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(To-low) <br /> Confidential Doeumett <br /> This form provides essential market information to the county assessor to ensure accurate,fair and uniform assessments for all prelim Y.This <br /> document is not recorded,is kept confidential,and is not available for public Impaction. <br /> This dedisalAW must be rnmgreted ant dgmed by dOw the grantor fedlerl or gramme f ideal. Questions 1,2.3.and 4 may 10 <br /> completed(prellilled)by a third party,such as a title company or dosing agent,familiar with details of the transaction.The signatory sh Kild <br /> confirm accuracy before signing. <br /> This form Is required when conveyance doaunents are presorted for recording.If this form is rat completed and submitted,the counill <br /> assessor may sand nodce.N the completed and signed form Is not returned to the assessor within 30 days of notice,the assessor maI <br /> Impose a penalq of$25.00 or 0.025%(0.00025)of the sale price,whichever is greater. p <br /> Additional Infwnsdon as to the purpose,requirements,and level of confidentiality regarding this form are outlined in Colorado RevIsK <br /> Statutes,sections 39.14-102,39-5-121.5.and 39-13-102. <br /> 1. Address andlor legal description of the real property add:Please do not use P.O.Box numbers <br /> See attached-Exhibit A" <br /> 2. T o1 ased Single Family Residential❑Townhome❑Condominium❑Multi-Unit Res❑Comm al <br /> LIndustriai Agricultural Mixed Use®Vacant Land❑Other <br /> 3. bate of Closing:December 06,2010 <br /> Date of Contract N different than date of ducting:September 17,=19 <br /> 4. Total sale price:Including all real and personal property.$790,390.37 <br /> ContradBd price(N different from final sale price) $790,39UY <br /> S. List any personal property included in the transaction that materially impacts the total sale price.Personal property may Includo,but is <br /> .,� not limited to:machinery or egtnfpnrnerlt,vehicles,exceptional appliances,electronic devices,furniture,or anything that would n <br /> typically transfer with the real property(attach additional pages if necessary). <br /> Quat9lan gpgroximate Value <br /> $ <br /> $ <br /> Personal Property Total: $ <br /> N no personal property is fisted,the entire purchase price will be assumed to be for the real property. <br /> 6. Did the total as as price include a trade or exchange of additional real or personal property?❑Yes®No <br /> If yes,give the approximate value of the goods or services as of the date of dosing.$ <br /> if yes,does this transaction Involve a trade under IRS Code Section 1031?❑Yes 2g No <br /> 7. Was 100%Interest in the real property purchased?Mark in'N only a partial interest is being purchased. <br /> ®Yes❑No if no,Interest purchased: % <br /> S. Is this a iranacdon between related parties or acquaintances?This includes persons connected by blood or marriage,or bush ess <br /> affiliates,or those acquainted prior to the transaction.❑Yes❑No <br /> 9. Please mark type of sale:iy�-��+i�Builder(new construction) Public(MILS or Broker Representation) <br /> U Private(For Sale By Owner) Lj Other(describe) <br /> 1 M Check any of the following that a to the condition of the hMrovenents at the time of purchase: <br /> ❑New ❑Excellent L19ood ❑Average ❑Fair ❑Poor ❑Selvage <br /> ^ Form lose ciceinghecordrgslrpt 2019 html 35046944 (502196) <br />