STATEMENT OF TAX DUE UNDER PROVISIONS OF THE DOCUMENTARY TRANSFER TAX ACT Revenue and Taxation Code 11932 AND REQUEST THAT AMOUNT OF TAX DUE NOT BE MADE A PART OF THE PERMANENT RECORD TO: James W. Fitch Kern County Assessor-Recorder FOR RECORDER’S USE ONLY The tax due pursuant to the provisions of the Documentary Transfer Tax Act on the deed, transfer, or conveyance from the following Grantor(s) or Lessor(s): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ to the following Grantee(s) or Lessee(s): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ of the following briefly described real property (include APN numbers): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ amounts to: $_______________ (Check one) Computed on full value, or Computed on full value, less liens and encumbrances After the permanent record is made, a copy of this document will be attached to the conveying document and returned to the party entitled thereto. This document will be placed on file for auditing purposes. PLEASE TAKE NOTE that accounting receipts reflecting payment of documentary transfer taxes are public records subject to disclosures upon request, regardless of whether you have listed the amount of documentary transfer tax paid on a separate sheet of paper. Although the amount of documentary transfer tax paid will not be shown on the face of the document contained in the official records, your payment is contained in other public records and receipts that are subject to disclosure under the California Public Records Act. This position is made in reliance on the opinion of the California Attorney General issued on July 19, 2007: 2007 Cal. AG LEXIS 7; 90 Op. Atty Gen. Cal. 40, No. 06-1009. Date: ________________ Signature: ___________________________________ Form Revised: March 24, 2008 American LegalNet, Inc. www.FormsWorkFlow.com