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PROMISSORY NOTE UBA RE 850 305 276 US ~' , 2023 Tender in terms of the Negotiable Instruments Ad. 1881: Public law 73-10. Chaffer 48' 48 Stat §112: U.C.0 Article 9: 31 U.S.C. 45118 (d1(2)• 31 U.S.C. 4463. Public Iaw 97-258:U.C.0 Article 4-4302: 12 U.S.C. 4411: Securities Act 4 2(1). 3(a)(3): Congressional Statutes At Iarge Title 62. Positive law 31 U.S.C.§5312:U.C.C. @-4304:12 USC 1813 (L): Public Polio+; AND settlement in terms of the United States Supreme High Court of Tustice. Rule 45. HOLDER has accepted this payoff, legal tender as full settlement and discharge of this debt by acquiescence under FRCP, rule 8 and the Administrative Act of 1946 and your bilateral contracted signature. At any time after the above date the undersigned promises to pay to the order of Flooring Systems of Arizona, Inc., for the amount of Sixty Thousand Eight Hundred and Ninety One Dollars ($60,891.00), NOTE, AS GOOD AS AVAL, FOR VALUE RECEIVED, with -0- %interest after the date until D~, 2023. The Payment will be made against the obligations of the United States~~~signs for settlement to that part of the public debt due its Principals and Sureties I hereby give permission to the HOLDER, BEARER and/or the PROTECTED HOLDER IN DUE COURSE of this Promissory Note security instrument, to use this NOTE in any way necessary as a negotiable instrument Collateral, to be financially traded or assigned on whereas such non -return, assign, sold, monetization, deposit, acceptance, or trade shall terminate the obligation herein. t Endorsement Guarantee ~~~`? ' ~''" 0~' ~~ Private Bankers National Banking Autograph of Chris Magis Nero Association, (PBNBA). Wii}IOUt RCCOl1CSC ACKNOWLEDGEMENT State of l~ ~•tL~~.~- County of ~ ~~-~~ Subscribed and sworn to (or affirmed) before me on this L~ t~', day of ~ ~ ' 20 -> ~ by proved to me on the basis of satisfactory evidence t be the persons) who appeared before me. ~~ sr~~~ ALY$$IACHAVIS Notary Public -Arizona ~ ~ Pima County \\ / I Commission p 638585 'i ,~' My Comm. Expires Sep 17, 2026 (seal) ARY PUBLIC
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8080 VOID CORRECTED LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. V V ~ , OMB No. 1545-0877 Farm 1099-A Acquisition or (Rev. January 2022) Abandonment of For calendar year Secured Property 20 ~S ~ 1~ ~~ ~ O 1 Date of lender's acquisition or 2 Balance of principal LENDER^S TO IN ~ B~ ROWE 'S TIN ~ knO'^'~9e f abandpnment outstanding ~~ U BORROWER'S name 3 4 Fair market value of property Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of Ol' ~ ~ ~ S~ ~C ]../K \~~~J.~ E,l~ the debt ► ❑ or town, state or province, country, and ZIP or fo~~gn postal co~~ 16 Description of property ~ ~~ R~~.U~e~e0 s3c~5 ~`7c~ ~l~ Form 1OJJ-A (Rev. 1-2022) Cat. No. 14412G Do Not Cut or Separate Forms on This Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information ~1~ ~ ~~U'~1 Returns. www.irs.gov/Form1099A Department of the Treasury -Internal Revenue Service Page — Do Not Cut or Separate Forms on This Page 8 D 8 D VOID CORRECTED LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. LENDER'S TIN I BORROWER'S TIN BORROWER'S name OMB No. 1545-0877 Form 1099 —H For calendar year 20 1 Date of lender's acquisition or 2 Balance of principal knowledge of abandonment outstanding Acquisition or Abandonment of Secured Property ~$ 3 4 Fair market value of property Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of the debt ► City or town, state or province, country, and ZIP or foreign postal code 6 Description of property Account number (see instructions) Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. Form 1099-A (Rev. 1-2022) Cat. No. 14412G www.irs.gov/Form1099A Department of the Treasury -Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 8080 VOID CORRECTED LENDER'S name, street address, city or town, state or province, country, ZIP or OMB No. 1545-0877 foreign postal code, and telephone no. ~ OA ~ _ A Form y /1 LENDER'S TIN I BORROWER'S TIN BORROWER'S name For calendar year 20 1 Date of lender's acquisition or 2 Balance of principal knowledge of abandonment outstanding Acquisition or Abandonment of Secured Property ~$ 3 4 Fair market value of property Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of the debt ► City or town, state or province, country, and ZIP or foreign postal code 6 Description of property Account number (see instructions) Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. Form 1 O9J-A (Rev. 1-2022) Cat. No. 14412G www.irs.gov/Form1099A Department of the Treasury -Internal Revenue Service
Instructions for Lender To complete Form 1099-A, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Forms 1099-A and 1099-C. To order these instructions and additional forms, go to www. irs. go v/Empl o yerForms. Caution: Because paper forms are scanned during processing, you cannot file certain Forms 1096, 1097, 1098, 1099, 3921, or 5498 that you print from the IRS website. Instructions for Lender To complete Form 1099-A, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Forms 1099-A and 1099-C. To order these instructions and additional forms, go to www. irs. go v/Emplo yerForms. Caution: Because paper forms are scanned during processing, you cannot file certain Forms 1096, 1097, 1098, 1099, 3921, or 5498 that you print from the IRS website. Instructions for Lender To complete Form 1099-A, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Forms 1099-A and 1099-C. To order these instructions and additional forms, go to www. irs.govlEmployerForms. Caution: Because paper forms are scanned during processing, you cannot file certain Forms 1096, 1097, 1098, 1099, 3921, or 5498 that you print from the IRS website. Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. Need help? If you have questions about reporting on Form 1099-A, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TrYlTDD equipment can call 304-579-4827 (not toll free). Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. Need help? If you have questions about reporting on Form 1099-A, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free). Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. Need help? If you have questions about reporting on Form 1099-A, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTYlTDD equipment can call 304-579-4827 (not toll free).
