Item #14 Addendum to City of Ocoee/Colburn Development Agreement - Maine Street FOLEY
FOLEY & LARDNER LLP
ATTORNEYS AT LAW
AGENDA ITEM COVER SHEET
Meeting Date: December 7, 2010
Item # 14
Reviewed By:
Contact Name: Paul E. Rosenthal, City Assistant City Craig Shadrix
Attorney Manager:
Contact Number: City Manager: Rob Frank
Subjects Add ; « g e /Colburn Development Agreement .1 Maine Street •
Background Summary:
In November 1998 the City entered into a Development Agreement with the Colburn family which
addressed various matters related to the development of their property along the east and west
sides of Bluford Avenue. The Agreement addressed the future development of Maine Street and
required that Colburn convey to the City approximately 3.0 acres +/- located south of the existing
Maine Street and north of the proposed Relocated Maine Street, all on the east side of Bluford
Avenue. This land is referred to as the "Park Land" and is part of what is referred to as the
"Donated Lands" in the Development Agreement. Attached hereto is Exhibit "E" from the
Development Agreement which depicts the location of the Park Land. The Colburn's do not receive
any road impact fee credits or other compensation in connection with the conveyance of the Park
Land, but do retain its vested rights for the benefit of their property on the west side of Bluford. In
order to facilitate the construction of Relocated Maine Street as part of the RAM Development
(Downtown Ocoee), the City has requested that Colburn proceed with the conveyance of the Park
Land at this time.
In connection with the conveyance of the Park Land, it is desirable for the City and
Colburn /Cambria to enter in an Addendum to the Development Agreement (copy attached). The
proposed Addendum provides for a specific legal description for the Park Land to be conveyed and
addresses other terms of the conveyance. Additionally, the Addendum confirms that the City has
no restrictions on its future use of the Park Land and may convey a portion thereof to third parties,
including the owner of the Downtown Ocoee project. The Addendum also provides for the City to
reaffirm the vested rights granted in 1999 to the Colburn property on the west side of Bluford.
These changes are beneficial to the City.
The legal description attached to the proposed Addendum has been provided by Colburn /Cambria
and is subject to revision based upon a survey of the Park Land. The final surveyed legal
description or such other description as may be approved by City staff will be addressed to the
LA_ 1665403.1
Addendum prior to execution by the City.
Colburn /Cambria intends to seek a charitable deduction on its taxes with respect tot the
conveyance of the Park Land. In connection therewith, they have requested that the City sign Part
IV, Donee Acknowledgement, of IRS Firm 8283 (copy attached). The City is making no
representation as to the value of the Park Land or as to whether it is eligible for a charitable
deduction. The City is acknowledging receipt of the property and certifying that it is a qualified
organization under section 170(c) of the Internal Revenue Code. IRC Section 170(c) provides the
definition for "Charitable contribution" as "a contribution to or for the use of (1) A State, a
possession of the United States, or any political subdivision of any of the foregoing...but only if the
contribution or gift is made for exclusively public purposes." The City of Ocoee qualifies as a
political subdivision of a State and so it would constitute a qualified organization under 170(c),
assuming the "exclusively public purposes" requirement quoted above is satisfied. If the City
disposes of any portion of the Park Land within 3 years, it would be required to file a form so
advising the IRS and give a copy to Colburn /Cambria. City staff has no objection to the City signing
the Form as requested. The proposed Addendum includes a provisions which addresses the
foregoing.
Issue:
Should the City Commission approve the proposed Addendum to the Colburn Development
Agreement?
Recommendations
It is recommended that the City Commission approve the Addendum to the Colburn Development
Agreement and authorize execution thereof by the Mayor and City Clerk with staff be authorized to
attached the final approved legal description of the Park Land, and in connection with the
conveyance of the Park Land from Colburn /Cambria to the City authorize the Mayor the sign Part IV
of IRS Form 8283.
