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DOR <br /> FLORIDA DEPARTMENT OF REVENUE Via— F10240300 <br /> RETURN FOR TRANSFERS OF INTEREST IN REAL PROPERTY DR-21911 <br /> .J <br /> (PLEASE READ INSTRUCTIONS BEFORE COMPLETING) <br /> =i R.07/98 <br /> U;;black ink. Enter numbers as shown below. If typing,enter numbers as shown below. I <br /> 1. Parcel Identffication Number P fl,:2] 23 <br /> (if Parcel ID not available -------; <br /> -------- <br /> r's Office) <br /> please call County Property <br /> Appraise 1111[1 Ij Ll I]i 0 Ll 11111 ------"L I]L L 111111 D <br /> Transaction is a split Property was improved <br /> 2. Mark(x)all Multi-parcel or cutout from with building(s)at time F7 <br /> that apply transaction? --, another parcel? of sale/transfer? <br /> 3. Grantor(Seller): LOST TREE VILLAGE CORPORATION <br /> Last First MI Corporate Name(if applicable) <br /> 3399 PGA BLVD. #260 PALM BCH GDNS FL 33410 ( <br /> Mailing Address city State Zip Code Phone No. <br /> 4. Grantee(Buyer): INDIAN RIVER COUNTY, ET AL. <br /> Last First MI Corporate Name(if applicable) <br /> 1840 25TH STREET VERO BEACH FL 32960 ( <br /> Mailing Address city State Zip Code Phone No. <br /> 5. Date of Sale/Transfer Saleffransfer Price <br /> [r-----, ------I .. ...... Property <br /> lIndian River <br /> In <br /> Located <br /> .03 110 1 <br /> L;Lq"L--- L <br /> .rrdj <br /> Month Day Year (RD to the nearest dollar.) <br /> 6. Type of Document ContracVAgreement Other 7. Are any mortgages an the property? If"Yes", YES <br /> for Deed outstanding mortgage balance: / NO <br /> Warranty <br /> Deed Quit Claim (Round to the nearest dollar.) D 11[11—][1 [17[11 <br /> Deed <br /> 8. To the best of your knowledge,were there unusual circumstances or conditions to the sale/transfer -- <br /> such as:Forced sale by court order?Foreclosure pending?Distress Sale?Title defects?Corrective Deed?Mineral rights? L Dill <br /> Sale of a partial or undivided interest?Related to seller by blood or marriage. YES NO <br /> 9. Was the sale/transfer financed? YES P / 01 <br /> NO If'Yes',please indicate type or types of financing: <br /> Ll <br /> Agreement or <br /> Conventional Ll Seller Provided Contract forOther Ij <br /> Institutional/ <br /> 10. Property Type: Residential Commercial Industrial Agricultural Miscellaneous Government Vacant Acreage Timeshare <br /> Mark(x)all F-771 <br /> Ix <br /> that apply Cents <br /> 11. To the best of your knowledge,was personal property <br /> YES !NO <br /> included in the sale/transfer?If'Yes",please state the R- E�]LE111-----�E-,F1 E ■ 1" J <br /> amount attributable to the personal property.(Round to the nearest dollar.) $ r........ i------I--I <br /> 12. Amount of Documentary Stamp Tax L41 D[I <br /> 13. If no tax is due in number 12,is deed exempt from Documentary Stamp Tax under s.201.02(6),Florida Statutes? YES : :NO <br /> NO <br /> Under penalties of pequry,I declare that I have read the foregoing return and that the facts stated in it are true.If prepared by someone other <br /> Lthan the taxpayer,his/her declaration is based on all information of which he/her has any knowledge. <br /> Signature of Grantor or Grantee or Agent I Date <br /> WARNING:FAILURE TO FILE THIS RETURN ORALTERNATFVE FORM APPROVED BY THE DEPARTMENT OF REVENUE SHALL RESILT INA PENALTY OF$25-00 INADDrrioN TO ANY <br /> OTHER PENALTY IMPOSED BY THE REVENUE LAW OF FLORIDA. <br /> To be completed by the Clerk of the Circuit Court's Office Clerks Date Stamp <br /> This copy to Property Appraiser <br /> : ; : ; <br /> ............ ....I ..... <br /> O. R. Book <br /> j <br /> and "l---IF] <br /> Page Number Lj ------- <br /> and 0 - -[I F1 F 1 -1 1-1 ------i <br /> File Number F-EIE][1 111E.... <br /> Date Recorded F—j El / 1-11-1 / 1]1-11:111 <br /> Month Day Year <br /> This copy to Property Appraiser <br />