~ 022 Form 1040~~ Department of the Treasury Internal Revenue Service What Is Form 1040-V? It's a statement you send with your check or money order for any balance due on the "Amount you owe" line of your 2022 Form 1040, 1040-SR, or 1040-NR. Consider Making Your Tax Payment Electronically —It's Easy You can make electronic payments online, by phone, or from a mobile device. Paying electronically is safe and secure. When you schedule your payment, you will receive immediate confirmation from the IRS. Go to www.irs.govlPayments to see all your electronic payment options. How To Fill in Form 1040-V Line 1. Enter your social security number (SSN). If you are filing a joint return, enter the SSN shown first on your return. pine z. 11 you are liiing a joint return, enter the SSN shown second on your return. Line 3. Enter the amount you are paying by check or money order. If paying online at www.irs.gov/Payments, don't complete this form. Line 4. Enter your names) and address exactly as shown on your return. Please print clearly. How To Prepare Your Payment • Make your check or money order payable to "United States Treasury." Don't send cash. If you want to pay in cash, in person, see Pay by cash, later. • Make sure your name and address appear on your check or money order. • Enter your daytime phone number and your SSN on your check or money order. If you have an Individual Taxpayer Identification Number (ITIN), enter it wherever your SSN is requested. If you are filing a joint return, enter the SSN shown first on your return. Also, enter "2022 Form 1040," "2022 Form 1040-SR," or "2022 Form 1040-NR," whichever is appropriate. • To help us process your payment, enter the amount on the right side of your check like this: $ XXX.XX. Don't use dashes or lines (for example, don't enter "$ XXX—" or "$ XXX Xx/,00"). Cat. No. 20975C Notice to taxpayers presenting checks. When you provide a check as payment, you authorize us either to use information from your check to make aone-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. No checks of $100 million or more accepted. The IRS can't accept a single check (including a cashier's check) for amounts of $100,000,000 ($100 million) or more. If you are sending $100 million or more by check, you will need to spread the payments over two or more checks, with each check made out for an amount less than $100 million. Pay by cash. This is an in-person payment option for individuals provided through retail partners with a maximum of $1,000 per day per transaction. To make a cash payment, you must first be registered online at www.officialpayments.com/fed, our Official Payment provider. How To Send in Your 2022 Tax Return, Payment, and Form 1040-V • Don't staple or otherwise attach your payment or Form 1040-V to your return or to each other. Instead, just put them loose in the envelope. • Mail your 2022 tax return, payment, and Form 1040-V to the address shown on the back that applies to you. How To Pay Electronically Pay Online Paying online is convenient, secure, and helps make sure we get your payments on time. You can pay using either of the following electronic payment methods. To pay your taxes online or for more information, go to www.irs.gov/Payments. IRS Direct Pay Pay your tvices directly from your checking or savings account at no cost to you. You receive instant confirmation that your payment has been made, and you can schedule your payment up to 30 days in advance. Debit or Credit Card The IRS doesn't charge a fee for this service; the card processors do. The authorized card processors and their phone numbers are all online at www.irs.gov/Payments. Detach Here and Mail With Your Payment and Return Form ~ ~4~-V (2022) ~0 1 040 V Payment Voucher OMB No. 1545-0074 Department of the Treasury Do not staple or attach this voucher to your payment or return. ~ O~~ Internal Revenue Service Go to www.irs.govlPaymenis for payment options and information. 1 Your social security number (SSN) 2 If a joint return, SSN shown second 3 Amount you are paying by check or (if a joint return, SSN shown first on your return) on your return money order. Make your check or money order payable to "United States Treasury" y 4 Your first name and middle initial Last name a p If a joint return, spouse's first name and middle initial Last name c .~ a Home address (number and street) Apt. no. Ciy, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code Foreign country name I Foreign province/state/county I Foreign postal code For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 20975C
9696 ❑VOID ❑CORRECTED PAYER'S name, street address, city or town, state or province, country, 1 Original issue discount for OMB No. 1545-0117 ZIP or foreign postal code, and telephone no. the year ~,N~~-Eo ~7~~-~s T~~s~~y $ G, ~ ~ s~~, r ~_T~~~, ~ ~ .y Form 1099-OID Origina~ issue —~ ~ ~ I ~ ~ (Rev. October 2019) ~ISCOUIIt 2 Other periodic interest 1 ^ r ~S~ ~'~C''~ ra C " ~ • ~ C (...~ ~ 2 2 `~ For calendar year vv ~ 2~~ PAYER'S TIN R~OEPI~W~€"5 ' 3 Early withdrawal penalty 4 Federal income tax withheld Copy A 5 Market discount 6 Acquisition premium For RE~ip~me ~ ~ ~, ~ - Internal Revenue Service Center 7 Description File with Form 1096. dress (including apt. no.) 1 ~~ ` 1 , For Privacy Act T~' and Paperwork City a16ir~wn, state or province, country, and ZIP or foreign postal code 8 Original issue discount on 9 Investment expen es Reduction Act U.S. Treasury obligations ~p ` ~ Notice, see the $ $ current General FATCA filing 10 Bond premium 11 Tax-exempt OID Instructions for requirement ~ -,, $ ~ $ ~ Certain ~ ' Information Returns. Account number (see instructions) 2nd TIN not. 12 State 13 State identification no. 14 State tax withheld ~. 8 S 0 3c~ ~ ~~ ° -------- ---------------------------- - ----.-~~ -$ Form 1099-OID (Rev. 10-2019) Cat. No. 14421 R www.irs.gov/Form109901D Department of the Treasury -Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 9696 ~J VOID ~J CORRECTED PAYER'S name, street address, city or town, state or province, country, 1 Original issue discount for OMB No. 1545-0117 ZIP or foreign postal code, and telephone no. `~~ the year ~N~ficD STI~~~ ~~~ $ C~l`~-5~7-~T~~~ ~~y Form 1099-OID Original Issue ~ ~ Discount (Rev. October 2019) 2 Other periodic interest q ~ ~ /L~ ~ ~ ~ (~'~ ~ D ~ LZ U Z2~ -, For calendar year V V /~4-~ a 6 20 PAYER'S TIN RECIPIENT'S TIN 3 Early withdrawal penalty 4 Federal income tax withheld Copy A ~ ~ ~ 5 Market discount 6 Acquisition premium V ~ L/ For $ ~ Internal Revenue $@YVIC@ C@Ilt@C RECIPIENT'S name 7 Description File with Form 1096. Street address (including apt. no.) For Privacy Act and Paperwork City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on 9 Investment expenses Reduction Act U.S. Treasury obligations Notice, see the $ $ current General FATCA filing 10 Bond premium 11 Tax-exempt OID Instructions for requirement ~ Certain $ $ Information Account number (see instructions) 2nd TIN not. 12 State 13 State identification no. 14 State tax withheld Returns. ~ $ -------- ---------------------------- ---------------------------- Form 1 OJ9-OID (Rev. 10-2019) Cat. No. 14421 R www.irs.gov/Form109901D Department of the Treasury -Internal Revenue Service
Instructions for Payer To complete Form 1099-OID, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Forms 1099-INT and 1099-OID. To order these instructions and additional forms, go to www.irs.gov/Form 10990ID. Caution: Because paper forms are scanned during processing, you cannot file Forms 1096, 1097, 1098, 1099, 3921, or 5498 that you print from the IRS website. Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. Instructions for Payer To complete Form 1099-OID, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Forms 1099-INT and 1099-OID. To order these instructions and additional forms, go to www.irs.govlForm 10990ID. Caution: Because paper forms are scanned during processing, you cannot file Forms 1096, 1097, 1098, 1099, 3921, or 5498 that you print from the IRS website. Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. To file electronically, you must have software that generates a file according to the specifications in Pub. 1220. The IRS does not provide afill-in form option for Copy A. Foreign recipient. If the recipient is a nonresident alien, you may have to withhold federal income tax and file Form 1042-S. See the Instructions for Form 1042-S and Pub. 515. Need help? If you have questions about reporting on Form 1099-OID, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free). To file electronically, you must have software that generates a file according to the specifications in Pub. 1220. The IRS does not provide afill-in form option for Copy A. Foreign recipient. If the recipient is a nonresident alien, you may have to withhold federal income tax and file Form 1042-S. See the Instructions for Form 7042-S and Pub. 515. Need help? If you have questions about reporting on Form 1099-OID, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free).
Do Not Staple 6 9 6 9 Form 1096 Department of the Treasury Annual Summary and Transmittal of U•S• Information Returns OMB No. 1545-0108 022 Internal Revenue Service address (including room or suite number) r town, state or province, country, and ZIP or foreign postal code of person to contact ne number For Official Use Only address Fax number m ployer identification number 2 Social security number 3 Total number of forms $Federal income tax withheld $Total amqun' reported ~ ith this Form 1096 ~ l c'~Q oa v a -~ 6 Enter an "X" in only one box below to indicate the type of form being filed. W-2G 1097-BTC 1098 1098-C 1098-E 1098-F 1098-Q 1098-T 1099-A 1099-8 1099-C 1099-CAP 1099-DIV 1099-G 1099-INT 1099-K 1099-LS 32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10 16 1099-LTC 1099-MISC 1099-NEC 1099-OID 1099-PATR 1099-D 1099-QA 1099-R 1099-5 1099-SA 1099-SB 3921 3922 5498 5498-ESA 5498-QA 5498-SA 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A 27 Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Send this form, with the copies of the form checked in box 6, to the IRS in a flat mailer (not folded). Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete. +w S re ► Instructions Future developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/Form 1096. Reminder. The only acceptable method of electronically filing information returns listed on this form in box 6 with the IRS is through the FIRE System. See Pub. 1220. Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the IRS. Caution: If you are required to file 250 or more information returns of any one type (excluding Form 1098-F), you must file electronically. If you are required to file electronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty. The Taxpayer First Act of 2019, enacted July 1, 2019, authorized the Department of the Treasury and the IRS to issue regulations that reduce the 250-return requirement for 2021 tax returns. If those regulations are issued and effective for 2022 tax returns required to be filed in 2023, we will post an article at www.irs.gov/Form1099 explaining the change. Until regulations are issued, however, the number remains at 250, as reflected in these instructions. For more information, see part F in the 2022 General Instructions for Certain Information Returns. Forms 1099-QA and 5498-QA can be filed on paper only, regardless of the number of returns. Who must file. Any person or entity who files any of the forms shown in line 6 above must file Form 1096 to transmit those forms to the IRS. Caution: Your name and TIN must match the name and TIN used on your 94X series tax returns) or you may be subject to information return penalties. Do not use the name and/or TIN of your paying agent or service bureau. Enter the filer's name, address (including room, suite, or other unit number), and taxpayer identification number (TIN) in the spaces provided on the form. The name, address, and TIN of the filer on this form must be the same as those you enter in the upper left area of Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. When to file. File Form 1096 as follows. • With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 28, 2023. • With Forms 1099-NEC, file by January 31, 2023. • With Forms 5498, file by May 31, 2023. Where To File Send all information returns filed on paper with Form 1096 to the following. If your principal business, office or agency, or legal residence in Use the following the case of an individual, is address located in Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Kentucky, Maine, Massachusetts, Mississippi, New Internal Revenue Service Hampshire, New Jersey, New Mexico, P~O. Box 149213 New York, North Carolina, Ohio, Texas, Austin, TX 78714-9213 Vermont, Virginia For more information and the Privacy Act and Paperwork Reduction Act Notice, Cat. No. 144000 Form 1096 (2022) see the 2022 General Instructions for Certain Information Returns.