Attachments:
1. Exhibit E to Development Agreement
2. Addendum to the Colbum Development Agreement
3. IRS Form 8283
Financial Impact:
NONE
..A_1665403.1
Type of Item:
❑ Public Hearing For Clerk's Dept Use:
❑ Ordinance First Reading ❑ Consent Agenda
❑ Ordinance First Reading ❑ Public Hearing
❑ Resolution XX❑ Regular Agenda
XX❑ Commission Approval
❑ Discussion & Direction
El Original Document/Contract Attached for Execution by City Clerk
XX❑ Original Document/Contract Held by Department for Execution
Reviewed by City Attorney Paul E, Rosenthal ❑ N/A
Reviewed by Finance Dept. ❑ N/A
Reviewed by ( Craig Shadrix, Assistant City Manager ❑ N/A
4_1665403.1
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THIS INSTRUMENT PREPARED BY
AND SHOULD BE RETURNED TO:
Paul E. Rosenthal, Esq.
FOLEY & LARDNER LLP
111 North Orange Avenue, Suite 1800
Post Office Box 2193
Orlando, FL 32802 -2193
(407) 423-7656
RETURN TO:
Beth Eikenberry, City Clerk
City of Ocoee
150 N. Lakeshore Dr.
Ocoee, FL 34761
For Recording Purposes Only
ADDENDUM TO
CITY OF OCOEE / COLBURN
DEVELOPMENT AGREEMENT
THIS ADDENDUM is made and entered into this day of December 2010, by and
between WILLIAM E. COLBURN AND JOHN D. COLBURN (collectively, "Colburn "),
CAMBRIA, a Florida general partnership ( "Cambria ") and the CITY OF OCOEE, FLORIDA,
a municipal corporation existing under the laws of the State of Florida (hereinafter "City ").
RECITALS
1. Colburn, CCN INVESTMENTS, INC., a Florida corporation, formerly known as
CYPRESS CREEK NURSERY, INC., (hereinafter "CCN "), Cambria and the City, previously
entered into the City of Ocoee /Colburn Development Agreement dated November 17, 1998 as
recorded in Official Records Book 5623, Page 2313 of the Public Records of Orange County,
Florida (hereinafter the "Agreement ").
2. Colburn and Cambria are the current owners of the Park Land as defined in the
Agreement.
3. Colonial Bluford LLC ( "Colonial Bluford ") is the current owner of all of the East
Property except for the Park Land.
4. Colburn and Cambria are required to convey the Park Land to the City pursuant to
the provisions of Section 4 of the Agreement.
5. Colburn, Cambria and the City desire to address certain matters in connection
with the conveyance of the Park Land which do not affect the rights of Colonial Bluford or CCN
under the Agreement.
ACCORDINGLY, in consideration of the Recitals hereof, and of the mutual covenants
and conditions contained herein, and other good and valuable consideration, the receipt and
ORLA_1661449.1
sufficiency of which are acknowledged by the parties, Colburn, Cambria and the City hereby
agree as follows:
SECTION 1. RECITALS. The above Recitals are true and correct, and form a material
part of this Agreement.
SECTION 2. DESCRIPTION OF PARK LAND. The parties agree that the Park
Land shall comprise that tract of land consisting of approximately acres as described
in Exhibit "A" attached hereto and incorporated by reference in this Addendum.
SECTION 3. CONVEYANCE OF PARK LAND. With respect to the conveyance
of the Park Land, the following shall apply in lieu of the provisions of Section 4.3 of the
Agreement:
(a) The conveyance of the Park Land shall be by general warranty deed, free and clear of
all liens and encumbrances, except for easements of record, if any, but subject to the Permitted
Encumbrances. The form of deed shall be prepared by the City consistent with this Agreement,
subject to the approval of Colburn and Cambria not to be unreasonably withheld. The
descriptive title ascribed to the Park Land is intended for convenience only and not as a
limitation on the use of such land by the City. Colburn and Cambria acknowledge that the City
may elect to dispose of or otherwise convey all or a portion of the Park Land to third parties,
including but not limited to Colonial Bluford, on such terms and conditions as may be
determined by the City in its sole and absolute discretion.
(b) The instrument of conveyance shall transfer all of the Colburn and Cambria interest in
and to all tenements, hereditaments and appurtenances belonging or in anywise appertaining to
the Park Land, including without limitation of the foregoing, all right, title and interest of
Colburn and Cambria in and to any land lying in the bed of Maine Street and any other street,
alley, road or avenue (before or after vacation thereof, and whether previously abandoned or
vacated or hereafter abandoned or vacated) in front of or adjoining the Park Land to the center
line thereof.
