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A TRUE COPY
<br />CERTIFICATION ON LAST PAGE
<br />RYAN L. BUTLER, CLERK
<br />NON -FOREIGN CERTIFICATION BY ENTITY TRANSFEROR
<br />(Seller's FIRPTA Affidavit)
<br />Transferor: Indian River County, a political subdivision of the State of Florida
<br />Transferee: Indian River County Habitat for Humanity, Inc., a Florida not for profit corporation
<br />Property: 4730 40th Avenue, Vero Beach, FL 32967
<br />Closing Date: February , 2024
<br />Before me, the undersigned authority, personally appeared the person(s) named below who, after being duly sworn, stated as
<br />follows:
<br />Transferor is selling that certain real property located in Indian River County, which is more particularly described as follows:
<br />Being a part of the SW 1/4 of Section 22, Township 32 South, Range 39 East, and more particularly
<br />described as follows:
<br />From the SW corner of Section 22, Township 32 South, Range 39 East, run South 890 59'30" East along
<br />said South Section line a distance of 935.50 feet; thence North 00 43135" West a distance of 1,585.12 feet to
<br />the Point of Beginning. Thence continue North 01 43'35" West, a distance of 210.00 feet; thence East a
<br />distance of 690.00 feet; thence South 0143'45" East a distance of 210.00 feet; thence West a distance of
<br />690.00 feet to the Point of Beginning, lying and being in Indian River County, Florida; less and except that
<br />parcel described in Official Records Book 683, page 2829, Public Records of Indian River County, Florida.
<br />Section 1445 of the Internal Revenue Code provides that a transferee of a U.S. real property interest must withhold tax if the
<br />transferor is a foreign person. For U.S. tax purposes (including section 1445), the owner of a disregarded entity (which has legal
<br />title to a U.S. real property interest under local law) will be the transferor of the property and not the disregarded entity. To inform
<br />the transferee that withholding of tax is not required upon the disposition of a U.S. real property interest by Indian River County,
<br />a political subdivision of the State of Florida the undersigned hereby certifies the following on behalf of Indian River County,
<br />a political subdivision of the State of Florida:
<br />1. Indian River County, a political subdivision of the State of Florida is not a foreign corporation, foreign partnership,
<br />foreign trust, or foreign estate (as those terms are defined in the Internal Revenue Code and Income Tax Regulations);
<br />2. Indian River County, a political subdivision of the State of Florida is not a disregarded entity as defined in § 1. 1445-
<br />2(b)(2)(iii);
<br />3. Indian River County's, a political subdivision of the State of Florida, U.S. employer identification number is
<br />=4-60674 ; and
<br />4. Indian River County's, a political subdivision of the State of Florida, office address is 1801 271 Street, Vero Beach,
<br />Florida 32960.
<br />Indian River County, a political subdivision of the State of Florida understands that this certification may be disclosed to the
<br />Internal Revenue Service by transferee and that any false statement contained herein could be punished by fine, imprisonment, or
<br />both.
<br />Under penalties of perjury, I declare that I have examined this certification and to the best of my knowledge and belief it is true,
<br />correct, and complete, and I further declare that I have authority to sign this document on behalf of Indian River County, a political
<br />subdivision of the State of Florida.
<br />India ver County, oliti sub ivisjo,, '01 A
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<br />State of Florida
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<br />County of Indian River
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<br />The foregoing instrument was acknowledged before me by means of LJ physical presence or U online notari2a�t��/M
<br />day of February, 2024 by Susan Adamsn, Chairman for Indian
<br />River County, a political subdivision of the State 0
<br />is personally known or [ 1 has produg
<br />rise as identification.
<br />10MBERLY K. MOIRANO
<br />•: :*= MY COMMI3S10N / HH 988125�_
<br />//
<br />� rl - "o
<br />[Seal] pPIRES pNd9.2027
<br />Notary Public
<br />Print Name: Kimberly K. Moirano
<br />My Commission Expires: February, 9, 2027
<br />APPROVED AS TO FORM
<br />AND LEGAL FF I I NC
<br />Attest: Ryan L. Butler, Clerk of
<br />Circuit Court and Comptroller
<br />BY
<br />WILLIAM K. DEBRAAL
<br />COUNTY ATTORNEY
<br />gy_
<br />puty Clerk
<br />
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