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FLORIDA DEPARTMENT OF REVENUE RX" <br /> D0240300 <br /> R-219 <br /> RETURN FOR TRANSFERS OF INTEREST IN REAL PROPERTY R..07/98 <br /> (PLEASE READ INSTRUCTIONS BEFORE COMPLETING) <br /> r Use black ink. Enter numbersas shown below. If typin enter be as shown below. ~ <br /> 1. Parcel Identification Number M [2]J;41i L?5 <br /> (If Parcel ID not available <br /> APP se call County Property i +�+ ?__i i._._.f 11 0 LJ�11 L]LJ' '. i 11• f � ! <br /> Appraiser's Office -► _f 1-1 <br /> Transaction is a split Property was improved <br /> 2. Mark(x)all Multi-parcel or cutout from n with building(s)at time <br /> that apply transaction? i_•_.; another parcel? t__.,` of sale/transfe(T —► i i <br /> LOST TREE VILLAGE CORPORATION <br /> 3. Grantor(Seller): <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 Salefrransfer Price <br /> 0 0 3 ! $ $ 5 0 0 0�0 `�i a In Indian River <br /> -••�-- - -- . t_�.- - <br /> Month Day Year (Round to the nearest dollar.) <br /> 6. Type of Document 1 Contract/Agreement (��Other 7. Are any mortgages on the property? If"Yes", YES `� / L NO <br /> `J for Deed (1 outstanding mortgage balance: <br /> _-W <br /> Warranty Quit Claim <br /> x i Deed (Round to the nearest dollar.) 3i i_ j0 V <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? <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 / i NO If"Yes',please indicate type or types of financing: <br /> g <br /> A regiment or <br /> Conventional Seller Provided Contract for Deed Other U <br /> Institutional/ <br /> 10. Property Type: Residential Commercial Industrial Agricultural Miscellaneous Government Vacant Acreage Timeshare <br /> Mark all <br /> that apply LJ 0 F1 D n <br /> � <br /> 11. To the best of •_._ n 1_____ '_____1 your knowledge,was personal property YES / ix NO ` io nt0 <br /> included in the sale/transfer?If"Yes",please state the i_____.l _____i _____ F1 ■ ... <br /> amount attributable to the personal property.(Round to the nearest dollar.) $ I Ir ! I <br /> 12. Amount of Documentary Stamp Tax <br /> 13. If no is due in number 12,is deed exempt from Documentary Stamp Tax under s.201-02(6),Florida Statutes? YES !�' / NO <br /> f---. <br /> Under penalties of perjury,I declare that I have read the foregoing return and that the facts stated in it are true.If prepared by someone other <br /> than 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 Date <br /> WARNING:FAILURE TO FILE THIS RETURN ORALTERNATIVE FORM APPROVED BY THE DEPARTMENT OF REVENUE SHALL RESULT INA PENALTY OF$25.00 IN ADDITION MANY <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 /> O. R. Book <br /> and ............. <br /> Page Number <br /> and <br /> File Number L__I <br /> Date Recorded El El / I-___!L-__1 -11 1 <br /> 11 <br /> Month Day Year <br /> This copy to Property Appraiser <br />