Form 1096 (2022) Page 2 Alaska, Colorado, Hawaii, Idaho, Form W-2G Box 1 Illinois, Indiana, Iowa, Kansas, Form 1097-BTC Box 1 Michigan, Minnesota, Missouri, Internal Revenue Service Center Form 1098 Boxes 1 and 6 Montana, Nebraska, Nevada, North P.O. Box 219256 Dakota, Oklahoma, Oregon, South Kansas City, MO 64121-9256 Form 1098-C Box 4c Carolina, South Dakota, Tennessee, Form 1098-E Box 1 Utah, Washington, Wisconsin, Wyoming Form 1098-F Box 1 California, Connecticut, Internal Revenue Service Center Form 1098-Q Box 4 District of Columbia, Louisiana, 193 North Rulon White Blvd. Form 1099-B Boxes 1d and 13 Ma land, Penns Ivania, ry y Ogden, UT 84201 Form 1099-C Box 2 Rhode Island, West Virginia Form 1099-CAP Box 2 If your legal residence or principal place of business is outside the Form 1099-DIV Boxes 1 a, 2a, 3, 9, 10, and 12 United States, file with the Internal Revenue Service, P.O. Box 749213, Form 1099-INT Boxes 1, 3, 8, 10, 11, and 13 Austin, TX 78714-9213. Form 1099-K Box 1a Transmitting to the IRS. Group the forms by form number and transmit Form 1099-LS Box 1 each group with a separate Form 1096. For example, if you must file Form 1099-LTC Boxes 1 and 2 both Forms 1098 and 1099-A, complete one Form 1096 to transmit your Form 1099-MISC Boxes 1, 2, 3, 5, 6, 8, 9, 10, 11, and 14 Forms 1098 and another Form 1096 to transmit your Forms 1099-A. You need not submit original and corrected returns separately. Do not Form 1099-NEC Box 1 send a form (1099, 5498, etc.) containing summary (subtotal) Form 1099-OID Boxes 1, 2, 5, 6, and 8 information with Form 1096. Summary information for the group of Form 1099-PATR Boxes 1, 2, 3, and 5 forms being sent is entered only in boxes 3, 4, and 5 of Form 1096. Form 1099-Q Box 1 Box 1 or 2. Enter your TIN in either box 1 or 2, not both. Individuals not Form 1099-QA Box 1 in a trade or business must enter their social security number (SSN) in Form 1099-R Box 1 box 2. Sole proprietors and all others must enter their employer Form 1099-S Box 2 identification number (EIN) in box 1. However, sole proprietors who do not have an EIN must enter their SSN in box 2. Use the same EIN or Form 1099-SA Box 1 SSN on Form 1096 that you use on Form 1097, 1098, 1099, 3921, 3922, Form 1099-SB Boxes 1 and 2 5498, or W-2G. Form 3921 Boxes 3 and 4 Box 3. Enter the number of forms you are transmitting with this Form Form 3922 Boxes 3, 4, and 5 1096. Do not include blank or voided forms or the Form 1096 in your total. Form 5498 Boxes 1, 2, 3, 4, 5, 8, 9, 10, 12b, 13a, Enter the number of correctly completed forms, not the number of pages, and 14a being transmitted. For example, if you send one page of three -to -a-page Form 5498 -ESA Boxes 1 and 2 Forms 1098-E with a Form 1096 and you have correctly completed two Forms 1098-E on that page, enter "2" in box 3 of Form 1096. Form 5498-QA Boxes 1 and 2 Box 4. Enter the total federal income tax withheld shown on the forms Form 5498-SA Box1 being transmitted with this Form 1096. Corrected returns. For information about filing corrections, see the Box 5. No entry is required if you are filing Form 1098-T, 1099-A, or 2022 General Instructions for Certain Information Returns. Originals 1099-G. For all other forms in the listing that follows, enter the total of and corrections of the same type of return can be submitted using the amounts from the specific boxes identified for each form. one Form 1096.
Form ~~~~ (Rev. November 2022) Department of the Treasury Internal Revenue Service Names) shown on return Allocation of Refund (Including Savings Bond Purchases) Go to www.irs.gov/Form8888 for the latest Information. Attach to your income tax return. OMB No. 1545-0074 For calendar year 20 Attachment Sequence No. Your social security number _■ Direct Deposit Complete this part if you want us to directly deposit a portion of your refund to one or more accounts. _ 1a Amount to be deposited in first account (see instructions) . b Routing number c ❑Checking ❑Savings d Account number 2a Amount to be deposited in second account 2a b Routing number c ❑Checking ❑Savings d Account number 3a Amount to be deposited in third account 3a b Routing number c ❑Checking ❑Savings d Account number U.S. Series I Savings Bond Purchases Complete this part if you want to buy paper bonds with a portion of your refund. ~ If a name is entered on line 5c or 6c below, co-ownership will be assumed unless the beneficiary box is checked. See instructions for more details. 4 Amount to be used for bond purchases for yourself (and your spouse, if filing jointly) 4 5a Amount to be used to buy bonds for yourself, your spouse, or someone else 5a b Enter the owner's name (First then Last) for the bond re istration c If ou would like to add a co-owner or beneficia ,enter the name here (First then Last . If beneficiary, also check here . ❑ 6a Amount to be used to buy bonds for yourself, your spouse, or someone else ~ 6a ~ b Enter the owner's name First then Last) for the bond re istration c If you would like to add a co-owner or beneficiary, enter the name here (First then Last). If beneficiary, also check here . ❑ Paper Check Complete this part if you want a portion of your refund to be sent to you as a check. 7 Amount to be refunded by check 7 Total Allocation of Refund 8 Add lines 1 a, 2a, 3a, 4, 5a, 6a, and 7. The total must equal the refund amount shown on your tax return 8 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 2~ 858A Form 8888 (Rev. ~ ~ -2022)
Form 8888 (Rev. 11-2022) Page 2 Future Developments Information about any future developments affecting Form 8888 (such as legislation enacted after we release it) will be posted on www.irs.gov/Form8888. What's New New entry space. An entry space has been added for the appropriate calendar year at the top of the form. Reminder Continuous -use form. Form 8888 has been converted from annual revision to continuous use. The form will be updated as needed. General Instructions Purpose of Form Use Form 8888 if: • You want us to directly deposit your refund (or part of it) to either two or three accounts at a bank or other financial institution (such as a mutual fund, brokerage firm, or credit union) in the United States, or • You want to use at least part of your refund to buy up to $5,000 in paper or electronic series I savings bonds. An account can be a checking, savings, or other account such as: • An individual retirement arrangement (IRA), • A health savings account (HSA), • An Archer MSA, • A Coverdell education savings account (ESA), or • A TreasuryDirectp online account. You can't have your refund deposited into more than one account or buy paper series I savings bonds if you file Form 8379, Injured Spouse Allocation. Deposit of refund to only one account. If you want your refund deposited to only one account, don't complete this form. Instead, request direct deposit on your tax return. Account must be in your name. Don't request a deposit of your refund to an account that isn't in your name, such as your tax return preparer's account. Although you may owe your tax return preparer a fee for preparing your return, don't have any part of your refund deposited into the preparer's account to pay the fee. The number of refunds that can be directly deposited to a single account or prepaid debit card is limited to three a year. After this limit is reached, paper checks will be sent instead. Learn more at www. irs. go v/Individuals/Direct-Deposit- Limits. Why Use Direct Deposit? • You get your refund faster by direct deposit than you do by check. • Payment is more secure. There is no check that can get lost or stolen. • It saves tax dollars because it costs the government less. • It is more convenient. You don't have to make a trip to the bank to deposit your check. IRA You can have your refund (or part of it) directly deposited to a traditional IRA, Roth IRA, or SEP-IRA, but not a SIMPLE IRA. You must establish the IRA at a bank or other eligible financial institution before you request direct deposit. Make sure your direct deposit will be accepted. You must also notify the trustee or custodian of your account of the year to which the deposit is to be applied (unless the trustee or custodian won't accept a deposit for the prior year). If you don't, the trustee or custodian can assume the deposit is for the year during which you are filing your return. See IRA under Refund in the Instructions for Form 1040 for more information. TreasuryDirect0 Account You can request a deposit of your refund (or part of it) to a TreasuryDirect~ online account to buy U.S. Treasury savings bonds. For more information, go to https: //treasurydirect. gov. U.S. Series I Savings Bonds You can request that your refund (or part of it) be used to buy up to $5,000 in series savings bonds. You can buy them electronically by direct deposit into your TreasuryDirect~ account. See instructions under Part 1 for details. Or, if you don't have a TreasuryDirect~ account, you can buy paper savings bonds. See the instructions under Part 11 for details. Specific Instructions Part If you are filing Form 8888 only TAP to buy paper series 1 savings bonds, skip Part I and go to Part II. If you file a joint return and complete Form 8888, your spouse may get at least part of the refund. Lines 1a, 2a, and 3a Enter the portion of your refund you want directly deposited to each account. Each deposit must be at least $1. Your entire deposit may be deposited in one account. If there are any delays in the processing of your return by the IRS, your entire refund will be deposited in the first account listed on Form 8888. Make sure the first account you list on Form 8888 is an account you would want the entire refund deposited in if this happens. An account can be a checking, savings, or other account such as an IRA, HSA, Archer MSA, ESA, or TreasuryDirect~ online account. Lines 1 b, 2b, and 3b The routing number must be nine digits. The first two digits must be 01 through 12 or 21 through 32. On the sample check below, the routing number is 250250025. Tony and Jennifer Maple would use that routing number unless their financial institution instructed them to use a different routing number for direct deposits. TONY MAPLE l 234 JENNIFER MAPLE SAMPLE 1.23 Pear Lane is-0000i o00 Anyplace, GA 00000 PAY TO TF~ ..~._....~,...r.._._ _. ORDER OF Routing Account $ ~ number number f~LLARS ANYPLACE BANK Anyplace, GA 00000 Don't include the check number. For x:250250025 ~ 202020^'86"• 1234 Note: The routing and account numbers may be in different places on your check.
