HomeMy WebLinkAboutKingsbury, Laverne & June Non-Foreign Affadavit - 2005 05 22
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NON-FOREIGN AFFIDAVIT
STATE OF FLORIDA
COUNTY OF SEMINOLE
THIS NON-FOREIGN AFFIDAVIT is provided pursuant to the requirements of
Section 1445(b)(2) of the Internal Revenue Code ("Code") in order to induce The City of
Winter Springs, a Florida municipal corporation, (the "Buyer"), to purchase United States
real property interest (as defined under Section 897 of the Code) from the Seller as set
forth below and to not withhold any portion of the sale proceeds. The Seller hereby
acknowledges that this Non-Foreign Affidavit will be relied upon by the Buyer and agree
to indemnify and hold the Buyer harmless from any loss or penalty incurred in reliance
hereon.
As such, under penalties of perjury, I swear and affirm that the following information
is true and correct:
SELLER:
Seller's Legal Name:
LAVERNE W. and JUNE L. KINGSBURY
Social Security No:
(Laverne W. Kingsbury)
Social Security No:
(June L. Kingsbury)
Legal Description:
See Exhibit "A" attached hereto.
The above Sellers are not nonresident aliens, a foreign corporation, foreign
partnership, foreign trust, or foreign estate for purposes of U.S. income taxation as those
terms are defined in the Code and Income Tax Regulations.
Additionally, I authorize the submission of this Affidavit to the Internal Revenue
Service if and when such submission is required.
IN WITNESS WHEREOF, the undersigned has sworn to and executed this Non-
Foreign Affidavit the date and year set out below.
./ ~.
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LAVERNE w. K~
DATED: L2-:- JJ'.-ol'
DATED:L~-/'- 0/
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STATE OF FLORIDA
COUNTY OF SEMINOLE
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Sworn to and subscribed before me this 18th day of December 2001, by
LAVERNE W. KINGSBURY, who U1s personally known to me, or 0 who has produced
as identification, and who did take an oath.
STATE OF FLORIDA
COUNTY OF SEMINOLE
N T ARY PUBLIC
My Commission Expires: ~(,dalL+
Sworn to and subj,Cribed before me this 18th day of December 2001, by JUNE
L. KINGSBURY, who tris personally known to me, or 0 who has produced
as identification, and who did take an oath.
i"'a' Deborah L Gillespie
*JIf* My Commission CC
\;"I\~ Expires March 21,2004
F:\Lawyer~effb\City of Winter Springs\Kingsbury\Non Foriegn Affidavit.wpd
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NOTARY PUBLIC
My Commission Expires: M~~ ( OltJDLf
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EXHIBIT "A"
LEGAL DESCRIPTION
That part of the Unnumbered Lot in Block "B", D.R. MITCHELL'S SURVEY OF THE
LEVY GRANT ON LAKE JESSUP as recorded in Plat Book 1, Page 5 of the Public
Records of Seminole County, Florida, more particularly described as follows:
Commence at the Southeast corner of Lot 30 Block "B", D.R. MITCHELL'S SURVEY
OF THE LEVY GRANT ON LAKE JESSUP said point being the intersection of the
West Right of Way line of Tuscawilla Road (formerly Brantley Avenue) and the North
Right of Way line of First Street (a 30 foot unopened Right of Way); thence run S
30004'55" W a distance of30.61 feet to the intersection of the West Right of Way line of
Tuscawilla Road and the South Right of Way line of First Street; said intersection being
the POINT OF BEGINNING; thence continue S 30004'55" W along the West Right of
Way line of Tuscawilla Road a distance of80.89 feet to the point of cusp ofa curve
concave Northwesterly having a radius of 15.00 feet and a chord bearing ofN 11054'34"
E; thence run Northeasterly along the arc of said curve through a central angle of
36020'43" for an arc distance of9.52 feet to a point of tangency; thence N 06015'47" W a
distance of 59.58 feet to the point of curvature of a curve concave Southwesterly having a
radius of 15.00 feet a chord bearing ofN 33029'40" W; thence run Northwesterly along
the arc of said curve through a central angle of 54 027'44" for an arc distance of 14.26 feet
to a point of tangency; thence N 60043'32" Wa distance of 40.41 feet to the South Right
of Way line of the aforementioned First Street; thence S 71024'05" E along said South
Right of Way line for a distance of 92. 78 feet; to the Point of Beginning.
Containing 0.0471 acres more or less.
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