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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 <br />lorida � s%. <br />o . <br />BMSusan <br />1 <br />State of Florida <br />dams, : *' <br />2 <br />County of Indian River <br />, <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 />