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3. Seller is not a non-resident alien (if individual) or a foreign corporation, foreign partnership, foreign trust or foreign estate (as those terns are defined in the Internal Revenue Code and Income Tax Regulations). 4. That the amount realized by the Seller ("Transferor) of the above-described real property as a result of this transaction does not exceed Three Hundred Thousand ($300,000.00) Dollars. 5. In connection with the sale or exchange of the Property you are required by law to provide Atlantic Coastal Land Title Company, LLC with your correct taxpayer identification number (TIN). If you do not so provide your TIN, you may be subject to civil or criminal penalties imposed by law. 6. Sellers' Taxpayer Identification Numbers: Karen S. Beck 7. For purposes of reporting this transaction to the Internal Revenue Service on Form 1099-S, the Property is Seller' (check one): ® Principal Residence ❑ Other Real Estate This taxpayer identification number is being provided in connection with a real estate transaction. The undersigned understands that this Certificate may be disclosed to the Internal Revenue Service by the Buyer and that any false statement contained herein could be punished by tine, imprisonment or both. Under penalties of perjury, T/we declares that T/we have examined this certification and to the best of my knowledge and belief it is true, correct and complete, and T/we further declare that Thve have authority to sign this document as or on behalf of the Seller, and that the number shown on this statement is Seller' correct TIN. Sella states that this instrument is given for the express purpose of inducing Indian River County, a Political Subdivision of The State of Florida to purchase the Property and to cause Atlantic Coastal Land Title Company, LLC as agent for Atlantic Coastal Land Title Company, LLC to insure title to said property. This Affidavit is made under the full understanding of the law regarding liability for any misrepresentation herein. / �� U/4 (Seal) Katsen S. Beck STATE OF FLORIDA COUNTY OF INDIAN RIVER Sworn to and subscribed before me this 6th day of April, 2018, by Karen S. Beck, who is personally known /1) / to me or has produced L. as identification. SEAL "'.'Ply P& JASON A. BEAL Y s®f>3rt�nrd6> Sate of Florida •'_ Commissic,l # GG 017550 'N9�F OF Ft?,," "Y Comm. Expires Oct 11• " 20 Bonded INough National Nolary AOqn. Fik No: 48083683 N y rc Printed Notary Name Page 2 of 3 in