EFTA Document EFTA01268612

HUD Settlement Statement Signatures We, the undersigned, identified in Section D hereof and Seller in Section E hereof, hereby acknowledge receipt of this completed Settlement Statement on December 13, 2019. The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. Borrower(s) Granite Reality LLC, By: Jeffrey W. Roberts, Manager Seller(s) Richard Yospin, Trustee of the Richard Yospin Family Trust Settlement Agent: Date: CONFIDENTIAL SDNY_GM_C0012703 EFTA 00123346 EFTA01268612 Buyer/Seller A. Settlement Statement Settlement Statement B. Type of Loan I. MI FHA 2. M MS 3. IZI Cony. Unins 4. El VA 5. El Cony. Ins 6. MI Cash 7. MI Other 8. File Number 2019-2700 19. Loan Number 1 10. Mortgage Insurance Case Number C NOTE: This form is furnished to give you a statement of actual senkment costs. Amounts paid to and by the settlement agent arc shown. hems marked "(po.c.r were paid outside the closing, they are shown here for informational purposes and arc not included in the totals. D. NAME AND ADDRESS OF BUYER: Granite Reality LLC 155 Seaport Blvd. do Nutter McLennan & Fish I.LP. Boston, MA 02210 E. NAME AND ADDRESS OF SELLER: Richard Yospin. Trustee of the Richard Yospin Family Trust 57 Royce Road. Newton. MA 02459 F. NAME AND ADDRESS OF LENDER: CASH G. PROPERTY LOCATION: 338 East Washington Road. Bradford NH 03221 H. SETTLEMENT AGENT Hudldns Law PLLC " . New London Nil 03257 PLACE OF SETTLEMENT i 9 Newport Road. New London NH 03257 I. SETTLEMENT DATE: 12/13/2019 DISBURSEMENT DATE 12/13/2019 J. Summary of Buyer's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due From Buyer 400. Gross Amount Due To Seller 101. Contract Sales Price 1,070,750.00 401. Contract Sales Price 1,070,750.00 102. Personal Property 402. Personal Property 103. Settlement charges to buyer (line 1400) 11,863.55 403. 104. 404. 105. 405. Adjustments for Items paid by seller In advance Adjustments for Items paid by seller In advance 106. City/Town taxes 12/13/2019 to 03/31/2020 6,630.44 406. City/Town taxes 12/13/2019 to 03/31/2020 6,630.44 107. County taxes 407. County taxes 108. 408. 109. Oil Proration - Main House 1,436.35 409. Oil Proration - Main House 1,436.35 110. Oil Proration - GLICS1Cottage 1,511.95 410. Oil Proration -Guest Cottage 1,511.95 Ill. Propane Adjustment - Main House 1,637.65 411. Propane Adjustment - Main House 1,637.65 112. Propane Adjustment - Equipment Barn 449.18 412. Propane Adjustment - Equipment Barn 449.18 120. Gross Amount Due From Buyer 1,094,279.12 420. Gross Amount Due To Seller 1,082,415.57 200. Amounts Paid By Or In Behalf Of Buyer 500. Reductions In Amount Due To Seller 201. Deposit or earnest money Four Seasons Sothebys International Real Estate 100,000.00 501. Excess deposit (we instnictions) 202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 58,368.50 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Bradford Tax Collector- Taxes Due 12/17 11,375.00 205. 505. Law Office of Margaret A. Jacobs 350.00 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller 210. CityiTown taxes 510. City/Town taxes 211. County taxes 511. County taxes 212. ASSCSKIIICIIIS 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid By/For Buyer 100000.00 520. Total Reduction Amount Due Seller 70,093.50 300. Cash At Settlement From/To Buyer 600. Cash At Settlement Frontrio Seller 301. Gross due from buyer 120) 1,094,279.12 601. Gross Amount due to Seller (line 420) 1,082,415.57 Amount (line 302. Less amounts paid by/foe buyer (line 220) 100,000.00 602. Less reductions in amount due seller (line 520) 70,093.50 303. CASH From Buyer 994.279.12 603. CASH To SELLER 1,012,322.07 We, the undersigned, identified in Section D hereof and Seller in Section E hereof, hereby acknowledge receipt of this completed Settlement Statement (Pages 1 and 2) on December 13. 2019. CONFIDENTIAL SDNY_Ght000 12704 EFTA_00123347 EFTA01268613 L. SETTLEMENT CHARGES 700. Total Real Estate Broker Fees Paid From Buyer's Fund. al Settlement Paid From Sellers Fund. al Settlement Division of commission (line 700) as follows: 701. 550,287.50 to Four Seasons Sothebys International Real Estate 702. 5.00 to Four Seasons Sothebys International Real Estate 703. Commission paid at settlement 50,28730 704. 705. 706. 800. Items Payable In connection with Loan 801. Loan Origination Fee 802. Loan Discount 803. 804. 805. 806. to CASH to CASH 900. Items Required By Lender To Be Paid In Advance 901. Interest from From 12/13/2019 To 01/01/2020 902. Mortgage insurance premium 903. Hazard Insurance premium 904. 