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<br /> Form 8283(Rev.10-98) Pae 2
<br /> Name(s)shown on your income tax return identifying number
<br /> LOST TREE VILLAGE CORPORATION 59-0947833
<br /> Section B—Appraisal Summary—List in this section only items (or groups of similar items) for which you claimed a
<br /> deduction of more than $5,000 per item or group. Exception. Report contributions of certain publicly
<br /> traded securities only in Section A.
<br /> If you donated art, you may have to attach the complete appraisal. See the Note in Part I below.
<br /> Information on Donated Property—To be completed by the taxpayer and/or appraiser.
<br /> 4 Check type of property:
<br /> ❑ Art` (contribution of$20,000 or more) ® Real Estate ❑ Gems/Jewelry ❑ Stamp Collections
<br /> ❑ Art` (contribution of less than $20,000) ❑ Coin Collections ❑ Books ❑ Other
<br /> 'Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antique furniture, decorative arts, textiles, carpets, silver, rare
<br /> manuscripts,historical memorabilia, and other similar objects.
<br /> Note: /f your total art contribution deduction was$20,000 or more,you must attach a complete copy of the signed appraisal. See instructions.
<br /> 5 (a)Description of donated property(if you need (b)If tangible property was donated,give a brief summary of the overall (c)Appraised fair
<br /> more space,attach a separate statement) physical condition at the time of the gift market value
<br /> A ISLAND PROPERTY SEE ATTACHED
<br /> B LEGAL DESCRIPTION
<br /> C
<br /> D
<br /> (d)Date acquired (e)How acquired (f)Donor's cost or (g)For bargain sales,enter See instructions
<br /> by donor(mo.,yr.) by donor adjusted basis amount received (h)Amount claimed as a (i)Average trading price
<br /> deduction of securities
<br /> A
<br /> B
<br /> C
<br /> D
<br /> 12. Taxpayer (Donor) Statement—List each item included in Part I above that the appraisal identifies as
<br /> having a value of $500 or less. See instructions.
<br /> I declare that the following item(s)included in Part I above has to the best of my knowledge and belief an appraised value of not more than$500
<br /> (per item). Enter identifying letter from Part I and describe the specific item. See instructions. ►
<br /> Signature of taxpayer(donor) ► Date ►
<br /> Declaration of Appraiser
<br /> 1 declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any
<br /> of the foregoing persons,or married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or
<br /> party to the transaction,I performed the majority of my appraisals during my tax year for other persons.
<br /> Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications
<br /> as described in the appraisal,I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based
<br /> on a percentage of the appraised property value. Furthermore, I understand that a false or fraudulent overstatement of the property value as
<br /> described in the qualified appraisal or this appraisal summary may subject me to the penalty under section 6701(a) (aiding and abetting the
<br /> understatement of tax liability). I affirm that I have not been barred from presenting evidence or testimony by the.Director of Practice.
<br /> Sign
<br /> Here I Signature ► Title 0. Date of appraisal ►
<br /> Business address(including room or suite no.) Identifying number
<br /> City or town,state,and ZIP code
<br /> MM Donee Acknowledgment—To be completed by the charitable organization.
<br /> This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated
<br /> property as described in Section B, Part I, above on ►
<br /> (Date)
<br /> Furthermore,this organization affirms that in the event it sells,exchanges,or otherwise disposes of the property described in Section
<br /> B, Part I (or any portion thereof) within 2 years after the date of receipt, it will file Form 8282, Donee Information Return, with the
<br /> IRS and give the donor a copy of that form.This acknowledgment does not represent agreement with the claimed fair market value.
<br /> Does the organization intend to use the property for an unrelated use? . . ► ❑ Yes ® No
<br /> Name of charitable organization(donee) Employer identification number
<br /> TOWN OF INDIAN RIVER SHORES 5-' _ 6 O 7 O
<br /> Address(number,street,and room or suite no.) City or town,state,and ZIP code
<br /> c/o Town Offices, 6001 North AM Vero Beach, FL 32963
<br /> A re Title Date
<br /> a -S 0
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