CALIFORNIA FORM
Exhibit 4.2
Request for Tax Clearance Certificate | CALIFORNIA FORM |
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Limited Liability Company or Limited Liability Partnership | 3555L |
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Limited Liability Company (LLC) or Limited Liability Partnership (LLP) Name |
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Excel Properties, Ltd., A California Limited Partnership | 198527700005 |
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Current Address | 92128 | Phone Number | Federal Employer Identification Number |
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17140 Bernardo Center Dr. #310, San Diego, CA |   ###-###-#### | 87-0426335 |
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Date business commenced in | Date business ceased or will cease | Latest California tax return |
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California: | in California: | Income period: | Date filed: |
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1985 | 12-31-2004 | 12-31-2004 |
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All tax returns must be filed and balances due must be paid or secured before we will issue a Tax Clearance Certificate. All returns will remain subject to audit until the expiration of the normal statutes of limitations. |
| Has the IRS changed the LLCs or LLPs income tax liability for any years that you have not reported to us? |
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| o Yes | ý No |
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If an individual or another business entity will act as the Assumer of any future tax liability, check the Assumer box below and follow the appropriate instructions. Requests taking advantage of the Assumer method generally receive a Tax Clearance Certificate within 30 days. |
| If yes, send us a copy of the Revenue Agents Report. |
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If the LLC or LLP is currently being examined or an examination is pending, identify the agency or agencies below: | ||||||||||||||||||
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ý | Assumer | Individual or Trust complete pages 2 and 3. Corporate, LLC, or LLP complete pages 3 and 4. | o IRS | o FTB | o Both |
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If you are requesting a tax clearance without an Assumer, check the appropriate box below. Requests other than the Assumer method generally take 6 to 9 months to receive a Tax Clearance Certificate. |
| If being examined, indicate which years: |
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o | Surety Bond | Current: |
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o | Cash Deposit |
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o | Taxes Paid | A final return must be filed before we will issue a Tax Clearance Certificate based on Taxes Paid. |
| Pending |
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Check tax return form filed: o Form 100 ý Form 565 o Form 568 |
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Supplemental information. Please furnish the following information ONLY if another business entity will continue to conduct the business in California after the current cancellation of the original LLC or LLP. |
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Name of Transferee | California Identification Number or Secretary of State File Number of Transferee |
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Current Address | Phone Number | Federal employer identification number |
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Date Assets Transferred to Transferee | Section of the Internal Revenue Code applicable to the transfer of taxpayers business or assets: |
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We will send a copy of the Tax Clearance Certificate to the California Secretary of State. If we are to mail the original Tax Clearance Certificate to someone other than the LLC or LLP listed above, please complete the following: |
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Name | Phone Number |
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Address |
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Mail completed form to: | LIMITED LIABILITY COMPANY/PARTNERSHIP UNIT |
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| SECRETARY OF STATE |
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| PO BOX 944228 |
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| SACRAMENTO CA ###-###-#### |
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For more information concerning this form, telephone the Franchise Tax Board at ###-###-####. |
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Assistance for persons with disabilities: We comply with the Americans with Disabilities Act. Persons with hearing or speech impairments please call TTY/TDD ###-###-####. |
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FTB3555L C1 (Rev 10-2004) PAGE 1 |
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FINANCIAL STATEMENT FOR INDIVIDUAL OR OTHER ENTITY
Closing or disappearing business entitys name | California corporation or SOS file number |
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Statement of Assets and Liabilities |
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| Present |
| Liabilities |
| Equity in |
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| Balance Due (B) |
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Cash |
| $ | 640,000 |
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Bank accounts |
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Stocks and bonds |
| 345,000 |
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Cash or loan value of insurance |
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Household furniture |
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Real property |
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Vehicles |
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Other assets (describe) |
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VARIOUS NOTES RECEIVABLE & OTHER ASSETS |
| 5,704,000 |
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Federal taxes outstanding |
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Loans |
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| 6,222,000 |
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Other (include judgements) |
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Net assets |
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(Total Column A less total column B) |
| $ | 6,689,000 |
| 6,222,000 |
| $ | 467,000 |
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General Information (Attach additional schedules if necessary.) | |||
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Net annual income | Source (name of business or employer) | ||
$375,000 | VARIOUS INVESTMENTS | ||
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Banks and savings and loan accounts (names and addresses) | |||
Merrill Lynch | ck# 272-07307 | ||
11811 Bernardo Plaza Ct. | sav# 258 ###-###-####-8 | ||
San Diego, CA 92128 | |||
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Description and license number of each vehicle | |||
NONE |
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Stocks and bonds (name of company, number of shares, etc.) | |||
VARIOUS STOCKS HELD AT AMERITRADE - ACCT.NO.770-278803 | |||
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Real property (brief descriptions and locations) | |||
NONE | |||
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I certify that the information above is correct to the best of my knowledge. | |||
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Assumers name (print) Excel Interfinancial Corporation | |||
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Assumers address | 17140 Bernardo Center Dr., Sec. 310 | Phone number(858) 613-1800 | |
| San Diego, CA 92128 |
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Assumers signature | /s/ James Y. Nakagawa | Date 2/2/05 | |
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FTB 3555L C1 (Rev 10-2004) PAGE 3 | |||
CORPORATION, LIMITED LIABILITY COMPANY, OR LIMITED LIABILITY PARTNERSHIP ASSUMPTION OF TAX LIABILITY | |||||||||||||
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The Assumption of Tax Liability | |||||||||||||
of (1) | Excel Properties, Ltd. | ) | |||||||||||
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A corporation, limited liability company, or limited liability partnership | ) |
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| ) | California corporation number, Secretaryof | |||||||||||
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by (2) | Excel Interfinancial Corporation | ) | identification number | ||||||||||
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A corporation limited liability company, or limited liability partnership | ) |
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| California corporation number, Secretaryof | |||||||||||
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| State file number, or federal employer | |||||||||||
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(Name of assumer) Excel Interfinancial Corporation unconditionally agrees to file with the Franchise Tax Board all tax returns and data required and pay in full all tax liabilities, penalties, interest and fees of (1) Excel Properties, Ltd., A California Limited Partnership; at the effective date of dissolution, surrender, or cancellation | |||||||||||||
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| (2) | Excel Interfinancial Corporation | |||||||||||
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| Exact corporation, limited liability company, or | |||||||||||
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| limited liability partnership name | |||||||||||
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Gary B. Sabin, President |
| /s/ Gary B. Sabin | |||||||||||
Print name and title of officer/manager/partner |
| Signature and title of officer/manager/partner | |||||||||||
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State of | California |
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Country of | San Diego |
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On February 3, 2005 before me, the undersigned, a notary public in and for said state, personally appeared Gary B. Sabin | |||||||||||||
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personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the entity upon behalf of which the person(s) acted, executed the instrument. | |||||||||||||
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WITNESS my hand and official seal. | |||||||||||||
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Signature | /s/ Janet S. Christensen |
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Name | Janet S. Christensen | [SEAL] |
| JANET S. CHRISTENSEN |
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| (typed or printed) |
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| COMM. #1509449 |
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| Notary Public - California |
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| San Diego County |
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| My Comm Expires Aug. 24, 2008 |
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Note: LLC, LLP, and corporation assumers must provide a financial statement. | |||||||||||||
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FTB 3555L C1 (Rev 10-2004) PAGE 4 | |||||||||||||