905. 1000. Reserves Deposited With Lender 1001. Ilazard Insurance 1002. Mortgage Insurance 1003. City property taxes 1004. County property taxes months at per month 1005. Annual assessments 1006. 1007. 1008. Aggregate Adjustments 1100. Me Charges 1101. 1102. 1103. 1104. 1105. 1106. 1107. Attorney's fees to Hudkins Law PLLC 1,250.00 1108. Title Insurance to Stewart Title Guaranty Company 2,537.00 1109. Lendet's coverage fie 5 .00 MO. Ownees coverage 51,070,750.00 S 2,537.00 MI. 1112. 1113. 1200. Government Recording and Transfer Charges 1201. Recording fees: Deed 545.55 Mortgage Releases 45.55 1202. City/county tax/stamps Deed Mortgage 1203. State tax/stamps: Deed 516,062.00 Mortgage 8,031.00 8,031.00 1204. 1205. I 1300. Additional Settlement Charges 1301. to 1302. 1303. CounerfWire/Fedex Fee to Hudkins Law PLLC 50.00 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES 11,86335 58,36830 We. the undersigned. identified in Section D hereof and Seller in Section E hereof. hereby acknowledge octopi of this completed Settlement Statement (Pages 1 and 2) on December 13, 2019. CONFIDENTIAL SONY_Ght000 12705 EFTA_00123348 EFTA01268614 SURVEY COVERAGE AFFIDAVIT STEWART TITLE GUARANTY COMPANY I/We Richard Yospin, Trustee of the Richard Yospin Family Trust being first duly sworn, depose and say as follows: 1. That I/We are the true and lawful owners in the fee of the premises situated in the City/Town of Bradford County of Merrimack State of New Hampshire Known as: 338 East Washington Road, Bradford, NH 03221. 2. Uwe have owned the property now being sold or mortgaged by me/us continuously for years Iasi past, and my/our enjoyment thereof has been peaceable and undisturbed and the title to said property has never been disputed or questioned to my/our knowledge, nor do I/we know of any facts by reason which the title to, or possession of, said property might be disputed or questioned, or by reason of which any claim to any of said property might be asserted adversely against me/us. 3. That within the last one hundred and twenty (120) days, no person or business entity has furnished any labor, services or materials in connection with the construction or repair of any buildings or improvements on the Property except (if none, state "none"): 4. That there are no present tenants, lessees or other parties in possession of the Property except (if none, state "none"). 5. That during the time of ownership of the premises above described. Uwe have conveyed no portion of the premises nor done any act or allowed any act to be done which has changed or could change the boundaries of the Property. 6. That Uwe have not allowed, nor do Uwe have knowledge of, any encroachments onto the Property by any adjoining land owners nor have Uwe created, allowed or maintained any encroachments upon any property of adjoining land owners. 7. That Uwe have not allowed, nor do I/we have knowledge of, any easements, rights of way, continuous driveway usage, drain, sewer. water, gas or oil pipeline or other rights of passage to others over the Property by any other persons or entities. 8. That Uwe have no knowledge of any old highways. abandoned roads, lanes, cemetery or family burial grounds. springs, streams. rivers, ponds. or lakes bordering or running through the Property. 9. That Uwe have no knowledge of any taxes or special assessments which are not shown as existing liens by the public records other than as shown in the current Municipal Lien Certificate and/or as reflected in the Closing Settlement Statement. 10. That I/we have not created and have no knowledge of any violation of any covenants, restrictions, agreements. conditions or zoning ordinances affecting said premises. II. That I/we make this Affidavit for the purpose of inducing a purchase or lease of said premises, and/or for the purpose of inducing the granting of a mortgage on said premises, and for the purpose of inducing STEWART TITLE GUARANTY COMPANY, in reliance upon this Affidavit, to issue a policy or policies of title insurance covering the Property and I/we hold harmless and indemnify Stewart Title Guaranty Company from loss or damage incurred due to any misrepresentation made in this affidavit. Executed on December 13. 