Form 8868 (Rev. 11-2022) Page 3 Ask your financial institution for the correct routing number to enter if: • The routing number on a deposit slip is different from the routing number on your checks, • Your deposit is to a savings account that doesn't allow you to write checks, or • Your checks state they are payable through a financial institution different from the one at which you have your account. Lines 1 c, 2c, and 3c Check the appropriate box for the type of account. Don't check more than one box for each line. If your deposit is to an account such as an IRA, HSA, brokerage account, or other similar account, ask your financial institution whether you should check the "Checking" or "Savings" box. You must check the correct box to ensure your deposit is accepted. If your deposit is to a TreasuryDirect~ online account, check the "Savings" box. Lines 1 d, 2d, and 3d The account number can be up to 17 characters (both numbers and letters). Include hyphens but omit spaces and special symbols. Enter the number from left to right and leave any unused boxes blank. On the sample check in these instructions, the account number is 20202086. Don't include the check number. Direct Deposit Request Rejected If your financial institution rejects one or two but not all of your direct deposit requests, you may get part of your refund as a paper check and part as a direct deposit. Example. You complete lines 1 and 2 correctly but forget to enter an account number on line 3d. You will get a paper check for any amount shown on line 3a. The parts of your refund shown on lines 1a and 2a will be directly deposited to the accounts you indicated. The IRS isn't responsible for a lost refund if you enter the ■ wrong account information. Check with your financial institution to get the correct routing and account numbers and to make sure your direct deposit will be accepted. See Reasons Your Direct Deposit Request Will Be Rejected under Refund in the Instructions for Form 1040 for more information. Changes in Refund Due to Math Errors or Refund Offsets The rules below explain how your direct deposits may be adjusted. Math Errors The following rules apply if your refund is increased or decreased due to a math error. Refund increased. If you made an error on your return and the amount of your refund is increased, the additional amount will be deposited to the last account listed. If you asked that your refund be split among three accounts, any increase will be deposited to the account on line 3. If you asked that your refund be split among two accounts, any increase will be deposited to the account on line 2. Example. Your return shows a refund of $300 and you ask that the refund be split among three accounts with $100 to each account. Due to an error on the return, your refund is increased to $350. The additional $50 will be added to the deposit to the account on line 3. Refund decreased. If you made an error on your return and the amount of your refund is decreased, the decrease will be taken first from any deposit to an account on line 3, next from the deposit to the account on line 2, and finally from the deposit to the account on line 1. Example. Your return shows a refund of $300, and you ask that the refund be split among three accounts with $100 to each account. Due to an error on your return, your refund is decreased by $150. You won't receive the $100 you asked us to deposit to the account on line 3, and the deposit to the account on line 2 will be reduced by $50. Note: If you appeal the math error and your appeal is upheld, the resulting refund will be deposited to the account on line 1. Refund Offset The following rules apply if your refund is offset (used) to pay past -due federal tax or certain other debts. Past -due federal tax. If you owe past-due federal tax and your refund is offset by the IRS to pay the tax, the past-due amount will be deducted first from any deposit to an account on line 3, next from the deposit to the account on line 2, and finally from the deposit to the account on line 1. Other offsets. If you owe other past-due amounts (such as state income tax, child support, spousal support, or certain federal nontax debts, such as student loans) that are subject to offset by the Treasury Departments Bureau of the Fiscal Service, the past-due amounts will be deducted first from the deposit to the account with the lowest routing number. Any remaining amount due will be deducted from the deposit to the account with the next lowest routing number and then from the deposit to the account with the highest routing number. If the deposit to one or more of ' your accounts is changed due ■ to a math error or refund offset, and that account is subject to contribution limits, such as an IRA, HSA, Archer MSA, or Coverdell ESA, or the deposit was deducted as a contribution to a tax-favored account on your tax return, you may need io correct your contribution or file an amended return. Example. You deduct $1,000 on your 2022 tax return for an IRA contribution. The contribution is to be made from a direct deposit of your 2022 refund. Due to an offset by the Bureau of the Fiscal Service, the direct deposit isn't made to your IRA. You need to correct your contribution by contributing $1,000 to the IRA from another source by the due date of your return (determined without regard to any extension) or file an amended return without the IRA deduction. Part II You may request up to three different savings bond registrations. However, each registration must be a multiple of $50, and the total of lines 4, 5a, and 6a can't be more than $5,000 (or your refund amount, whichever is smaller). You can skip line 4 if you want TAP to buy bonds for someone other than yourself (and your spouse, if filing jointly). Line 4 Enter the portion of your refund you want to use to buy bonds for yourself (and your spouse, if filing jointly). These bonds will be registered in the names) shown on your return. Lines 5a and 6a Enter the portion of your refund you want to use to buy bonds for yourself, your spouse, or someone else. This amount must be a multiple of $50.
Form 8888 (Rev. 11-2022) Page 4 Lines 5b and 6b Enter the owner's name for this bond registration. This can be you, your spouse, or someone else. However, enter only one name. Enter the first name followed by the last name and place one space in between them. Use the person's given name and don't use nicknames. Use only letters and print clearly. Don't use symbols. Lines 5c and 6c If you want to add a co-owner or beneficiary to this registration, enter their name. This can be you, your spouse, or someone else. However, enter only one name. Enter the first name followed by the last name and place one space in between them. Use the person's given name and don't use nicknames. Use only letters and print clearly. Don't use special symbols. If this is a beneficiary designation, also check the box on line 5c or 6c. Otherwise, co-ownership will be assumed. The bonds will be issued in the names you have requested and mailed to you. If you have determined that the IRS processed your refund and placed the order for your bonds, you can contact the Treasury Retail Securities site at 844-284-2676 to ask about the status of your bonds. When your bonds won't be issued. Your bonds won't be issued if any of the following apply. • The bond request isn't a multiple of $50. • Your refund is decreased because of a math error. • You enter more than one name on line 5b, 5c, 6b, or 6c. • Your refund is offset for any reason. Instead, your refund will be sent to you in the form of a check. Math errors that increase your refund. If you made an error on your return and the amount of your refund is increased, the additional amount will be sent to you in the form of a check. However, if you requested direct deposit in Part !, the rules under Changes in Refund Due to Math Errors or Refund Offsets will apply. Part III Line 7 If any portion of your refund remains after completing Parts I and II, you can request this portion be sent to you in the form of a check. Enter the amount on line 7 that you would like to be sent by check. Part iv Line 8 The total on line 8 must equal the total amount of the refund shown on your tax return. It must also equal the total of the amounts on lines 1a, 2a, 3a, 4, 5a, 6a, and 7. If the total on line 8 is different, a check will be sent instead. Don't file a Form 8888 on which ' you have crossed out or whited ■ out any numbers or letters. If you do, the IRS will reject your allocation of refund and savings bond purchases, and send you a check instead.
