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2024-017
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2024-017
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Last modified
2/8/2024 12:11:05 PM
Creation date
2/8/2024 11:05:00 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
01/09/2024
Control Number
2024-017
Agenda Item Number
13.B.
Entity Name
Indian River County Habitat for Humanity, Inc. (HFH
Subject
Agreement to Purchase and Sell Real Estate Donation of Former Gifford Gardens
4730 40th Avenue
Warranty Deed
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❑ VOID <br />FILER'S name, street address, city or town, state or province, country, ZIP or <br />foreign postal code, and telephone number. <br />Collins Brown Barkett, Chartered <br />756 Beachland Boulevard <br />Vero Beach FL 32963 <br />(772)231-4343 <br />FILER'S federal identification number I TRANSF ROS identification number <br />59-1795861 �_ 4R'000 6 74 <br />TRANSFEROR'S Name <br />Indian River County, a political subdivision of the <br />State of Florida <br />Street Address (including apt. number) <br />1801 27th Street <br />City, State, and ZIP code <br />Vero Beach, Florida 32967 <br />Account or escrow number (see instructions) <br />07-183.230 <br />Form 1099-S www.irs.gov1form1099s <br />❑ CORRECTED <br />1 Date of dosing <br />02/ /2024 <br />2 Gross proceeds <br />$ 10.00 <br />3. Address or legal description <br />A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />OMB Nc. 1545-0997 <br />2024 <br />Form 1099-S <br />4730 40th Avenue <br />Vero Beach FL 32967 <br />4. Transferor •eceived or will receive properly or services as <br />part of the consideratioi (if checked) ............ .�❑ <br />s. If checked, transferor is a foreign person (nonresident <br />alien, foreign partnership, foreign estate, or foreign <br />trust) ............................................. <br />6. Buyer's part of real estate tax <br />$ .00 <br />Proceeds From Real <br />Estate Transactions <br />Copy C <br />For Filer <br />For Privacy Act <br />and Paperwork <br />Reduction Act <br />Notice, see the <br />2024 General <br />Instructions for <br />Certain <br />Information <br />Returns. <br />Department of the Treasury — Internal Revenue Service <br />YOU ARE REQUIRED BY LAW to provide your correct taxpayer name and identification number for the transaction described above to Collins <br />Brown Barkett, Chartered <br />If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. <br />UNDER PENALTIES OF PERJURY, I certify that the number shown on this statement is my correct taxpayer identification number. I acknowledge <br />that I have received a copy of this statement <br />APPROVED AS TO FORM <br />AND SU16; <br />BY <br />WILLIAM K. DEBRAAL <br />COUNTY ATTORNEY <br />Attest: Ryan L. Butler, Clerk of <br />Circuit Court and Comptroller <br />l!`I n L!I <br />
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