2019. Richard Yospin, Trustee of the Richard Yospin Family Trust State of New Hampshire Merrimack. ss. On December 13, 2019, before me, the undersigned notary public, personally appeared the above-named and proved to me through satisfactory evidence of identification, which was a driver's license, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she/they signed it voluntarily for its stated purpose. Notary Public: My Commission Expires: CONFIDENTIAL SONY_GM_00012706 EFTA 00123349 EFTA01268615 CERTIFICATION OF NON-FOREIGN STATUS (Entity) Section 1445 of the Internal Revenue Code provides that a transferee of U.S. real property interest must withhold tax if the transferor is a foreign entity. To inform the transferee that withholding of tax is not required upon our disposition of a U.S. real property interest, I hereby certify the following. I. Richard Yospin Family Trust is not a foreign entity for purposes of U.S. income taxation. 2. The company Federal Tax ID number is: TIN#: ( Company mailing address is: 57 Royce Road Newton MA 02459 I understand that this certification may be disclosed to the Internal Revenue Service by the transferee and that any false statement I have made herein could be punished by fine, imprisonment, or both. Under penalties of perjury, I declare that I have examined this certification to the best of my knowledge and believe it is true, correct and complete. Richard Yospin Family Trust By: Richard Yospin Dated: December 13, 2019 CONFIDENTIAL SONY_GM_00012707 EFTA_00123350 EFTA01268616 New Hampshire Department of Revenue Administration CD57-S I S00057S1.51.8475t II • REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR) STEP 1 - SELLER Grantor !Assignor !Transferor (use new mailing address) Original Return Entity Type - (Check One) K lndMdual 0 K Joint 0 Partnership 0 Corporation CKI Trust 0 LLC 0 Amended Return Seller 1 • Last Name / Entity First Name FEIN ISSN Richard Yospin Family Trust Seller 2 • Last Name / Entity First Name FEIN ISSN Street No. Street Name Apt Unit Phone Number City State Zip Code + 4 (or Canadian Postal Code) MIRO Tar STEP 2 - PURCHASER GranteelAssignee / Transferee (use new mailing address) Last Name / Entity First Name Granite Reality LLC Last Name / Entity First Name STEP 3 - REAL ESTATE Municipality Bradford Street No. Street Name County Merrimack Multi Town Sale? II Yes. list municipalities: ❑yes ®No STEP 4 - DEED Apt / Unit Transfer Date 12132019 Recording Date Deed Type rtia Warranty 0 Quitclaim 0 Mortgage (Check One) In I-1 Commissioner's 0 Fiduciary El Sheriffs 0 Probate Book No. Page No. 0 Tax 0 Foreclosure El In Lieu of Foreclosure • Bradford CO-57-3 Floy 3.008/2017 Granite Reality LLC 155 Seaport Blvd 12132019 CONFIDENTIAL S0NY_GM_000f2Na °I 3 • EFTA_0012335 I EFTA01268617 New Hampshire Department of Revenue Administration CD-57-S 11 II III *01:05751.528475* REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR) • STEP 5 - TAX AMOUNT a) Full once or consideraton for the real estate 1070750.00 b) Divide Line 5(a) by 510Q 10707.50 c) Tax rate per $100 al time of transfer 0.75 0) Subtotal of Sellers tax (Minimum of $20 for all considerations $4.000 or less. per RSA 7S-B:11 8031 e) Total lax paid to County on behalf of Seller and Purchaser 16062 Are you claiming tax exemption under RSA 78-8:2? 0 Yes E No DO NOT file form CD-57-S for transfers speohcalty exempted from taxation under RSA 78-8:2. except transfers exempted by RSA 78-82.1X. Fenn CD-57-S must be flied for non-contractual transfers although exempted under RSA 78-b:2. IX. STEP 6 - TAXPAYER'S SIGNATURE 84 INFORMATION(Sellers Signature is Required) Under penalties of penury. I declare that I have examined this return and to the best of my belief it is true. correct and complete. Seller 1 Signature MMDDYYYY Seller I Printed Name Richard Yospin, Trustee of the Richard Yospin Family Trust Seller 2 Signature Seller 2 Printed Name Witness Signature Witness Printed Name It II ttig i tJin N k FM Granite Reality LLC Bradford MMDDYYYY MMDDYYYY 12132019 155 Seaport Blvd ill CO-57-S • RW3.006/2017 PO02013 CONFIDENTIAL SDNY_GM_000 12709 EFTA_00123352 EFTA01268618 New Hampshire Department of Revenue Administration CD-57-S 11 III II t0C057S1.538475* • REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR) STEP 7 - PREPARER'S SIGNATURE & INFORMATION (If prepared by someone other than the Seller) Power of Attorney (POA): By checking this box and signing Step 6, you authorize the preparer fisted on this velum to act on your behalf for this return only. including entering the bock and page numbers and filing this return electronically. Under penalties of perjury. I declare that I have examined this return and to the best of my belief