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TAXABLE YEAR CALIFORNIA FORM 2419 Real Estate Withholding Certificate 593-C Part I — 5elferlTransferor Information Return this form to your escrow company Name SSN or ITIN Spouse'sIRDP's Name (ifJain y owned) Spouse'sIRDP's SSN or ITIN (fldritly owned) Address (apt.lsle., room, PO Box, or PM9 no.) AFEIN ❑ CA Corp. no ❑ CA SOS f le no. �j 6� - &0c,73i Dly (if y have a foreign address see Instructions.) Stale ZIP Code &-t\cA Z, CA- c1 `Z3�13 Ownership Percentage � (It c�, % Property address (if no street address provide parcel number and county) 330 N, Third Street Redlands, CA 92374 0169 28147 0.000, 0169-28149 0-000,0169 281-48 0-000 0169 281.50.0-000 San Bernardino County To certify that you qualify for a full or partial withholding exemption, check all boxes that apply to the property being sold or transferred. (See instructions) Part II — Certifications which fully exempt the sale from withholding 1 ❑ The property qualifies as the sellershransferots (or decedent's if solo by the decedent's estate or trust) principal residence within the meaning of Intemal Revenue Code (IRC) Section 121 2, ❑ The sellerltransferor (or decedent, if sold by the decedent's estate or trust) last used the property as the sellersltransferors (decedent's) principal residence within the meaning of IRC Section 121 without regard to the two-year time period 3 ❑ The sellerltransferor has a loss or zero gain for California income tax purposes on this sale To check this box you must complete Form 593-E (teal Estale Withholding-Compulation of Estima led Gain or Loss and have a loss or zero gain on line 16 4 ❑ The property is being compulsorily or involuntarily converted and the selieritransferor intends to acquire property that is similar or related in service or use to qualify for nonrecognition of gain for California income tax purposes under IRC Section 1033, 5 ❑ The transfer qualifies for nonrecognition treatment under IRC Season 351 (transfer to a corporation controlled by the transferor) or IRC Section 721 (contribution to a partnership in exchange for a partnership Interest) 6 ❑ The sellerltransferor is a corporation (or a limited liability company (LLC) classified as a corporation for federal and California income tax purposes) that Is either qualified through the California Secretary of State (SOS) or has a permanent place of business in California 7 ❑ The seller/transferor is a Califomia partnership or a partnership qualified to do business in California (or an LLC that is classified as a paMarshlp for federal and California income tax purposes and is not a single member LLC that is disregarded for federal and California income tax purposes) 6 X The seller/transferor Is a tax-exempt entity under California or federal law 9 ❑ The sellerltransferor is an insurance company, individual retirement account, qualified penslonlprofl sharing plan, or charitable remainder trust Part Ill -- Certifications that may partially or fully exempt the sale from withholding Real Estate Escrow Person (RESP) See instructions for amounts to withhold 10 ❑ The transfer qualifies as a slmulianeous like -kind exchange within the meaning of li Secllon 1031 The transfer qualifies as a deferred like4dnd exchange within the meaning of IRC Section 1031 12 Cl The transfer of this property is an installment sale where the buyerltransferee is required to withhold on the principal portion of each inslailment payment Copies of Form 593.1, (teal Estate Withholding Installment Sale Acknowledgement, and the promissory note are attached Selled1f ransferor Signature To learn about your privacy rights how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.govlforms and search for 1131 To request this notice by mail call 800.852.5711 Under penalties of perjury I declare that I have examined the information on this form. Including accompanying schedules and statements and to the best of my knowledge and belief it is true, correct, and complete I further declare under penalties of perjury that if the facts upon which this form are based change, l will promptly notify the REEP SolieeslTransferors name and Title J&,Ae[ �j- t✓ r Sellerslfransieror's Signature( ��to Cil 49,nnA4 Spouse'slRDPs' name Spouse's1RDP's Signature Date Selled If you checked any box in Part 11 you are exempt from real estate withholding Transferor If you checked any box in Part III, you may qualify fora partial or complete withholding exemption Except as to an installment sale, if the sellerltransferor did not check any box in Part II or Part111 of Form 593-C the withholding will be 3 VA (,0333) of the total safes price or the optional gain on sale withholding amount from line 5 of Form 593, Real Est -ale Withholding Tax Statement If the sellerltransferor does not return the completed Form 593 and Form 593-C by the close of the real estate transaction the withholding will be 3 113%(.0333) of the total sales price, unless the type of transaction is an installment safe if the transaction is an Instailment sale, the withholding will be 3113%(.0333) of the down payment li you are withheld upon, the RESP should give you one copy of Form 593 Attach a copy to the lower front of your California Income tax return and make a copy for your records, 7131193 r Form 593 G 2018