
MFG
2
City Attorney
a. Review, revise, and comment on draft agreement
Click here to
and return to Project Manager
enter a date.
❑
b. Confirm insurance requirements, create Job on
Click here to
PINS, send PINS insurance notice to contractor
enter a date.
❑
3 Department Director
Approval of final agreement form to send to
Click or tap
❑
contractor
to enter a
date.
4 Project Manager
Forward three (3) originals of final agreement to
Click here to
❑
contractor for their signature
enter a date.
5
Project Manager
When necessary, contractor -steed agreement
❑ N/A
agendized for City Council approval *
*City Council approval required for Professional Services
❑
Agreements and purchases of goods and services that exceed
Or
$75,000; and for Public Works Contracts that exceed $175,000
Click here to
Date of City Council approval
enter a date.
_
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
6
1 Project Manager
Forward signed original agreements to City
_
City Attorney
Attorney with printed copy of this routing form
7
Review and approve hard copy of signed
J
agreement1
8
City Attorney
Review and approve insurance in PINS, and bonds
p�f
(for Public Works Contracts)
o/ 17/��
9
City Manag /Mayor
Agreement executed by City Council authorized
��
official
10
r
I City Clerk
Attest signatures, retains original agreement and
t'
I"
forwards copies to Project Manager