(c) In connection with the conveyance of the Park Land, Colburn and Cambria have
requested that the City execute Part IV, Donee Acknowledgment, of IRS Form 8283. The City
agrees to execute such form with the understanding that the City makes no warranty,
representation or guaranty regarding whether or not Colburn and Cambria are entitled to claim a
deduction on their tax returns in connection with the conveyance of the Park Land to the City.
SECTION 4. VESTED RIGHTS. The City has previously issued to Colburn and
Cambria Certificate of Vesting Number CV -99 -01 dated February 16, 1999, which Certificate
remains in full force and effect. The City hereby reaffirms the provisions of Section VI.13 of the
Certificate of Vesting which provides that upon conveyance of the Park Land to the City the
West Property will be allowed to be developed as a vested parcel for commercial purposes in
accordance with the City's C -2 zoning district, as it may from time to time be amended.
SECTION 5. EFFECT OF THIS ADDENDUM. Except as expressly provided in
this Addendum, the Agreement shall remain unchanged and is hereby ratified and confirmed.
Nothing contained in this Addendum shall be construed to affect the rights of CCN and Colonial
Bluford under the Agreement.
2
ORLA_1661449.1
IN WITNESS WHEREOF, the Colburn, Cambria and the City have caused this
instrument to be executed as of the day and year first above written.
Signed, sealed and delivered CITY
before these witnesses:
CITY OF OCOEE, a Florida municipal
corporation
By:
Print Name: S. SCOTT VANDERGRIFT, Mayor
Attest:
BETH EIKENBERRY, City Clerk
Print Name:
(SEAL)
FOR USE AND RELIANCE BY THE
CITY OF OCOEE, FLORIDA;
APPROVED AS TO FORM AND APPROVED BY THE OCOEE CITY
LEGALITY this day of COMMISSION AT A MEETING HELD ON
,2010 ,2010 UNDER
AGENDA ITEM NO.
FOLEY & LARDNER LLP
By:
City Attorney
STATE OF FLORIDA
COUNTY OF ORANGE
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and
County aforesaid to take acknowledgments, personally appeared S. SCOTT VANDERGRIFT and BETH
EIKENBERRY, personally known to me to be the Mayor and City Clerk, respectively, of the CITY OF
OCOEE and that they severally acknowledged executing the same in the presence of two subscribing
witnesses freely and voluntarily under authority duly vested in them by said municipality. They are
personally known to me.
WITNESS my hand and official seal in the County and State last aforesaid this day of
December, 2010.
Signature of Notary Public
Print Notary Name
My Commission Expires:
AFFIX NOTARY STAMP Commission No.:
3
ORLA_1661449.1
Signed, sealed and delivered COLBURN:
before these witnesses:
Print Name: WILLIAM E. COLBURN
Print Name:
Print Name: JOHN D. COLBURN
Print Name:
CAMBRIA, a Florida general partnership
By:
Print Name:
Name:
Title:
Print Name:
4
ORLA_1661449.1
STATE OF FLORIDA
COUNTY OF
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and
County aforesaid to take acknowledgments, personally appeared WILLIAM E. COLBURN, [ ] who is
personally known to me, or [ ] who produced as identification, and
that he acknowledged executing the same in the presence of two subscribing witnesses freely and
voluntarily.
WITNESS my hand and official seal in the County and State last aforesaid this day of
December, 2010.
Signature of Notary Public
Print Notary Name
My Commission Expires:
AFFIX NOTARY STAMP Commission No.:
STATE OF FLORIDA
COUNTY OF
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and
County aforesaid to take acknowledgments, personally appeared JOHN D. COLBURN, [ ] who is
personally known to me, or [ ] who produced as identification, and
that he acknowledged executing the same in the presence of two subscribing witnesses freely and
voluntarily.
WITNESS my hand and official seal in the County and State last aforesaid this day of
December, 2010.
Signature of Notary Public
Print Notary Name
My Commission Expires:
Y P
AFFIX NOTARY STAMP Commission No.:
5
ORLA_1661449.1
STATE OF FLORIDA
COUNTY OF
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and
County aforesaid to take acknowledgments, personally appeared , as General
Partner, of CAMBRIA, a Florida general partnership, [ ] who is personally known to me, or [ ] who
produced as identification, and that he acknowledged executing the
same in the presence of two subscribing witnesses freely and voluntarily.
