EXHIBIT G
TO PURCHASE AND SALE AGREEMENT
All Phases
Form of Certificate of Non-Foreign Status
CERTIFICATE OF NON-FOREIGN STATUS
Section 1445 of the Internal
Revenue Code provides that a transferee of a U.S. real property interest must withhold tax if the transferor is a foreign person. To inform the transferee that withholding of tax is not required upon the disposition of a U.S. real property interest
by the undersigned Seller, the undersigned hereby certifies the following:
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1. |
Seller is not a foreign person, foreign corporation, foreign partnership, foreign trust, or foreign estate (as those items are defined in the Internal Revenue Code and
Income Tax Regulations); |
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2. |
Seller is not a disregarded entity as defined in Treasury Regulation §1.1445-2(b)(2)(iii); |
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3. |
Sellers Taxpayer Identification Number
is: |
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4. |
Sellers office address is: |
c/o Vulcan Inc.
505 Fifth Avenue South, Suite 900
Seattle, WA 98104-3821
The undersigned understands that this certification may
be disclosed to the Internal Revenue Service by transferee and that any false statement contained herein could be punished by fine, imprisonment, or both.
Under penalties of perjury, the undersigned declares that it has examined this certification and to the best of its knowledge and belief it is true, correct and complete.
DATED as
of , 2012.
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| SELLER: |
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[VARIES] LLC, a Washington limited liability company |
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By: |
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City Investors LLC, a Washington limited liability company, its Manager |
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By: |
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Name: |
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Title: |
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EXHIBIT G