Notice Concerning Fiduciary Relationship Form ~~ (Rev. November 2022) ~ (Internal Revenue Code Sections 6036 and 6903) ~ OMB No.1545-0013 Department of the Treasury Go to www.irs.gov/Form56 for instructions and the latest information. Internal Revenue Service Identification Name of person for whom you are acting (as shown on the tax return) Identifying number Decedents social security no. Address of person for whom you are acting (number, street, and room or suite no.) or town, state, and ZIP code (If a foreign address, see instructions.) Fiduciary's name Address of fiduciary (number, street, and room or suite no.) or town, state, and ZIP code telephone number (optionaq Section A. Authority 1 Authority for fiduciary relationship. Check applicable box: a ❑Court appointment of testate estate (valid will exists) b ❑Court appointment of intestate estate (no valid will exists) c ❑Court appointment as guardian or conservator d ❑Fiduciary of intestate estate e ❑Valid trust instrument and amendments f ❑Bankruptcy or assignment for the benefit of creditors g ❑Other. Describe: ----------------------------------------------------------------------------------------------------------------------------------------------- 2a If box 1 a, 1 b, or 1 d is checked, enter the date of death: ----------------------------------------- b If box 1 c, 1 e, 1 f, or 1 g is checked, enter the date of appointment, taking office, or assignment or transfer of assets: ------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section B. Nature of Liability and Tax Notices 3 Type of taxes (check all that apply): ❑Income ❑Gift ❑Estate ❑Generation-skipping transfer ❑Employment ❑ Excise ❑Other (describe): ----------------------------------------------------------------------------------------------------------------------------4 Federal tax form number (check all that apply): a ❑ 706 series b ❑ 709 c ❑ 940 d ❑ 941, 943, 944 e ❑ 1040 or 1040-SR f ❑ 1041 g ❑ 1120 h ❑Other (list): -------------------------------------------------------------------------- 5 If your authority as a fiduciary does not cover all years or tax periods, check here ❑ and list the specific years or periods within your authority: _____________________________________________________________________________________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- For Paperwork Reduction Act and Privacy Act Notice, see separate instructions. Cat. No. 163751 Form 56 (Rev. 11-2022)
Form 56 (Rev. 11-2022) Page 2 Revocation or Termination of Notice Section A —Total Revocation or Termination 6 Check this box if you are revoking or terminating all prior notices concerning fiduciary relationships on file with the Internal Revenue Service for the same tax matters and years or periods covered by this notice concerning fiduciary relationship ❑ Reason for termination of fiduciary relationship. Check applicable box: a ❑Court order revoking fiduciary authority b ❑Certificate of dissolution or termination of a business entity c ❑Other. Describe: Section B —Partial Revocation 7a Check this box if you are revoking earlier notices concerning fiduciary relationships on file with the Internal Revenue Service for the same tax matters and years or periods covered by this notice concerning fiduciary relationship ❑ b Specify to whom granted, date, and address, including ZIP code. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Section C —Substitute Fiduciary 8 Check this box if a new fiduciary or fiduciaries have been or will be substituted for the revoking or terminating fiduciary and specify the names) and address(es), including ZIP code(s), of the new fiduciary(ies) ❑ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Courtand Administrative Proceedings Name of court (if other than a court proceeding, Identify the type of proceeding and name of agency) Date proceeding Initiated Address of court Docket number of proceeding City or town, state, and ZIP code Date Time ~ y.m. Place of other proceedings ❑ P.m. Si nature Under penalties of perjury, I declare that I have examined this document, including any accompanying statements, and to the best of my Please knowledge and belief, it is true, correct, and complete. Sign Here Fiduciary's signature Title, If applicable Date Form rJs (Rev. 11-2022)
NATIONAL LIEN SERVICES US POSTAGE AND FEES PAID ~i easypo5t PO BOX 51616 2022-1 o-2s ~=YP~=~.=~m)s~gnup SPARKS NV 89435 89435 ~, ~~ C4000823 ~ Retail $0.57 ~ 1.0 OZ LTR 0901000005202 iiiiii,iiiii,ill~l~lli.i~~,ii,ii,ll~ii.~i.,ii.lil~il~i~i~~illilll NORSTAR 9 LLC 2120 E BROADWAY BLVD TUCSON AZ 85719-5938 ~~~ ~ ''1 ~~ c G?~~.-Ref# 221025-10222-6CEF Questions? Visit www.NationalLienServices.com DK PLEASE DATE, COMPLETE, AND MAIL, EMAIL, OR FAX THE BELOW ACKNOWLEDGMENT OF RECEIPT Acknowledgment of Receipt Proof that this Notice was given In accordance with appropriate state statutes shall be made as follows: This acknowledges receipt of a copy of this Notice 221025-11014 on / / 20 for If a person to whom the notice is served fails to complete the acknowledgment or fails to complete and return the acknowledgment within thirty days from the date of mailing, proof of mailing may be made by affidavit of the person making the mailing, showing the time, place and manner of mailing and facts showing that such service was made in accordance with appropriate state statutes. The affidavit shall show the name and address of the person to whom a copy Notice was mailed, and, if appropriate, the title or capacity in which he was given the notice. If mailing was made by first class mail sent with a certificate of mailing, the certificate of mailing shall be attached to the affidavit. If the mailing was by certified or registered mail, the receipt of certification or registration shall be attached to the affidavit. Thank you! PrelienPro Technologies, LLC All Rights Reserved O 2022
NATIONAL LIEN SERVICES US POSTAGE AND FEES PAID ~i ~SypOSt
PO BOX 51616 2022-10-26 a~sY~~~~=gym/s~A„up
SPARKS NV 89435 ~' ' 89435 r r
C4000823 ~ '~
Retail $0.57 ~ ~ {
1.0 OZ LTR 0901000005202
.,iii,i,~.i,lr~ll~~iuiii.~~in,i~,.~i,i~,.i.iiii~,~,~i~nin~ii
NERD CHRIS MAGIS &BULLOCK MARIA CP/RS
7200 W PICTURE ROCKS RD
TUCSON AZ 85743-8769
Ref# 221 025-1 1 01 4-0049
Questions? Visit
www.NationalLienServices.com
DK
PLEASE DATE, COMPLETE, AND MAIL, EMAIL, OR FAX THE BELOW ACKNOWLEDGMENT OF RECEIPT
Acknowledgment of Receipt
Proof that this Notice was given in accordance with appropriate state statutes shall be made as follows:
This acknowledges receipt of a copy of this Notice 221025-11014 on / 120 for
If a person to whom the notice is served fails to complete the acknowledgment or fails to complete and return the acknowledgment within thirty days
from the date of mailing, proof of mailing may be made by affidavit of the person making the mailing, showing the time, place and manner of mailing
and facts showing that such service was made in accordance with appropriate state statutes. The affidavit shall show the name and address of the
person to whom a copy Notice was mailed, and, if appropriate, the title or capacity in which he was given the notice. If mailing was made by first class
mail sent with a certificate of mailing, the certificate of mailing shall be attached to the affidavit. If the mailing was by certified or registered mail, the
receipt of certification or registration shall be attached to the affidavit.
Thank you!
PrelienPro Technologies, LLC All Rights Reserved OO 2022
Firm Mailing Book For Accountable Mail USPS Form 3877 Facsimile
#Pieces Listed By Sende 9]
#P(eces Rece(ved By Post Office
Postmaster, Per (Name of rece{ving PITNEY BOWES
54.60 4 employee)
f 1 us Poarnoc~M ~ coaREcnoN PosUnark with Date of Receipt
20002„vee / ~ . ,
SP514198670
OCT 26 2022
, ~ ~ ~.
~ ~'
~ ~r
- ~l r j ~~. ,:
Name and Address of Sender.