WITNESS my hand and official seal in the County and State last aforesaid this day of
December, 2010.
Signature of Notary Public
Print Notary Name
My Commission Expires:
AFFIX NOTARY STAMP Commission No.:
6
ORLA_1661449.1
EXHIBIT "A"
PARK LAND
LAND DESCRIPTION
CAMBRIA PORTION OF PARK LAND
A PORTION OF THE SOUTHWEST ONE - QUARTER (SW '/) OF SECTION 20,
TOWNSHIP 22 SOUTH, RANGE 28 EAST, ORANGE COUNTY, FLORIDA, BEING MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
COMMENCE AT THE SOUTHEAST CORNER OF THE SOUTHWEST ONE - QUARTER
(SW '/) OF SAID SECTION 20; THENCE SOUTH 89 °44'53" WEST ALONG THE SOUTH
LINE OF THE SOUTHWEST ONE QUARTER (SW '/) OF SAID SECTION 20, A
DISTANCE OF 1330.55 FEET; THENCE NORTH 00 °30'50" WEST ALONG THE EAST
LINE OF THE WEST ONE -HALF (W %2) OF THE SOUTHWEST ONE - QUARTER (SW '/)
OF SAID SECTION 20, A DISTANCE OF 1348.57 FEET; THENCE NORTH 89 °30'01"
WEST, 7.50 FEET TO A POINT ON THE ARC OF A NON - TANGENT CURVE (RADIAL
LINE THROUGH SAID POINT BEARS SOUTH 29 °51'31" EAST); THENCE WESTERLY
ALONG THE ARC OF SAID NON - TANGENT CURVE BEING CONCAVE TO THE
SOUTH, HAVING A RADIUS OF 520.00 FEET, A CENTRAL ANGLE OF 05 °34'44 ", AN
ARC DISTANCE OF 50.63 FEET TO A POINT OF REVERSE CURVATURE; THENCE
WESTERLY ALONG THE ARC OF SAID REVERSE CURVE, BEING CONCAVE TO THE
NORTH, HAVING A RADIUS OF 380.00 FEET, A CENTRAL ANGLE OF 35 °56'13 ", AN
ARC DISTANCE OF 238.34 FEET; THENCE NORTH 89 °30'01" WEST, 266.60 FEET,
THENCE WESTERLY ALONG THE ARC OF A TANGENT CURVE, BEING CONCAVE
TO THE NORTH, HAVING A RADIUS OF 640.78 FEET, A CENTRAL ANGLE OF
11°08'39", AN ARC DISTANCE OF 124.63 FEET TO THE POINT OF BEGINNING;
THENCE CONTINUE ALONG THE ARC OF SAID CURVE, BEING CONCAVE TO THE
NORTH, HAVING A RADIUS OF 640.78 FEET, A CENTRAL ANGLE OF 4 °01'45 ", AN
ARC DISTANCE OF 45.06 FEET TO A POINT OF REVERSE CURVATURE; THENCE
WESTERLY ALONG THE ARC OF SAID REVERSE CURVE, BEING CONCAVE TO THE
SOUTH, HAVING A RADIUS OF 220.00 FEET, A CENTRAL ANGLE OF 51°49'59", AN
ARC DISTANCE OF 199.03 FEET; THENCE SOUTH 53 °60'03" WEST, 36.39 FEET;
