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Please answer, to the best of your knowledge, all applicable questions, sign and date. If a question does not apply, indicate with "N/A." <br />PART III: PURCHASE PRICE AND TERMS OF SALE <br />A. <br />CASH DOWN PAYMENT OR Value of Trade or Exchange (excluding closing costs) <br />Amount $113,000.00 <br />B. <br />FIRST DEED OF TRUST @ % interest for years. Pymts/Mo. _ $ (Prin. & Int. only) <br />Amount $ <br />()FHA ( Discount Pts.) ( ) Fixed Rate <br />0 Conventional ( ) Variable Rate <br />() New Loan <br />() Assumed Existing Loan Balance <br />() VA ( Discount Pts.) ( ) All inclusive D.T. ($ wrapped) <br />( ) Bank or Savings & Loan <br />( ) Cal -Vet Q Loan Carried by Seller <br />( ) Finance Company <br />C. <br />Balloon Payment () Yes () No. Due date: <br />SECOND DEED OF TRUST @ % interest for years. Pymts./Mo.= $ (Prin. & Int. only) <br />Amount $ <br />Amount $ <br />( ) Bank or Savings & Loan () Fixed Rate <br />0 Loan Carried by Seller () Variable Rate <br />() New Loan <br />0 Assumed Existing Loan Balance <br />D. <br />Balloon Payment ( ) Yes ( ) No Due date: ( ) <br />OTHER FINANCING: Is other financing involved not covered in (b) or (c) above? ()Yes <br />Amount $ <br />(X) No Amount $ <br />Type: @ % interest for years. Pymts./Mo. _ $ (Princ. & Int. only) <br />❑ Bank or Savings & Loan ❑ Fix Rate <br />0 Loan Carried by Seller ❑ Variable Rate <br />() New Loan <br />0 Assumed Existing Loan Balance <br />E. <br />Balloon Payment ❑ Yes ❑ No Due Date: <br />WAS AN IMPROVEMENT BOND ASSUMED BY THE BUYER? ❑ Yes ❑ No Outstanding <br />Amount $ <br />Balance Amount $ <br />F. <br />TOTAL PURCHASE PRICE (or acquisition price, if traded or exchanged, include real estate commission if aid. <br />Total Items A through E <br />$113,000.00 <br />G. <br />PROPERTY PURCHASED 0 Through a Broker (X) Direct from Seller ❑ From a family member ❑ Other: <br />If purchased through a broker, provide Broker's name and phone number: , <br />Please explain any special terms, seller concessions, or financing and any other information that would help the Assessor understand the <br />purchase price and terms of sale. <br />PART IV: PROPERTY INFORMATION <br />A. TYPE OF PROPERTY TRANSFERRED: <br />❑ Single Family Residence ❑ Agricultural <br />❑ Timeshare <br />❑ Multiple Family Residence (# of units: ) ❑ Co-op/Owner your own <br />❑ Manufactured Home <br />F1 <br />14 <br />Commercial/Industrial ElCondominium <br />Other (Description:�A33 4� STe _e7 W I pe a,N y Pv _Po 5 Es <br />El Unimproved lot <br />B. IS THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? ❑ Yes [XNo <br />If yes, enter date of occupancy / / or intended occupancy <br />Month Day Year <br />/ / <br />Month Day Year <br />C. IS PERSONAL PROPERTY INCLUDED IN PURCHASE PRICE (i.e., furniture, farm equipment, machinery, etc.) <br />(other than a manufactured home subject to local property tax)? ❑ Yes <br />No <br />D. IS A MANUFACTURED HOME INCLUDED IN PURCHASE PRICE? ❑ Yes <br />No <br />lNo <br />E. DOES THE PROPERTY PRODUCE INCOME? ❑ Yes <br />If yes, is the income from: <br />❑ Lease/Rent ❑ Contract ❑ Mineral Rights ❑ Other - Explain: <br />F. WHAT WAS THE CONDITION OF THE PROPERTY AT THE TIME OF SALE? <br />❑ Good ❑ Average ❑ Fair ❑ Poor <br />Please explain the physical condition of the property and provide any other information (such as restrictions, etc.) that would assist the <br />Assessor in determining the value of the property. <br />I certify that the foregoing is true, correct and complete to the best of my knowledge and oeuer. <br />Signed q-_ <br />- Cz. <br />New Owner/Corporate Officer cl/7' v J :J rr_.,� �r�s, e—/i'7' /",1—,4lC�� �j]_ �i� <br />/ <br />Please print name of New Owner/Corporate Officer CITY OF SAN LEANDRO Phone No. = J�- <br />(8:00 a.m. - 5:00 p.m.) <br />(NOTE: The Assessor may contact you for further information) <br />If a document evidencing a change of ownership is presented to the recorder for recordation without the concurrent filing of a preliminary <br />change of ownership report, the recorder may charge an additional recording fee of twenty dollars ($20). <br />Page 2 of 2 - 6/3/05 <br />n\orno d.... ,nvmi <br />