STATE OF CALIFORNIA DEPARTMENT OF REAL ESTATE PUBLIC REPORT AMENDMENT/RENEWAL APPLICATION FOR DRE USE ONLY Note: Submit this package and one photocopy of pages 1 and 2; FILE NUMBER AMOUNT REQUIRED QUESTIONNAIRE $1. THIS APPLICATION IS FOR A: [check box(es)] AMOUNT RECEIVED AMENDMENT OF: RENEWAL OF: $ FINAL PUBLIC REPORT FINAL PUBLIC REPORTREFUND AMOUNT CONDITIONAL PUBLIC REPORT CONDITIONAL PUBLIC REPORT$INTERIM PUBLIC REPORT AMT TRANSFERRED FOR LOTS NEW CONDITIONAL PUBLIC REPORT $2. TYPE OF SUBDIVISION FROM FILE #STANDARD COMMUNITY APARTMENT CONDOMINIUM MOBILE HOME PLANNED DEVELOPMENT CONVERSION CHECK THE APPROPRIATE BOXES: STOCK COOPERATIVE LIMITED EQUITY HOUSING CO-OP UNDIVIDED INTEREST MIXED USE TENANCY-IN COMMON 3. SUBDIVISION IDENTIFICATION AND LOCATION DRE FILE NUMBER PREVIOUS REAL ESTATE SPECIALIST ASSIGNED FILE LIST MASTER FILE NO. (IF APPLICABLE) NAME OF SUBDIVISION TRACT NUMBER NAME TO BE USED IN ADVERTISING STREET ADDRESS (OR NEAREST CROSS STREETS) CITY COUNTY IF SUBDIVISION IS LOCATED WITHIN CITY LIMITS, LIST NAME OF CITY. IF RURAL SUBDIVISION, LIST NAME OF NEAREST TOWN/CITY. LIST THE MILES/DIRECTION FROM NEAREST TOWN/CITY. IF STOCK COOPERATIVE CONVERSION OR LEHC, IDENTIFY UNIT NUMBERS. 4. WILL YOU ALSO FILE WITH CFPB? (Refer to Question 22.) NO YES 5. INTERESTS TOTAL NUMBER OF INTERESTS IN SUBDIVISION NUMBER OF INTERESTS TO BE COVERED BY THIS AMENDMENT/RENEWAL NUMBER OF SHARES/MEMBERSHIPS RE-ACQUIRED BY COOPERATIVE The cooperative corporation has re-acquired shares memberships in this subdivision. I have acquired lots/units/shares in this subdivision. Not applicable or same owner. 6. SIZE OF THIS FILING NUMBER OF RESIDENTIAL LOTS/UNITS/INTERESTS (DO NOT COUNT COMMON AREA LOTS) NUMBER OF COMMERCIAL UNITS/INTERESTS/MODULES (MIXED USE PROJECTS ONLY) NUMBER OF COMMON AREA LOTS NUMBER OF ACRES IN THIS PHASE LIST COMMON AREA LOT NUMBERS/LETTERS/MODULES Check appropriate box(es) Lots/Units to be: Sold Leased All residential lots to be sold vacant All residential lots to be sold with completed residential structures. Residential lots to be sold both vacant and improved with residential structures. Vacant lots to be sold under agreement obligating buyer to enter into construction contract with seller or seller controlled entity. All lots to be sold as raw land. All lots/units to be sold with age restrictions. At least 50% of the lots/units will be sold subject to affordable WAS A PRELIMINARY/INTERIM PUBLIC REPORT ISSUED FOR THIS FILING? YES If PRELIMINARY/INTERIM ISSUEDnumber below. [Assigned File Number] WHEN PUBLIC REPORT IS READY: EMAIL TO SRP EMAIL ADDRESS: MAIL TO SRP CALL SRP FOR PICK UP American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 2 of 17 7. SUBDIVIDER INFORMATION NAME 9. BUDGET PREPARER NAME ATTENTION ATTENTION BUSINESS ADDRESS BUSINESS ADDRESS CITY CITY STATE ZIP CODE STATE ZIP CODE TELEPHONE NUMBER (INCLUDE A/C) FAX NUMBER TELEPHONE NUMBER (INCLUDE A/C) FAX NUMBER EMAIL ADDRESS EMAIL ADDRESS 8. SINGLE RESPONSIBLE PARTY (SRP) NAME ATTENTION BUSINESS ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER (INCLUDE A/C) FAX NUMBER EMAIL ADDRESS 10. SUBDIVISION SALES RECORDS Yes No NAME OF CUSTODIAN TELEPHONE NUMBER BUSINESS ADDRESS (POST OFFICE BOXES ARE NOT ACCEPTABLE) CITY COUNTY STATE ZIP CODE 11. ALWAYS SUBMIT THE FOLLOWING Note: American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 3 of 17 12. PUBLIC REPORT CHANGES AND CURRENT INFORMATION 225 13. DOCUMENT CHANGES Note: submit If YES, submit completed in sample form If NO, submit Yes No Yes No Yes No NA Yes No NA Yes No NA American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 4 of 17 If YES, submit Yes No Yes No NA If YES, submit Yes No If YES, submit Yes No If YES, submit Yes No If YES, submit Yes No Yes No NA If NO, submit Yes No NA If YES, submit 14. UTILITIES/SERVICES/SOILS/SCHOOLS/ USES NA Now Completed Not Completed Yes No NA If NO, submit Note: Subdivider must submit American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 5 of 17 If Yes, submit YES YES NO submit current information, if