Laserfiche WebLink
5. NON-FOREIGN CERTiFlCATION—FtRPTA. Section 1445 of the internal Revenue Code provides <br /> that a transferee(buyer)of a U.S. real property interest rnust withhold tax if the transferor is a foreign <br /> person. For purposes af this paragraph,`Transferee"shal(mean"Grantee"and'Transferar"shall <br /> mean"Grantor". To inform the Grantee that withholding of tax is not required upon the disposition of a <br /> U.S. reai property interest by Grantor,the Grantor hereby certifies the foilowing: <br /> a. Transferor is the oumer of the reai property being conveyed; <br /> b. Transferor is noi a foreign person, entity,or disregarded entity(as such terms are defined in the <br /> (nternal Revenue Code and income Tax Regulations);and <br /> c. Transferor's U.S.Taxpayer ldentification Number and address set#orth above are true and correct. <br /> Transferor understands that this certification may be disclosed to tfie Internal Revenue Service by <br /> Transferee and that any false stafement contained herein could be punished by fine, imprisonrnent Qf <br /> both. t <br /> Initla! <br /> 6. Illinois law(15 ILCS 405/10.05 to 405/14.05b) requires the State of Illinois Comptrolter to deduct from <br /> any State of illinois warrants or payments the amount of any outstanding accaunt or claim in favor of <br /> the State of Illinois and any amount necessary to satisfy past due child support or delinquent student <br /> loan and financial aid obligations on any loan guaranteed by the 11linois Student Assistance � <br /> Commission. <br /> 7. This Receipt of Conveyance Documents and Disbursement Siatement is the entire and exclusive <br /> agreement between the parties and supersede any written or orai understanding, promise or <br /> agreement, directly or indirectly related to the conveyance of parcel and improvements. The parties <br /> agree that any changes to this Receipt may only be made in writing and signed by the parties. <br /> Date: Julv i2, 2019 <br /> G rantor: <br /> ignature Ig re <br /> Jeremy Szczelaszczyk�Owner Darryl Szczelaszczyk, Owner <br /> Print Name(and Title,if applicable) Print Name(and Title,if applicable) <br /> Signature Signature <br /> Print Name(and Titte,if applicable) Print Name(and Titte,if appiicable} <br /> � <br /> Date: <br /> Grantee: <br /> City of D atur, illinais <br /> ��r the City of D tur,tNinois <br /> Page 2 ot 2 LA 4112A Tampiate(Rev,02/9/16) <br />