THENCE NORTH 36 °03'35" WEST ALONG THE EASTERLY RIGHT -OF -WAY OF
BLUFORD AVENUE, 275.35 FEET; THENCE CONTINUE ALONG THE EASTERLY
RIGHT -OF -WAY OF BLUFORD AVENUE NORTHWESTERLY ALONG THE ARC OF A
TANGENT CURVE, BEING CONCAVE TO THE NORTHEAST, HAVING A RADIUS OF
1688.83 FEET, A CENTRAL ANGLE OF 07 °56'49 ", AN ARC DISTANCE OF 234.24 FEET;
THENCE SOUTH 61 °59'51" EAST, 480.76 FEET; THENCE EASTERLY ALONG THE ARC
OF A TANGENT CURVE, BEING CONCAVE TO THE NORTH, HAVING A RADIUS OF
540.78 FEET, A CENTRAL ANGLE OF 14 °02'29 ", AN ARC DISTANCE OF 132.53 FEET
(THE LAST TWO (2) COURSES DESCRIBED BEING COINCIDENT WITH THE
SOUTHERLY RIGHT -OF -WAY OF MAINE STREET); THENCE SOUTH 00 °29'51" EAST,
102.79 FEET TO THE POINT OF BEGINNING.
SAID LANDS LYING IN THE CITY OF OCOEE, ORANGE COUNTY, FLORIDA,
CONTAINING 1,873 ACRES, MORE OR LESS.
7
ORLA_1661449.1
LAND DESCRIPTION
COLBURN PORTION OF PARK LAND
A PORTION OF THE SOUTHWEST ONE - QUARTER (SW ') OF SECTION 20,
TOWNSHIP 22 SOUTH, RANGE 28 EAST, ORANGE COUNTY, FLORIDA, BEING MORE
PARTICULARLY DESCRIBED AS FOLLOWS:
COMMENCE AT THE SOUTHEAST CORNER OF THE SOUTHWEST ONE - QUARTER
(SW 'A) OF SAID SECTION 20; THENCE SOUTH 89 °44'53" WEST ALONG THE SOUTH
LINE OF THE SOUTHWEST ONE - QUARTER (SW ' /4) OF SAID SECTION 20, A
DISTANCE OF 1330.55 FEET; THENCE NORTH 00 °30'50" WEST ALONG THE EAST
LINE OF THE WEST ONE -HALF (W 'A) OF THE SOUTHWEST ONE - QUARTER (SW '/)
OF SAID SECTION 20, A DISTANCE OF 1348.57 FEET; THENCE NORTH 89 °30'01"
WEST, 7.50 FEET TO THE POINT OF BEGINNING (RADIAL LINE THROUGH SAID
POINT BEARS SOUTH 29 °51'31" EAST); THENCE WESTERLY ALONG THE ARC OF
SAID NON - TANGENT CURVE, BEING CONCAVE TO THE SOUTH, HAVING A RADIUS
OF 520.00 FEET, A CENTRAL ANGLE OF 05 °34'44 ", AN ARC DISTANCE OF 50.63 FEET
TO A POINT OF REVERSE CURVATURE; THENCE WESTERLY ALONG THE ARC OF
SAID REVERSE CURVE, BEING CONCAVE TO THE NORTH, HAVING A RADIUS OF
380.00 FEET, A CENTRAL ANGLE OF 35 °58'13 ", AN ARC DISTANCE OF 238.34 FEET;
THENCE NORTH 89 °30'01" WEST, 266.60 FEET; THENCE WESTERLY ALONG THE
ARC OF A TANGENT CURVE, BEING CONCAVE TO THE NORTH, HAVING A RADIUS
OF 640.78 FEET, A CENTRAL ANGLE OF 11 °08'39 ", AN ARC DISTANCE OF 124.63
FEET, THENCE NORTH 00 °29'51" WEST, 102.79 FEET TO A POINT ON THE ARC OF A
NON - TANGENT CURVE (RADIAL LINE THROUGH SAID POINT BEARS NORTH
13 °57'40" EAST); THENCE EASTERLY ALONG THE ARC OF SAID NON - TANGENT
CURVE, BEING CONCAVE TO THE NORTH, HAVING A RADIUS OF 540.78 FEET, A
CENTRAL ANGLE OF 13 °27'42 ", AN ARC DISTANCE OF 127.06 FEET; THENCE SOUTH
89 °30'01" EAST, 531.75 FEET TO THE POINT OF BEGINNING (THE LAST TWO (2)
COURSES DESCRIBED BEING COINCIDENT WITH THE SOUTHERLY RIGHT -OF -WAY
OF MAINE STREET).
SAID LANDS LYING IN THE CITY OF OCOEE, ORANGE COUNTY, FLORIDA,
CONTAINING 1.307 ACRES, MORE OR LESS.