different from the If YES If YES, submit submit submit Code; of the Corporations Code; and Yes No Yes No Yes No NA Yes No NA Yes No Yes No NA (rate) (tax yr.) Yes No Yes No NA American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 6 of 17 If YES, state If NOprovideYes No NA Yes No NAME OF SOIL PUBLIC AGENCY ADDRESS CITY STATE ZIP CODE NAME OF FILLED GROUND PUBLIC AGENCY ADDRESS CITY STATE ZIP CODE NAME OF GEOLOGICAL REPORT PUBLIC AGENCY ADDRESS CITY STATE ZIP CODE (one for each school district serving the subdivision) If YES, submit If NO, submit Note: Note: Yes No Yes No NA Yes No NA American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 7 of 17 Special Flood Hazard Area (any type Zone Special Flood Hazard Area Special Flood Hazard Area Area of Potential Flooding Area of Potential Flooding Area of Potential Flooding Very High Fire Hazard Severity Zone as Very High Fire Hazard Severity Zone the fact that the property Very High Fire Hazard Severity Zone Yes No information not No Change Yes No information not No Change Yes No No Change American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 8 of 17 State Responsibility Area State Responsibility Area the fact that the property State Responsibility Area Earthquake Fault Zone pursuant Earthquake Fault Zone the fact that Earthquake Fault Zone Seismic Hazard Zone pursuant to the Seismic Seismic Hazard Zone the fact that the property is Seismic Hazard Zone Yes No No Change Yes No No Change Yes No Yes No No Change American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 9 of 17 * Future changes which place any part of the unsold lots/units in this subdivision within amended public report application. Note: Note If YES Note: Notice of Airport in Vicinity Notice of San Francisco Bay Conservation and Development Commission Jurisdiction Yes No Yes No Yes No Yes No Yes No NA Yes No Yes No American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 10 of 17 Notice of Right to Farm 15. OFFERING INFORMATION If YES If YES, submit If YES, submit Yes No Yes No Yes No Yes No Yes No Yes No Note: American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 11 of 17 16. COMPLETION INFORMATION (COMMON INTEREST PROJECTS ONLY) Yes No Yes No NA YES Yes No NA YES submit NO Yes No NA YES, submit NO Yes No NA YES NO Yes No Yes No NA YES Yes No NA YESsubmit NO Yes No NA YES , submit NO Yes No Yes No Note: Yes No American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 12 of 17 Note: Yes No Note Notes: 225 225 225 225 17. BUDGET REVIEW (COMMON INTEREST PROJECTS ONLY) Yes No Yes No Yes No Yes No Yes No Procedure, Yes No NA American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 13 of 17 submit of the Association's current reserve bank Submitthan 18. SUBSIDY /MAINTENANCE AGREEMENT (COMMON INTEREST PROJECTS ONLY) Note If YES, check Subsidy Agreement And submit Note: 19. FINANCING If YES, submit Note: Yes No NA Yes No NA American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 14 of 17 Yes No NA Yes No If YES, submit Yes No If YES, submit 20. PURCHASE MONEY HANDLING Yes No (Check code section.) Yes No YES, list NAME BUSINESS ADDRESS (POST OFFICE BOXES ARE NOT ACCEPTABLE) CITY STATE ZIP CODE Note: not be used NO[bond][ bond] (Check code section.) Note: submit complete Yes No NA SECURITY NUMBER AMOUNT PRINCIPAL ISSUER American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 15 of 17 (Check code section.) Yes No NA YES, indicate NAME CHECK ONE ESCROW TRUST ACCOUNT BUSINESS ADDRESS (POST OFFICE BOX IS NOT ACCEPTABLE) CITY STATE ZIP CODE NO(Check code section) Yes No NA If YES, explain Yes No If YES 21. REAL PROPERTY SALES CONTRACTS Yes No If YES 22. CFPB Yes No If YES Note: 23. CONDITIONAL/INTERIM PUBLIC REPORT Yes No (Submit a copy of the statement.) American LegalNet, Inc. www.FormsWorkFlow.com RE 635 Part III Page 16 of 17 Note: provide NAME CODE SECTION (CHECK ONE) BUSINESS ADDRESS (POST OFFICE BOXES ARE NOT ACCEPTABLE) CITY STATE ZIP CODE Yes No If YES, submit 24. SUBDIVIDER STATUS Yes No submit Yes No If YES, submit America