Batch: 102822•AZ- National Llen Services, LLC Page 2 of 5 BULK PO BOX 51616
SPARKS NV 89436
Notice Number Parties/Addressees USPS Tracking Number
MARICOPA MEADOWS HOA C/O GIN PFZOPERTY
221020-12031 MANAGEMENT CERTIFICATE OF MAILING 4645 E COTTON GIN LOOP
PHOENIX AZ 85040-8885
221025-10222 NORSTAR 9 LLC
221025-11014 2120 E BROADWAY BLVD CERTIFICATE OF MAILING
TUCSON AZ 85719-5938
CAPELLA LTD INVS LLC
221025-10222 890 W GRANT RD CERTIFICATE OF MAILING
TUCSON AZ 85705-5307
NERD CHRIS MAG1S &BULLOCK MARIA CPIRS
221025-11014 7200 W PICTURE ROCKS RD CERTIFICATE OF MAILING
TUCSON AZ 85743-8769
INSIGHT HOMES/ INSIGHT INVESTMENT COMPANY
221025-11170 3561 E SUNRISE DR STE 201 CERTIFICATE OF MAILING
TUCSON AZ 8571&3228
JAG CONSTRUCTION LLC
221025-12405 PD BOX 2346 CERTIFICATE OF MAILING
SUN CITY AZ 85372-2346
BFL PROJECTS fNC DBA BFL BUILDERS
221025-12405 700 E BROADWAY BLVD STE 200 CERTIFICATE OF MAILING
TUCSON AZ 85719-5784
NEXMETRO BROADWAY LLC
221025-12405 2355 E CAMELBACK RD STE 805 CERTIFICATE OF MAILING
PHOENIX AZ 85016-9063
Stone Beach Capital, I.LC
221025-12405 452 5TH AVE FL 28 CERTIFICATE OF MAILING
NEW YORK NY 10018-2771
Prelien Pro All Rights Reserved D 2022
AFFIDAVIT AND PROOF OF SERVICE OF ARIZONA PRELIMINARY TWENTY DAY NOTICE AMY HOUK FIRST DULY SWORN UPON HER OATH DEPOSES AND SAYS: THAT SHE ISA PRINCIPALOF NATIONAL LIEN SERVICES, LLC WHO ARE ACTING IN THEIR CAPACITY AS LIMITED AGENTS FOR: Flooring Systems of Arizona, Inc THAT THE ARIZONA PRELIMINARYTWENTY DAY NOTICE WAS SERVED IN ACCORDANCE WITH ARIZONA STATUTES) A.R.S. § 33-993, et seq. ON OCTOBER 26, 2022 ON ALL PARTIES LISTED BELOW FOR THE PROJECT COMMONLY REFERENCED TO AS: 7200 W PICTURE ROCK Located at: 7200 W PICTURE ROCKS RD, TUCSON, PIMA COUNTY, ARIZONA HEREIN REFERENCED AS NOTICE # 221025-11014 THAT THE ARIZONA PRELIMINARY TWENTY DAY NOTICE WAS SERVED IN ACCORDANCE WITH ARIZONA STATUTES) A.R.S. § 33-993, et seq. TO THE FOLLOWING PARTIES: OWNER REPRESENTATIVE / REPUTED AGENT NORSTAR 9 LLC 2120 E BROADWAY BLVD TUCSON AZ 85719 OWNER OF RECORD /OWNER ON TITLE NERD CHRIS MAGIS & BULLOCK MARIA CP/RS 7200 W PICTURE ROCKS RD TUCSON AZ 85743 THAT THE PROOF OF MAILINGS ARE CERTIFICATE OF MAILING RECEIPTS AND CERTIFIED MAIL RECEIPTS TO THE AFOREMENTIONED PARTIES. ,~ 9~~~ AMY H K, AZCLDP #82039 & #81536 SUBSCRIBED AND SWORN TO BEFORE ME ON DECEMBER 8, 2o2z gY AMY HOOK. MY COMMISSION EXPIRES ON MAY 28, 2023. REBECCA BpTTJEN REBECCA BOTfJEN —NOTARY PUBLIC Notary Public -State ofq~iZona MARICOPq COUNTY ~o~ Commission # 563387 Expires May 28, 2023
Recorded at the Request of:
FLOORING SYSTEMS OF ARIZONA, INC.
i iiiiii iiii iiiii iiiii iiiii i ii iiiii i ii iiiii iiiii iiii i iii i ii iiii SEQUENCE: 20223430284
No. Pages: 20 ~y
12/9/2022 2:19 PM ~ o
9'9I2 0~'P
GABRIELLA CP.ZARES-KELLY, RECORDER
Recorded By: LW(e-recording)
3501 E GOLF LINKS RD
TUCSON, AZ 85713 ~'
PH: (520) 745-0292 ~~
FOR RECORDING IN THE OFFICIAL RECORDS OF PIMA COUNTY, ARIZONA, ~~
GJ
FLOORING SYSTEMS OF ARIZONA, INC, )
Claimant,
vs.
NORSTAR 9 LLC,
Owner Representative /Reputed Agent,
and
CHRIS MAGIS NERD &MARIA BULLOCK,
Owner of Record / Owner on Title,
and
CASTLE MORTGAGE CORP,
Lender /Reputed Lender,
and
MAMBIO FLP,
Lender /Reputed Lender.
STATE OF ARIZONA
ss.
County of Pima )
This document is to inform you that:
NOTICE AND CLAIM OF MECHANIC'S,
MATERIALMEN'S OR PROFESSIONAL
SERVICES LIEN
ARIZONA STATUTES) A.R.S. §33-993, et
seq.
THIS LIEN ENCUMBERS
PIMA COUNTY APN #214-12-0050
1. This lien is effective as of its recordation as reflected on the Recorder's stamp
hereinabove;
2. The party on whose behalf this Mechanic's and Materialmen's Lien is filed is
FLOORING SYSTEMS OF ARIZONA, INC ("Claimant"j, duly registered with the Arizona State
Registrar of Contractors under License No. ROC 264688 and the physical address 3501 E Golf
Links Rd, Tucson, AZ 85713;
3. The undersigned claims a lien upon the property described in this document for,
including but not limited to, Flooring as detailed in the Proposal dated September 21, 2022,
revised October 7, 2022 and November 2, 2022, and signed November 11, 2022, as hereinafter
described;
4. Claimant was contracted by NORSTAR 9 LLC ("Owner Representative"), whose
address is 2120 E Broadway Blvd, Tucson, AZ 85719, in which Claimant furnished material,
equipment and labor under that duly executed September 21, 2022, revised October 7, 2022 and
November 2, 2022, and signed November 11, 2022, a copy of which is attached and incorporated
here as Exhibit A, for the improvement of the following described property of the project
commonly known as 7200 W PICTURE ROCK, located at 7200 W PICTURE ROCKS RD, TUCSON,
PIMA COUNTY, ARIZONA ("Subject Property");
5. The Subject Property is referenced as Pima County Assessor's record 214-12-0050
as evidenced by a copy of said records and legal descriptions attached and incorporated here as
Exhibit e;
6. The name of the Owner on Title of the Subject Property and any improvements
there as identified as CHRIS MAGIS NERO &MARIA BULLOCK, CP/RS ("Owner on Title"), 7200 W
Picture Rocks Rd, Tucson, AZ 85743;
7. Upon information and belief, the following parties have a current financial interest
in the Subject Property:
a. CASTLE MORTGAGE CORPORATION, 4000 MacArthur, Ste 300,
Newport Beach, CA 92660, is named beneficiary under that certain Deed of
Trust duly recorded under Document No. 20212940874 on October 21, 2021
with the Pima County Recorder, incorporated here by this reference; and
b. MAMBIO FLP, 5732 Columbine Rd, Prescott, AZ 86305, is named
beneficiary under that certain Promissory Note duly recorded under Document
No. 20223000052 on October 27, 2022 with the Pima County Recorder,
incorporated here by this reference;
8. That Claimant's improvements to the Subject Property was in the original amount
of Twenty -Two Thousand Six Hundred Sixty-Five Dollars and 00/100 ($22,665.00) pursuant to the
Contract with the final adjusted amount, less just offsets, remaining due and owing claimant
2
Twenty -Two Thousand Six Hundred Sixty-Five Dollars and 00/100 ($22,665.00) representing the remaining balance due, retainage, and change orders, collectively attached and incorporated here as Exhibit C, which verified the reasonable value of the labor, materials, professional services, machinery, fixtures, tools, and/or equipment provided and which balance due remains unpaid; 9. Claimant's knowledge, information and belief, as of the date of the filing of this document, this project is complete, but a Certificate of Occupancy for the Claimant's scope of work has not been issued, nor has a Notice of Completion been filed or served with the appropriate governing body; 10. The Claimant claims its lien against the Subject Property to be charged, after deducting all just credits and offsets, in the amount of Twenty -Four Thousand One Hundred Sixty-Five Dollars and 00/100 ($24,165.00) comprised of the balance remaining of $22,665.00 plus $1,500.00 in currently accrued collection costs associated with the Notice of Lien investigation, preparation, filing, and service of said lien —plus interest on the principal owed accruing at the highest rate allowed pursuant to