it is true, correct and complete. (If prepared by a person other than the taxpayer. this declaration is based on all information of which the preparer has knowledge.) Preparers Signature (if other than taxpayer) MMDDYYW 12/13/2019 Preparers Printed Name (required if POA box is checked) Rebecca Russo Entity Hudkins Law PLLC Last Name First Name Russo Rebecca Street No. Street Name Apt! Unit PO Box City State Zip Code + 4 (or Canadian Postal Code) GCaltite Reality LLC Bradford rYT 12132019 t"6 155 Seaport Blvd Phone Number • CO-57-S Rev3.0 • 0612017 Page3 0(3 • CONFIDENTIAL SDNY_GM_00012710 EFTA_00123353 EFTA01268619 LAW H HUDKINS LAWLLe Attorneys • Jacqueline M. linekins • Bengmin f Percy • Lowe N. lornyiello (met ( Goering Rekord G Aneenon. • Moine Nitro • ',einem., to NM. in NH & MA • Ailminal to Prania, Vr & MA Pteme 1. Mama • Mnitted to Pranne in MA & HI /Wanted to Nina in NH Dorris P 'Cotton. hAnitud Pngta-in MA • (entice 51. Of towel Geo; Rock( Property Tax Disclaimer and Re-Proration Agreement In order to complete the HUD Settlement Statement, it was necessary for Hudkins Law PLLC to obtain information concerning real estate property taxes and other municipal charges such as water, sewer, municipal assessments or betterments, insurance, electric, gas, oil or condominium fees as applicable ("Third Party Information"). Although every effort was made to obtain accurate information, we the undersigned Buyer and Seller hereby agree to hold Hudkins Law PLLC harmless for the accuracy of any and all Third Party Information obtained by Hudkins Law PLLC or provided to Hudkins Law PLLC. We, Buyer and Seller acknowledge that Hudkins Law PLLC obtains Third Party Information through oral dialogue with various municipal employees and that in many cases, a written statement for Third Party Information is not available. We, Buyer and Seller further acknowledge that it is common for a municipal tax collector to provide "estimated" property tax amounts due. Even if an actual tax bill is available, it could be an estimate of the tax payment that will ultimately be due for the current tax year and actual tax bills could contain errors or may not include penalties that could be attributed to the parcel being conveyed from the Seller to the Buyer. Current Use penalties may not be assessed until after the date of closing and may or may not be attributable to the Seller. After the date of closing, in the event that such Third Party Information proves to be inaccurate or outdated, or if tax or other obligations or penalties are assessed after the closing date that may be attributable to the Seller, it shall be the responsibility of the Buyer and Seller to cooperatively re-adjust or re-prorate any amounts due or credited. If it is determined that the Buyer, Seller or Hudkins Law PLLC has made a disbursement or payment that should have been attributed to another party (a "Responsible Party"), the Responsible Party shall pay restitution to the party that made the payment on behalf of the Responsible Party. Notwithstanding the provisions herein, the Buyer and Seller further represent and agree to the following: 1. The payments, pro-rations and adjustments which have been computed and set forth on the Settlement Statement represent the good faith effort of the parties to allocate all items adjusted accordingly. 2. Any prorated item which has been incorrectly adjusted in the computation of the pro-rations, upon delivery of such omission or error, shall be promptly readjusted. 3. The undersigned parties agree to hold the Lender, (if applicable), the title insurance company and Hudkins Law PLLC harmless therefrom. 4. The Seller agrees to be responsible for any outstanding water or sewer liens and charges as of the date of closing, and any subsequent final readings. S. In the event that there are any outstanding real estate taxes, water or sewer liens and charges as of the date of closing, seller agrees to pay them forthwith upon receipt of a bill from the municipality. 6. We, the undersigned Buyer and Seller, agree to indemnify and hold harmless Hudkins Law PLLC, the Buyer's Lender (if applicable), for any adjustments or pro-rations which were made between the Buyer and Seller. Buyer and Seller agree that neither Hudkins Law PLLC or a Lender (if applicable), takes responsibility for these adjustments as they were negotiated. 