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Home My WebLink AboutC11-229 Escro Instructions Derby Junction Property DATE: 07/11/2011 ESCROW NO.: H0311828 PROPERTY ADDRESS: 22499 Colorado River Rd. Derby Junction, CO 80426 ESCROW INSTRUCTIONS ADDENDUM (Interest Bearing Accounts) From the funds deposited in the above - numbered escrow for my account, you are hereby instructed to deposit $10,000.00 with Wells Fargo Bank, N.A> whose address is: 550 California St., 10th Flood San Fransisco, CA 94104, in an interest bearing account, at the prevailing rate of interest. My Taxpayer Identification Number is 84- 6000762 . (W -9 must be completed and provided to closing agent) The account is to be entitled "Heritage Title Company, Inc., For the benefit of Eagle County, Colorado." X Any interest earned by such deposit shall be credited to the account of the undersigned depositor at close of escrow. In the event the escrow does not close, all interest earned shall be payable as stated on those instructions that allow the escrow to be cancelled. (or) ❑ Any interest eamed by such deposit shall be credited to the account of: The undersigned hereby acknowledges the following: 1. The selection of the depository was made at the sole discretion of the undersigned. 2. The undersigned has made their independent inquiry of the depository and Heritage Title Company, Inc. has no liability in the event of failure, insolvency or inability of the depository to pay said funds, or accrued interest upon demand for withdrawal. 3. The undersigned acknowledge their familiarity with limitations on payments made on accounts in excess of $250,000 and the cumulative effect of other accounts held or owned by undersigned in the above -named depository. 4. The total responsibility of the Escrow Holder is to make the deposit as above instructed 5. The escrow company is prohibited from withdrawing funds except to redeposit them into the escrow account. 6. Heritage Title Company, Inc. is not responsible for levies by taxing authorities based upon the taxpayer identification number used to establish this interest bearing account. 'epositor Depositor Print Name - -4N VIA Print Name OJI l Form W-9 (Rev. January 2011) Request for Taxpayer Give form to t quester. e Do Department of the Treasury Identification Number and Certification sot Internal Revenue Service send d to the IRS Name (as shown on your income tax return) Eagle County, Colorado Business name /disregarded entity name, if different from above Check appropriate box for federal tax 0 classification (required): ❑ Individual /sole proprietor ❑ C Corporation 0 S Corporation ❑ Partnership ❑ Trust/estate 0 o ❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ► ❑ Exempt payee ❑ Other (see instructions) ► a. E Address (number, street, and apt. or suite no.) Requester's name and address (optional) y 5 00 QO f9 De,o rrl y C P Box g .5 Heritage Title Company, Inc. y City, state, and ZIP code P.O. Box 1980, 50 Chambers Ave. Suite I Eagle, CO 81631 E Co £ / 3I List account number(s) R ere (optional) H0311816- 060 -MH1 Part I: Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" I Social security number line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For _ - other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose I Employer identification number number to enter. b � 1&1010104-6 Part II:, Certification C � Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). and 2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification Instructions. . You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Signature Here U.S. person / Date ► • General Instructions Note: If a requester gives you a form other than Form W -9 to request Section references are to the Internal Revenue Code unless otherwise your TIN, you must use the requester's form if it is substantially similar to noted. this Form W-9. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: • A person who is required to file an information return with the IRS, • An individual who is a U.S. citizen or U.S. resident alien, must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest • A partnership, corporation, company, or association created or you paid, acquisition or abandonment of secured property, cancellation of organized in the United States or under the laws of the United States, debt, or contributions you made to an IRA. • Any estate (other than a foreign estate) or Use Form W -9 only if you are a U.S. person (including a resident • A domestic trust (as defined in Regulations section 301.7701 -7). alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding 1. Certify that the TIN you are giving is correct (or you are waiting for tax on any foreign partners' share of income from such business. Further, a number to be issued), in certain cases where a Form W -9 has not been received, a partnership 2. Certify that you are not subject to backup withholding, or is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your partnership rm W- 9 to t h e conducting partnership hip to establish business y u the United a n d a, o allocable share of any partnership income from a U.S. trade or business withholding W-9 on n the your share of partnership r ne sh your U.S. status and avoid is not subject to the withholding tax on foreign partners' share of w your share of partnership income. effectively connected income. Cat. No. 10231X Form W -9 (Rev. 1 -2011)