A.R.S. §44-1201 until paid in full, plus future accruing reasonable attorney's fees, where applicable, and allowed pursuant to A.R.S. §33-995E and A.R.S. §33-998 to pursue foreclosure on this Lien Claim; 11. The Claimant properly served the Arizona Preliminary Twenty Day Notice upon all required recipients and parties in accordance with A.R.S. §33-992.01 on October 26, 2022, a copy of which is attached with corresponding Certificate of Mailing and Affidavit of Service at Exhibit D; and 12. That Claimant claims a lien upon the Subject Property and all structures and improvements including, without limitation, removable, thereon under the benefits of the laws of the State of Arizona relating to liens of Mechanic's, Materialmen, Laborers, and others; WHEREFORE, in accordance with A.R.S. §33-993, for the sums due under the above described Contract in addition to those accrued and for the purpose of satisfying this Claim, the Claimant does claim and fix upon the property this Lien in the amount provided herein by causing the Notice and Claim of Mechanic's, Materialmen's, and Professional Services Lien within a 3 ~I~ v
reasonable time upon the parties herein or any interested person, if they can be found within Pima County, Arizona. Dated this , ~~ti day of December, 2022. FLOORING SYSTEMS OF ARIZONA, INC. ~, ~.. /~,~y ~ /~ ~~_ By. Destry DeLim STATE OF ARIZONA ) )ss. County of Pima I, DESTRY DeLIMA, being first duly sworn on oath according to law, deposes and says: am the Controller of FLOORING SYSTEMS OF ARIZONA, INC. and am authorized to effectuate this Notice and Claim of Lien on its behalf. I have read the foregoing Notice and Claim of Lien, know the contents thereof and state that the same is true of my own personal knowledge, except those matters stated upon information and belief, and, as to those matters, I believe them to be true. ` _J . , DESTRY DeLIMA~ SUBSCRIBED and SWORN TO before me, a Notary Public, on this day personally appeared DESTRY DeLIMA, known to me to be the person and officer whose name is subscribed to the foregoing instrument, who after being by me duly sworn, acknowledged that the statements contained above are true and correct and that she executed the same for the purposes and consideration therein expressed, in the capacity therein stated, and as the act and deed of said FLOORING SYSTEMS OF ARIZONA, INC. r~ _ ~j _ Yl GIVEN UNDER MY HAND this ' day of December, 2022. .~ ~~el Notary~Public in and for ~ima County, State of Arizona [Seal] 4 ~-~~s;, MARIACORELtA r ~_~~~ Notary P1,bec • A~Izona Y ~ Pima County ~M~~~.~ Cort;rrisslor ~ 5963x2 ~ My Comm, Expires Feb i 3, 2025
EXHIBIT A
flooring systems ~: OF ,I ~ 1 %On' ,I 3501 E. Golf Links Rd. Tucson, AZ 85713 Ph: (520) 745-0292 Fax: (520) 745-0929 AZ Contractor's License #ROC 264688 PROPOSAL DATE: 9.21.22 Revised 10.7.22 Revised 11.2.22 ATTENTION: Chris Nero CONII'ANY: Norstar 9 LLC PHONE: EMAIL: FROM: Victor Co►•ella Jr. PROJECT: New LVT and Carpet PROTECT ADDRESS: 7200 W. Picture Rocks Road Addenda Acknowledged: DESCRIPTION OF WORK (Division 9 onlv): Flooring Systems of Arizona is pleased to submit the following pricing for the furnishing of all equipment, materials and labor necessary to install flooring and finishes per plans and specifications on the above referenced Project: Floor prep with Primer and skim coat of existing the $1,750.00 Install Shaw Endura Waterproof Click Flooring in FR, Kitchen, Hall, Panty, DR, hall and Enhy. $8,255.00 Install Quarter Round along cabinets $253.00 Insta114" new Wall Base along perimeter of walls $1,581.00 Install T-mold and End Mold Transitions $290.00 Install Stair nose at edge of sunken Living Room $385.00 Install Shaw Flagstaff Carpet over 7/16" 61b. Pad in upstairs Halls, Bedrooms and Closets (Credit Master Bedroom and Closet $1,345.00) $4,116.00 Install Shaw Endura Click Flooring, in lieu of Carpet with Baseboard and Molding $4,675.00 I-Iandle Furniture Upstairs and Downstairs $800.00 Extra Labor to install Carpet on Stairs 560.00 All for the Sum of $22,665.00 (does not include downstairs Bedroom, Batluoom or Laundry Room) TOTAL AMOUNT TO BE PAID TO CONTRACTOR (taxes if augticable) $22,665.00 TERMS: 0 down payment and progress payments monthly. Price of this contract is based on Flooring Systems invoicing and receiving payment on stored materials (in our warehouse or on jobsite). Due to the continuing escalation of material and transportation costs, this pricing may be withdrawn if not accepted within 15 days of issuance. This job quote shall become a part of any agreed upon contract entered for the job and work quoted. Acceptance of this proposal is expressly limited to the terms, notes and exclusions herein. Flooring Systems of Arizona, Inc. will establish lien rights by filing an Arizona 20 -day preliminary notice as required per ARS 33- 992.01. NOTE: Flooring Systems of Arizona will not warranty any product due to exceeding moistu~~e levels recommended by the Manufacturer. We conduct Calcium Chloride and/or RHT moisture testing as recommended by ASTM E-1907-04 and F-
.= flooring systems OR ,I ll l %01 :1 3501 E. Golf Links Rd. Tucson, AZ 85713 Ph. X520) 745-0292 Fax: (520) 745-0929 AZ Contractor's License #ROC 264688 TAXES WHEN APPLICABLE ARC SHOWN ABOVE... PROJECT ESTIMATED DATE OF COMPLETION: / / FLOORING SYSTEMS OF ARIZONA AUTHORIZED REPRESENTATIVE; Printed Name: Authorized Signature: Date: Pursuant to Arizona law we are required to inform you of your right to file a written complaint with the Registrar of Contractors for an alleged violation of Arizona Revised Statutes section 32-1154, subsection A. Any complaints -must - be made within - the applicable time-.period as set forth in section 32-1155; subsection A.The ROC can be contacted aY(602} 542-1525 or online at http://www:azroc.gov: We request that if any portion of our work is unsatisfactory that you notify us prior to filing a complaint so we:can attempt to resolve any concerns! ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted. You ar~aU~horized to do th~ work as specified. Payment will be made as outlined above. Printed Name: Authorized Signature: Date: l / L
EXH 161T 6 ~~
12/8/22, 2:10 PM Pima County Assessor's Office Parcel Number: 214-12-0050 Property Address Street Number Street Direction Street Name Location 7200 W PICTURE ROCKS RD Pima County Contact Information Property Owner Information: NERD CHRIS MAGIS &BULLOCK MARIA CPlRS 7200 W PICTURE ROCKS RD TUCSON AZ 85743-8769 Valuation Data Property Appraiser: Rachel Valenzuela Phone: (520) 724-7427 Valuation Year Property Class Assessment Ratio 2022 RES OTHER (4) 10.0 2023 RES OTHER (4) 10.0 Property Information Property Description: PT OF W275' OF E1444.97' OF SE4 5.07 AC SEC-4-13-12 Total FCV Limited Value Limited Assessed $410,546 $410,546 541,055 $499,175 $431,073 $43,107 Township: 13.0 Section: 4 Ranpe: 12.0E Map: Plat: Block: Tract: Land Measure: 5.07A Lot: Census Tract: 4406 File Id: 1 Group Code: 000 Use Code: 8712 (SFR ON > 5 AC URBAN NON SUBDIVIDED) Date of Last Change: 11 /5/2021 Sales Information (1) Affidavit of Fee No. Parcel Count Sale Date Property Type Sale Time Adjusted Sale Cash Validation 20060501209 1 2/2006 Unknown $820,000 $820,000 N X RJK Valuation Area District Supervisor: SHARON BRONSON District No: 3 DOR Market Land Subarea Neighborhood Sub ID Economic District 44 1101034 DEL 01006906 00000 DEL 11 https://www.asr.pima.gov/Parcel/Index 1/3