7. The provisions herein shall survive the delivery of the deed and the closing. The Buyer and Seller have read and hereby acknowledge the understanding memorialized in this Property Tax Disclaimer and Re-Proration Agreement and agree to its terms. Buyer/Borrower Date Seller Date Buyer/Borrower Date Seller Date WINDHAM, NH 603.4341770 CONCORD, NH 603434.1770 NEW LONDON, NH 603-526-2660 NORWICH, VI 802-649-92OL, Aspiqyqt, 918-248-011I 25 Silicei Rod Peed, PO lox 719, 03087 (*al Nut 57 NA ry,N7 Frp,EN3/7r FIALA Suille 201, PO BOX 111105.5'4GT/04164 *ore, Soile 201, 01810 EFTA_DO I 23354 EFTA01268620 Attorneys H LAW HUDKINS LAW Wearable M. Hudkins • Martha I. Prize • Boomin I Pay Roane T. Moroun • burn M. Imam& Dennis P. *elm. Emily C. Goering • (ondke M. Oleg' Piked G. Wesson' Greg kaki' Compliance Agreement and Privacy Policy Compliance Agreement • AilnItt.- to Frew .3 NH MA • Adninnl u.Prarun. & MA • sinitttd ta Nil kXI Adnittecl u. Prans., n ll Mnitte.I ta 1'r-4,j4. n MA We, the undersigned Buyer and Seller hereby agree to sign, execute and/or resign and re-execute any and all closing documents to correct errors, or to make changes due to mistake or misinformation. We, the undersigned Buyer and Seller hereby agree to indemnify and hold Hudkins Law PLLC harmless for any mistake or misinformation, whether obtained by Hudkins Law PLLC or provided to Hudkins PLI.0 from third parties, used to calculate, pro-rate or otherwise charge, any and all items appearing on the HUD Settlement Statement, including but not limited to the following: property taxes, hazard or homeowner insurance, water, sewer or other municipal charges, fuel pro-rations, electricity pro-rations, or condominium association dues pro-rations. Privacy Policy Hudkins Law PLLC collects nonpublic personal information about you from the following sources: 1. Information we receive from you, such as your name, address, telephone number and social security number. 2. Information about your transaction from any of the following parties as they apply to your transaction: your lender, Realtor, attorney, spouse, CPA or tax professional, home inspector or various public records. Hudkins Law PLLC does not disclose any nonpublic personal information about our clients, or buyers or sellers of real estate, except as permitted or required by law or except as authorized by you. Hudkins Law PLLC maintains physical, electronic and procedural safeguards that comply with relevant federal and state regulations regarding privacy. We, the undersigned have received and have reviewed Hudkins Law PLLCS Privacy Policy and Compliance Agreement. Buyer/Borrower Date Seller Date Buyer/Borrower Date Seller Date WINDHAM, NH 603-434-1770 CONCORD, NH 603-434-1770 NEW LONDON, NH 603-526-2660 NORWICH, VI 802449-9200 ANDOVER, MA 978-248.0111 Bloat Itedt lemi, PO libx 719, OM ciod Plat 57 NMIWl kieet Suiti 10I, 03301 9 Nespett Read, PO Bat SOO, 03257 316 WA Sired, kite III, PO Sox Liclq,ssaokimiNvsecTuile 301, COI 0 CONFIDENTIAL EFTA _00123355 EFTA01268621 Substitute FORM 1099-S Proceeds From Real Estate Transactions For The Tax Year 2019 OMB No. 1545-0997 FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Hudkins Law PLLC 9 Newport Road New London, NH 03257 Telephone: (603) 526-2660 Fax: (603) 434.7226 FILER'S federal identification number Account or escrow number (see instructions) TRANSFEROR'S name, street address (including apt. no.), city TRANSFEROR'S identification or town, state or province, country, and ZIP or foreign postal number(s) code Richard Yospin Family Trust 37.1528702 2019.2700 1 Date of closing December 13. 2019 3 Address or legal description (including city. state, and ZIP code) 338 East Washington Road. Bradford, NH 03221 2 Gross Proceeds 51,070,750.00 For Privacy Act and Paperwork Reduction Act Notice, see the 2017 General Instructions for Certain Information Returns. 4 Check here if the transferor received or will receive property or services as part of the consideration >>>>> K 5 Check here if the transferor is a foreign person (nonresident alien, foreign partnership, foreign estate, or foreign trust) >»» K 6 Buyers part of real estate tax 6,630.44 This is important tax information and is being furnished to the internal revenue service. If you are required to file a return. a negligence penalty or other sanction may be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required by law to provide Hudkins Law PLLC with your correct federal tax identification number. If you do not provide Hudkins Law PLLC with your correct federal tax identification number, you may be subject to civil or criminal penalties