INSTRUCTIONS FOR COMPLETION OF DECLARATION OF DOCUMENTARY TRANSFER TAX NUMBER OF FORMS REQUIRED: Please complete one (1) Declaration of Documentary Transfer Tax Form for each economic appraisal unit that transferred as part of a change in corporate control. DO NOT COMPLETE THIS FORM WHEN RECORDING A DOCUMENT (I.E. GRANT DEED, QUITCLAIM DEED). An economic appraisal unit is a collection of real estate assets that persons in the marketplace commonly buy and sell as a unit, or that is normally valued separately from other property. For example, a shopping center containing 10 parcels will only require completion of one Declaration of Documentary Transfer Tax Form with all 10 parcels listed. Alternatively, a transfer of a shopping center, and a separate economically unrelated gas station would require two separate Declarations identifying the parcels associated with each economic unit. **If more forms are necessary, you may photocopy the “Declaration of Documentary Transfer Tax” Form. EXEMPTIONS: If no documentary transfer tax is due, please state the reasons for the exemption on the Declaration of Documentary Transfer Tax Form and provide necessary supporting documentation. EXAMPLES OF SUPPORTING DOCUMENTATION (may include, but is not limited to): Board of Equalization Forms 100, Gift Tax Return, Tax Returns, Death/Marriage Certificates, Living Trust, Revocable, Irrevocable, etc.., Court Orders, LA County Assessment Appeals, Contracts, Recorded Deeds, etc. Please note that any documentation submitted may be subject to the provisions of the California Public Records Request Act (California Government Code 6250 et. Seq.) CITY TAX: In addition to the Countywide documentary transfer tax of $1.10 per $1,000.00 an additional City documentary transfer tax has been imposed on all documents that convey real property within the cities of Culver City, Los Angeles, Pomona, Redondo Beach and Santa Monica (R&T 11911C). Both the Countywide and additional City documentary transfer tax are collected and administered pursuant to Revenue and Taxation Code sections 11911 through 11935. The City documentary transfer tax rate listed below is computed per $1,000.00 of the consideration or value of the property conveyed, exclusive of existing liens and encumbrances, and is added to the Countywide $1.10 per $1,000.00 documentary transfer tax. PLEASE USE CAUTION TO APPROPRIATELY ALLOT THE CORRECT ADDITIONAL CITY TAX IF APPLICABLE. CITY Culver City Los Angeles Pomona Redondo Beach Santa Monica TAX RATE (per $1,000.00) $4.50 $4.50 $2.20 $2.20 $3.00 American LegalNet, Inc. www.FormsWorkFlow.com LAvote.net P.O. Box 1130, Norwalk, California 90651-1130 LArecorder.net DECLARATION OF DOCUMENTARY TRANSFER TAX The undersigned having knowledge of the transaction, does hereby disclose the following information to the Recorder of Los Angeles County for the purpose of determining transfer tax on a conveyance of real property in which the controlling interest of a legal entity has transferred. You are required to read the enclosed instruction sheet prior to completing this form. You may wish to consult your legal advisor. NAME OF THE ACQUIRED LEGAL ENTITY CONTACT PERSON TELEPHONE NUMBER NAME OF THE ACQUIRING PERSON OR LEGAL ENTITY EMAIL ADDRESS CONTACT MAILING ADDRESS CITY STATE ZIP CODE Date ownership control (i.e., transfer of more than 50 percent of the ownership interests) was obtained: ___________________________ APN: __________________________________ STREET ADDRESS, CITY, ZIP: _____________________________________________________________ APN: __________________________________ STREET ADDRESS, CITY, ZIP: _____________________________________________________________ APN: __________________________________ STREET ADDRESS, CITY, ZIP: _____________________________________________________________ Change in Legal Entity Controlling Interest COMPUTATION INFORMATION (as of date of conveyance) Total Consideration/Value of the interest or property Value obtained by appraisal $__________________________ / Percentage transferred _________% Yes__________ No__________ LESS: Liens or encumbrances remaining at the time of transfer (i.e., loans assumed) $__________________________ Amount tax based on $__________________________ Countywide Tax ($.55 per $500, or $1.10 per $1000) $__________________________ City Tax (if applicable) – See Instructions and Tax Bulletin $__________________________ REASON FOR NO TAX DUE: (If this transfer is exempt from the documentary transfer tax, please complete this section, indicate the reason and submit supporting documentation. Failure to provide supporting documentation may result in denial of your request.) _____ Instrument given to secure a debt. (RTC § 11921, LA CC § 4.60.040) _____ Instrument or writing to which the US or any state or political subdivision is a party. (RTC §11922, LA CC § 4.60.050) _____ Instrument involving bankruptcy, reorganization, receivership or change of identity. (RTC §11923, LA CC § 4.60.060) _____ Securities and Exchange Commission Order Conveyance. (RTC § 11924, LA CC § 4.60.070) _____ Transfer of Realty held by a continuing partnership. (RTC § 11925, LA CC § 4.060.080) _____ Instrument taken in lieu of foreclosure. (RTC § 11926) _____ Instrument transferring marital property. (RTC § 11927) _____Transfer involving an Inter vivos gift, or upon death (RTC § 11930) CERTIFICATION I certify ( or declare ) under penalty of perjury that the foregoing and all information hereon, including any accompanying statements or documents, is true and correct to the best of my knowledge and belief SIGNATURE: DATE TELEPHONE PRINT/TYPE NAME OF PERSON MAKING AFFIDAVIT TITLE EMAIL ADDRESS LAvote.net P.O. Box 1130, Norwalk, California 90651- 1130 ( ) LArecorder.net American LegalNet, Inc. www.FormsWorkFlow.com