12/8/22, 2:10 PM Recording Information (5) Sequence No. 20212940873 20191290648 20183030371 20060501209 0 Residential Characteristics Main Structure: Pima County Assessor's Office Docket Page Date Recorded Type 0 0 10/21/2021 WTDEED 0 0 5/9/2019 WTDEED 0 0 10/30/2018 DEEDTR 12761 6697 3/15/2006 VYfDEED 8585 404 7/24/1989 Appreisel Date: 11 /3D/2012 Property Type: Single Family Residence Area ID: Ed 1 1-010069-06-4 Processed: 12/31 /1969 Bulldfng Class: 4 Physical Condklon: Good Total LIW~g Area: 4,574 Garage type: Garage Effective Constructlon Year: 1993 Garege Capacity: 3 Stories: 2 Patio Type: Covered Rooms: 9 Patio Number: 5 Quality: Good Pool Area: 450 Exterior Walls: Slump Block Valuation Type: 00 Roof Type: Tile Total Main: $413,224 Heating: Forced Total Control: $413,224 Coding: Refrigeration Total Actual: $499.175 Bath Fixtures: 1 S FCV Adjustment Factor: 1.000 Enhancement: $17,450 Leat Calc: 0913 Enhancement: Description Quality Construction Value Storage 61dg Average Block $9.000 Storage Bldg Average Block $8,450 Petition Information (3) Tax Year Owner's Estimate 2004 $382,295 2003 $352,198 2002 $365,920 https://www.asr.pi ma.gov/Pa rce I/Index Petition Work Up 2/3
12/8/22, 2:10 PM Pima County Assessor's Office Notes (4) Created: 5/2/2019 2020 supp to class 4.01 non- primary financial institutions do not qualify rule a Modified: 5/2/2019 Created:ll/30/2012 Unidentified Enhancement Review: No answerto letters. Story Count 1.5>2, Porch Count COVERED-4>COVERED-5, Enhancement ID #66 Modified:ll /30/2012 for 360 SQ FT Average Brick Storage Room, Enhancement ID # 66 for 338 SQ FT Average Brick Storage Room, for 2014N. Created: 10/16/2012 Unidentified Enhancement Review: Field checked 10/12/2012, no answer. Updated drawing and sent 1st letter 10/16/2012, sent 2nd Modified: 10/29/2012 letter 10/29/2012. Created: 6/24/2003 A-LEVEL OK Modified: 6/24/2003 https://www.asr.pima.gov/Parcel/Index 3/3
LEGAL DESCRIPTION: PARCEL NUMBER: 214-12-0050 LEGAL DESCRIPTION: PT OF W275' OF E1444.97' OF SE4 5.07 AC SEC-4-13-12 WARRANTY DEED: 20212940873 ~~
EXHIBITC
Flooring Systems of AL t 3501 E. Golf Links Rd Tucson, AZ 85713 Bill To Cl-IItIS NERD 2120 E BROADWAY BLVD #108 TUCSON, A1, 85719 Ship To !OB #22-650 7200 W PICTURE ROCKS TUCSON, AZ 85743 Invoice Date Invoice # ~a~bno22 ~z.22.226so P.O. Number Terms Rep Ship Via F.O.B. Project VGR 12/6/2022 22-650 - 7200 W PICTURE R... Quantity Item Code Description Price Each Amount Residential F[,OOR PREP Wl"CH PRIMER AND SKIM COAT OF 1,750.00 1,750.00 EXISTING TILE Residential INSTALL SHW ENDURA WATERPROOF CLICK 8,255.00 8,255.00 FLOORING IN FR,KITCHEN,HALL,PANTRY,AR,HALL AND ENTRY Residential INSTALL QUARTER ROiJND ALONG CABINETS 253.00 253.00 Residential , ; INSTALL 4" NEW WALL BASE ALQNGPERIIvfETER OF 1,5$1.00- 1,581.00 WALLS Residential MSTALL T MOLD AND GND MOLD TRANSITIONS 290.00 290.00 Residential INSTALL STAIR NOSE AT EDGE OF SiJNKEN LIVING 385.00 385.00 ROOM Residential INSTALL SHAW FLAGSTAFF CARPET OVER 7/16 6 LB 4, t 16.00 4,116.00 PAU IN UPSTAIItS HAI.I,S,BEDROOMS AND CLOSETS(CREDIT MASTER BEDROOM AND CLOSEST $1,345.00) Residential INSTALL SHAW SNDUItA CLICK FLOORING IN LIEU O~ 4,675.00 4,675.00 CARPET WI'T'H BASEBOARD AND MOLDING Residential HANDLE FURNITURE UPSTAIRS AND DOWNSTAIRS 800.00 800.00 Residential EXTRA LABOR TO INSTALL CARPET ON STAIRS 560.00 560,00 Sales Tax 5,655% 0.00 ~~ Total ~ x22,665.00
EXHIBIT D
~~ Arizona Preliminary Twenty Day Notice N,~u~ ~Nn~ t u ~~ikv~c~> In accordance with ARIZONA STATUTES) A.R.S. § 33-993, et seq., this is not a lien. This is not a reflection on the integrity of any contractor or subcontractor. NOTICE NUMBER: 221025-11014 The name and address of the person or firm who conVacted for the purchase of such labor, materials, machinery, fixtures, tools, or professional services: NORSTAR 9 LLC 2120 E BROADWAY BLVD TUCSON AZ 85719 OWNER REPRESENTATIVE /REPUTED OWNER OF RECORD /OWNER ON TITLE CONSTRUCTION LENDER UNAVAILABLE AGENT NERO CHRIS MAGIS &BULLOCK MARIA TO CLAIMANT "LENDER INFORMATION, NORSTAR 9 LLC CPlRS IF ANY, IS HEREBY REQUESTED"* 2120 E BROADWAY BLVD 7200 W PICTURE ROCKS RD TUCSON AZ 85719 TUCSON AZ 85743 Claimant: Flooring Systems of Arizona, Inc. ~ 3501 E GOLF LINKS RD ~ TUCSON AZ 85713 YOU ARE HEREBY NOTIFIED THAT we have furnished labor, materials, machinery, fixtures, tools or professional services of the following general description: FLOORING (JOB# 22-650) in the construction, alteration or repair of the building, structure or improvement located at 7200 W PICTURE ROCKS RD and situated upon that certain lots) parcels) of land in TUCSON, Pima County, in the state of Arizon8 , legally described as and/or commonly referred to as: 7200 W PICTURE ROCK An estimate of the total price of the labor, materials, machinery, fixtures, tools, or professional services furnished or to be furnished is: $19,415.00 TOTAL NOTICE TO PROPERTY OWNER If bills are not paid in full for the labor, professional services, materials, machinery,fixtures or tools furnished or to be furnished, a mechanic's lien leading to the loss, through court foreclosure proceedings, of all or part of your property being improved may be placed against the property. You may wish to protect yourself against this consequence by either: Requiring your contractor to furnish a conditional waiver and release pursuant to state statutes signed by the person or firm giving you this notice before you make payment to your contractor. Requiring your contractor to furnish an unconditional waiver and release pursuant to state statutes signed by the person or firm giving you this notice after you make payment to your contractor. Using any other method or device that is appropriate under the circumstances. WITHIN TEN DAYS OF RECEIPT OF THIS NOTICE THE OWNER OR OTHER INTERESTED PARTY IS REQUIRED TO FURNISH ALL INFORMATION NECESSARY TO CORRECT ANY INACCURACIES IN THE NOTICE OR LOSE AS A DEFENSE ANY INACCURACY OF THAT INFORMATION. WITHIN TEN DAYS OF THE RECEIPT OF THIS NOTICE, IF ANY PAYMENT BOND HAS BEEN RECORDED, THE OWNER MUST PROVIDE A COPY OF THE PAYMENT BOND INCLUDING THE NAME AND ADDRESS OF THE SURETY COMPANY AND BONDING AGENT PROVIDING THE PAYMENT BOND TO THE PERSON WHO HAS GIVEN THE NOTICE. IN THE EVENT THAT THE OWNER OR OTHER INTERESTED PARTY FAILS TO PROVIDE THE BOND INFORMATION WITHIN THAT TEN DAY PERIOD, THE CLAIMANT SHALL RETAIN LIEN RIGHTS TO THE EXTENT PRECLUDED OR PREJUDICED FROM ASSERTING A CLAIM AGAINST THE BOND AS A RESULT OF NOT TIMELY RECEIVING THE BOND INFORMATION. Claimant: Flooring Systems of Arizona, Inc. Date: Wednesday October 26th, 2022 Proteselonally preparetl and servntl on behalf of elelmanl by: ~ ~ ~., NATIONAL LIEN SERVICES, LLC '' PO BOX 51616 I SPARKS, NV 89435 AMY K ~' Email: info~NationalLienServices.com AZCLDP #82039 8~ #81536 PrelienPro Technologies, LLC All Rights Reserved OO 2022 AZ-PN 3.0