CALIFORNIA FORM

EX-4.2 3 a05-2988_1ex4d2.htm EX-4.2

Exhibit 4.2

 

Request for Tax Clearance Certificate

CALIFORNIA FORM

 

Limited Liability Company or Limited Liability Partnership

3555L

 

 

 

Limited Liability Company (LLC) or Limited Liability Partnership (LLP) Name

 

Secretary of State File Number

 

Excel Properties, Ltd., A California Limited Partnership

198527700005

 

 

 

 

Current Address

92128

 Phone Number

Federal Employer Identification Number

 

17140 Bernardo Center Dr. #310, San Diego, CA

  ###-###-####

87-0426335

 

 

 

 

Date business commenced in

Date business ceased or will cease

Latest California tax return

 

California:

in California:

Income period:

Date filed:

 

1985

12-31-2004

12-31-2004

 

 

 

 

 

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 LLC’s or LLP’s income tax liability for any years that you have not reported to us?

 

 

o  Yes

ý No

 

 

 

 

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 Agent’s Report.

 

If the LLC or LLP is currently being examined or an examination is pending, identify the agency or agencies below:

 

 

 

 

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

 

 

 

 

 

 

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:

 

 

 

 

o

Surety Bond

Current:

 

 

 

o

Cash Deposit

 

 

o

Taxes Paid

A final return must be filed before we will issue a Tax Clearance Certificate based on Taxes Paid.

 

Pending

 

 

 

 

 

 

 

 

 

Check tax return form filed:  o Form 100  ý Form 565  o Form 568

 

 

 

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.

 

 

 

Name of Transferee

California Identification Number or Secretary of State File Number of Transferee

 

 

 

 

Current Address

Phone Number

Federal employer identification number

 

 

(          )

 

 

 

 

 

 

Date Assets Transferred to Transferee

Section of the Internal Revenue Code applicable to the transfer of taxpayer’s business or assets:

 

 

 

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:

 

 

 

Name

Phone Number

 

 

(          )

 

 

 

 

Address

 

 

 

 

Mail completed form to:

LIMITED LIABILITY COMPANY/PARTNERSHIP UNIT  

 

 

SECRETARY OF STATE

 

 

PO BOX 944228

 

 

SACRAMENTO CA ###-###-####

 

 

 

For more information concerning this form, telephone the Franchise Tax Board at ###-###-####.

 

 

 

Assistance for persons with disabilities: We comply with the Americans with Disabilities Act. Persons with hearing or speech impairments please call TTY/TDD ###-###-####.

 

 

 

FTB3555L C1 (Rev 10-2004) PAGE 1

 

 

 



 

FINANCIAL STATEMENT FOR INDIVIDUAL OR OTHER ENTITY

Closing or disappearing business entity’s name

California corporation or SOS file number

 

 

Statement of Assets and Liabilities

 

 

 

Present

 

Liabilities

 

Equity in

 

Item

 

Value (A)

 

Balance Due (B)

 

Asset

 

Cash

 

$

640,000

 

 

 

 

 

Bank accounts

 

 

 

 

 

 

 

Stocks and bonds

 

345,000

 

 

 

 

 

Cash or loan value of insurance

 

 

 

 

 

 

 

Household furniture

 

 

 

 

 

 

 

Real property

 

 

 

 

 

 

 

Vehicles

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other assets (describe)

 

 

 

 

 

 

 

VARIOUS NOTES RECEIVABLE &  OTHER ASSETS

 

5,704,000

 

 

 

 

 

 

 

 

 

 

 

 

 

Federal taxes outstanding

 

 

 

 

 

 

 

Loans

 

 

 

6,222,000

 

 

 

 

 

 

 

 

 

 

 

Other (include judgements)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net assets

 

 

 

 

 

 

 

(Total Column A less total column B)

 

$

6,689,000

 

6,222,000

 

$

467,000

 

 

General Information (Attach additional schedules if necessary.)

 

Net annual income

Source (name of business or employer)

$375,000

VARIOUS INVESTMENTS

 

 

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

 

Description and license number of each vehicle

NONE

 

 

 

Stocks and bonds (name of company, number of shares, etc.)

VARIOUS STOCKS HELD AT AMERITRADE - ACCT.NO.770-278803

 

Real property (brief descriptions and locations)

NONE

 

I certify that the information above is correct to the best of my knowledge.

 

Assumer’s name (print)  Excel Interfinancial Corporation

 

Assumer’s address

17140 Bernardo Center Dr., Sec. 310

Phone number(858) 613-1800

 

San Diego, CA 92128

 

 

 

 

Assumer’s signature

/s/ James Y. Nakagawa

Date 2/2/05

 

 

 

FTB 3555L C1 (Rev 10-2004) PAGE 3

 



 

CORPORATION, LIMITED LIABILITY COMPANY, OR LIMITED LIABILITY PARTNERSHIP ASSUMPTION OF TAX LIABILITY

 

The Assumption of Tax Liability

of (1)

Excel Properties, Ltd.

)

 

)

A corporation, limited liability company, or limited liability partnership

)

 

 

)

California corporation number, Secretaryof

 

)

State file number, or federal employer

by (2)

Excel Interfinancial Corporation

)

identification number

 

)

 

A corporation limited liability company, or limited liability partnership

)

 

 

 

California corporation number, Secretaryof

 

 

State file number, or federal employer

 

 

identification number

 

 

 

(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 

 

 

 

 

(2)

Excel Interfinancial Corporation

 

 

Exact corporation, limited liability company, or

 

 

limited liability partnership name

 

 

 

Gary B. Sabin, President

 

/s/ Gary B. Sabin

Print name and title of officer/manager/partner

 

Signature and title of officer/manager/partner

 

 

 

State of

California

 

 

 

 

 

 

Country of

San Diego

 

 

 

 

 

 

On February 3, 2005 before me, the undersigned, a notary public in and for said state, personally appeared Gary B. Sabin

 

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.

 

WITNESS my hand and official seal.

 

Signature

/s/ Janet S. Christensen

 

 

Name

Janet S. Christensen

[SEAL]

 

JANET S. CHRISTENSEN

 

 

(typed or printed)

 

 

COMM. #1509449

 

 

 

 

 

Notary Public - California

 

 

 

 

 

San Diego County

 

 

 

 

 

My Comm Expires Aug. 24, 2008

 

 

 

 

 

Note: LLC, LLP, and corporation assumers must provide a financial statement.

 

FTB 3555L C1 (Rev 10-2004) PAGE 4