imposed by law. Under the penalty of perjury. Uwe certify that the number(s) shown above on this statement is/are my/our correct federal tax identification number(s). I/we acknowledge receipt of a copy of this statement. Richard Yospin Family Trust DATE Sign and return a copy of this form immediately to Hudkins Law PLLC. Instructions for Transferor For sales or exchanges of certain real estate, the person responsible for closing a real estate transaction must report the real estate proceeds to the IRS and must furnish this statement to you. To determine if you have to report the sale or exchange of your main home on your tax return, see the instructions for Schedule D (Form 1040). If the real estate was not your main home, report the transaction on Form 4797, Form 6252, and/or the Schedule D for the appropriate income tax form. If box 4 is checked and you received or will receive like-kind property, you must file Form 8824. Federal mortgage subsidy. You may have to recapture (pay back) all or part of a federal mortgage subsidy if all of the following apply. • You received a loan provided from the proceeds of a qualified mortgage bond or you received a mortgage credit certificate. Your original mortgage loan was provided after 1990. • You sold or disposed of your home at a gain during the first 9 years after you received the federal mortgage subsidy. • Your income for the year you sold or disposed of your home was over a specified amount. This will increase your tax. See Form 8828 and Pub. 523. Transferor's taxpayer identification number. For your protection, this form may show only the last four digits of your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN). or employer identification number (EIN). However, the issuer has reported your complete identification number to the IRS. Account number. May show an account or other unique number the filer assigned to distinguish your account. CONFIDENTIAL SDNY_GM_000 12713 EFTA_0011 23356 EFTA01268622 Box 1. Shows the date of closing. Box 2. Shows the gross proceeds from a real estate transaction, generally the sales price. Gross proceeds include cash and notes payable to you, notes assumed by the transferee (buyer), and any notes paid off at settlement. Box 2 does not include the value of other property or services you received or will receive. See Box 4. Box 3. Shows the address or legal description of the property transferred. Box 4. If marked, shows that you received or will receive services or property (other than cash or notes) as part of the consideration for the property transferred. The value of any services or property (other than cash or notes) is not included in box 2. Box 5. If checked, shows that you are a foreign person (nonresident alien, foreign partnership. foreign estate, or foreign trust). Box 6. Shows certain real estate tax on a residence charged to the buyer at settlement. If you have already paid the real estate tax for the period that includes the sale date, subtract the amount in box 6 from the amount already paid to determine your deductible real estate tax. But if you have already deducted the real estate tax in a prior year, generally report this amount as income on the "Other income" line of the appropriate income tax form. For more information, see Pub. 523, Pub. 525, and Pub. 530. Instructions for Filer To complete Form 1099-S, use: • the 2017 General Instructions for Certain Information Returns, and • the 2017 Instructions for Form 1099-S. To order these instructions and additional forms, go to www.ks.gov/form1099s. Caution: Because paper forms are scanned during proceeding, you cannot file Forms 1096, 1097, 1098, 1099, 3921. 3922, or 5498 that you print from the IRS website. Due dates: Furnish Substitute 1099-S to the transferor by February 16, 2018. File an official Form 1099-S with the IRS by February 28, 2018. If you file electronically, the due date is April 2, 2018. To file electronically. you must have software that generates a file according to the specification in Pub. 1220. The IRS does not provide a fill-in form option. Foreign transferors. Sales or exchanges involving foreign transferors are reportable on Form 1099-S. For information on the transferee's responsibility to withhold income tax when a U.S. real property interest is acquired from a foreign person, see Pub. 515. Need help? If you have questions about reporting on Form 1099-S. call the information reporting customer service site toll free at 1- 866-455-7438 or 304.263-8700 (not toll free). Person with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free). CONFIDENTIAL SDNY_GM_000 12714 EFTA_00 I 23357 EFTA01268623 CERTIFICATION FOR NO INFORMATION REPORTING ON THE SALE OR EXCHANGE OF A PRINCIPAL RESIDENCE This form may be completed by the seller of a principal residence. This information is necessary to determine whether the sale or exchange should be reported to the seller, and to the Internal Revenue Service on Form 1099-5, Proceeds From Real Estate Transactions. If the seller properly completes Parts I and III, and makes a "true" response to assurances (I) through (6) in Part II (or a "not applicable" response to assurance (6)), no information reporting to the seller or to the Service will be required for that seller. The term "seller" includes each owner of the residence that is sold or exchanged. Thus, if a residence has more than one owner, a real estate reporting person must either obtain a certification from each owner (whether married or not) or file an information return and furnish a payee statement for any owner that does not make the certification. Part I. Seller Information I. Name: Richard Yospin Family Trust 2. Address or legal description (including city, state, and ZIP code) of residence being sold or exchanged: 338 East Washington Road, Bradford, NH 03221 3. Taxpayer Identification Number (TIN): Pan II. Seller Assurances Check "true" or "false" for assurances (I) through (5), and "true", "false", or "not applicable" for assurance (6). True False (I) I owned and used the residence as my principal residence for periods aggregating 2 years or more during the 5-year period ending on the date of the sale or exchange of the residence. (2) I have not sold or exchanged another principal residence during the 2-year period ending on the date of the sale or exchange of the residence. (3) I (or my spouse or former spouse, if I was married at any time during the period beginning after May 6, 1997, and ending today) have not used any portion of the residence for business or rental purposes after May 6, 1997. (4) At least one of the following three statements applies: The sale or exchange is of the entire residence for $250,000 or less. OR I am married, the sale or exchange is of the entire residence for $500,000 or less, and the gain on the sale or exchange of the entire residence is $250,000 or less. OR I am married, the sale or exchange is of the entire residence for $500,000 or less, and (a) I intend to file a joint return for the year of the sale or exchange, (b) my spouse also used the residence as his or her principal residence for periods aggregating 2 years or more during the 5-year period ending on the date of the sale or exchange of the residence, and (c) my spouse also has not sold or exchanged another principal residence during the 2-year period ending on the date of the sale or exchange of the principal residence. K K (5) During the 5-year period ending on the date of the sale or exchange of the residence, I did not acquire the residence in an exchange to which section 1031 of the Internal Revenue Code applied. True False N/A K K K (6) If my basis in the residence is determined by reference to the basis in the hands of a person who acquired the residence in an exchange to which section 1031 of the Internal Revenue Code applied, the exchange to which section 1031 applied occurred more than 5 years prior to the date I sold or exchanged the residence. Pan III. Seller Certification Under penalties of perjury, I certify that all the above information is true as of the end of the day of the sale or exchange. Signature of Seller Date CONFIDENTIAL SONY_GM_00012715 File Number: 2019-2700 EFTA_00123358 EFTA01268624 No Mortgage Affidavit Property Address: 338 East Washington Road, Bradford, NH 03221 l/We, the undersigned, are the current owner(s) of the referenced property do certify and swear that all mortgages on this property have been paid, are discharged and there are no outstanding mortgages on the property being refinanced/sold by us. The Undersigned do so certify, swear and warrant. Date: December 13, 2019 Richard Yospin, Trustee of the Richard Yospin Family Trust State of New Hampshire County of Merrimack, ss. December 13, 2019 Personally appeared the above named, Richard Yospin, Trustee of the Richard Yospin Family Trust, acknowledged the foregoing instrument to be his free act and deed, before me Notary Public — CONFIDENTIAL SDNY_GM_00012716 EFTA_00123359 EFTA01268625