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HomeMy WebLinkAboutC11-230 Escrow Instructions Bond Property DATE: July 7, 2011 ESCROW NO.: H0311816 PROPERTY ADDRESS: 13550 Highway 131 Bond, CO 80423 ESCROW INSTRUCTIONS ADDENDUM (Interest Bearing Accounts) From the funds deposited in the above - numbered escrow for my account, you are hereby instructed to deposit $20,000.00 with Wells Fargo whose address is: 550 California St., 10"' Floor, San Fransisco, CA 94104, in an interest bearing account, at the prevailing rate of interest. My Taxpayer Identification Number is . (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 C ouunty, Colorado." lE 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) 0 Any interest earned 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. .010,1 0.6 01 Coi-49410b 4111111, Depositor : /2E/7 /"7 /14c "T Print Name Print-Neme (oo r y ,(4 ffn/fi iF A2 C,l 200 Form W-9 Request for Taxpayer Give form to the requester. (Rev. January s Department of the ary Identification Number and Certification send the IRS the T reasury to Treasury Internal Revenue Service Name (as shown on your Income tax return) Eagle County, Colorado Business name /disregarded entity name, if different from above Check appropriate t ox for federal tax classification ( required): ❑ Individual /sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate 0 0 .2. ❑ Limited liability c¢mpany. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) • 0 Exempt payee o • ❑ Other (see instrustions) • n Address (number, street, and apt. or suite no.) Requester's name and address (optional) N 500 Gi'Df5,0t. i9 )/ (p o a d i ( s>„5-c, Heritage Title Company, Inc. / P.O. Box 1980, 50 Chambers Ave. Suite I S City, and ZIP �e co 653 / - 3/ Eagle, CO 81631 List account ) nu ere (optional) CY H0311816 -060 -M H1 Part 1: ? Taxpaye 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 will holding. 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. 8 - & Part Ii:' Certificat on Under penalties of perju y, 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 suoject 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 reporl all interest and dividends on your tax return. 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 this Form W -9. noted. 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 re ired to file an information return with the IRS, • An individual who is a U.S. citizen or U.S. resident alien, must obtain your corr t taxpayer identification number (TIN) to report, for • A partnership, corporation, company, or association created or example, income paid o you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition abandonment of secured property, cancellation of debt, or contributions ou 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 orrect TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when pplicable, to: business in the United States are generally required to pay a withholding 1. Certify that the IN 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 issue , in certain cases where a Form W -9 has not been received, a partnership 2. Certify that you re not subject to backup withholding, or is required to presume that a partner is a foreign person, and pay the 3. Claim exemptio from backup wif you are a U.S. exempt withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide payee. If applicable, u are also backup p withholding ith certifying ding if a U.S. person, your Form W-9 to the partnership allocable share of any partnership income from a U.S. trade or business on p rtners i withholding establish your U.S. status and avoid is not subject to the wi hholding tax on foreign partners' share of withholding on your share of partnership income. effectively connected i come. Cat. No. 10231X Form W -9 (Rev. 1 -2011)