8
ORLA_1661449.1
Form 8283 Noncash Charitable Contributions
OMB No. 1545 -0908
(Rev. December 2006) I. Attach to your tax return if you claimed a total deduction
department of the Treasury of over $500 for all contributed property.
Attachment
internal Revenue Service ► See separate instructions. Sequence No. 155
Names) shown on your income tax retum Identifying number
Note. Figure the amount of your contribution deduction before completing this form. See your tax return instructions.
Section A. Donated Property of $5,000 or Less and Certain Publicly Traded Securities —List in this section only
items (or groups of similar items) for which you claimed a deduction of $5,000 or less. Also, list certain
publicly traded securities even if the deduction is more than $5,000 (see instructions).
Part I Information on Donated Property —lf you need more space, attach a statement.
(a) Name and address of the (b) Description of donated property
1 donee organization (For a donated vehicle, enter the year, make, model, condition, and mileage,
and attach Form 1098 -C if required.)
A
B
C
D
E
Note. If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (d), (e), and (f).
f (c) Date of the (d) ate acquired ) q (e) How acquired (f) Donor's cost (g) Fair market value
R�3.,- (h) Method used to determine
contribution by donor (mo., yr.) by donor or adjusted basis (see instructions) the fair market value
A
B
C _
Part 11 Partial Interests and Restricted Use Property— Complete lines 2a through 2e if you gave less than an
entire interest in a property listed in Part I. Complete lines 3a through 3c if conditions were placed on a
contribution listed in Part I; also attach the required statement (see instructions).
2a Enter the letter from Part I that identifies the property for which you gave less than an entire interest ►
If Part 11 applies to more than one property, attach a separate statement.
b Total amount claimed as a deduction for the property listed in Part 1: (1) For this tax year ►
(2) For any prior tax years ►
c Name and address of each organization to which any such contribution was made in a prior year (complete only if different
from the donee organization above):
Name of charitable organization (donee)
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
d For tangible property, enter the place where the property is located or kept ►
e Name of any person, other than the donee organization, having actual possession of the property ►
3a Is there a restriction, either temporary or permanent, on the donee's right to use or dispose of the donated Yes No
property?
b Did you give to anyone (other than the donee organization or another organization participating with the donee - -
organization in cooperative fundraising) the right to the income from the donated property or to the possession of z `, ''
the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or�`
to designate the person having such income, possession, or right to acquire?
c Is there a restriction limiting the donated property for a particular use?
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 62299J Form 8283 (Rev. 12 -2006)
Form 8283 (Rev. 12 -2006) Page 2
Name(s) shown on your income tax return Identifying number
Section B. Donated Property Over $5,000 (Except Certain Publicly Traded Securities)—List in this section only items (or groups of similar
items) for which you claimed a deduction of more than $5,000 per item or group (except contributions of certain publicly traded
securities reported in Section A). An appraisal is generally required for property listed in Section B (see instructions).
Part I Information on Donated Property—To be completed by the taxpayer and /or the appraiser.
4 Check the box that describes the type of property donated:
❑ Art' (contribution of $20,000 or more) ❑ Qualified Conservation Contribution ❑ Equipment
❑ Art' (contribution of less than $20,000) ❑ Other Real Estate ❑ Securities
❑ Collectibles" ❑ Intellectual Property ❑ Other
'Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antiques, decorative arts, textiles, carpets, silver, rare manuscripts, historical memorabilia, and
other similar objects.
"Collectibles include coins, stamps, books, gems, jewelry, sports memorabilia, dolls, etc., but not art as defined above.
Note. In certain cases, you must attach a qualified appraisal of the property. See instructions.
5 (a) Description of donated property (if you need (b) If tangible property was donated, give a brief summary of the overall (c) Appraised fair
more space, attach a separate statement) physical condition of the property at the time of the gift market value
A
B
C
D
(d) Date acquired (e) How acquired (f) Donor's cost or (g) For bargain sales, enter See instructions
by donor (mo., yr.) by donor adjusted basis amount received (h) Amount claimed as a (i) Average trading price
deduction of securities
A
B
c
D
Part II Taxpayer (Donor) Statement —List each item included in Part I above that the appraisal identifies as having
a value of $500 or less. See instructions.
I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500
(per item). Enter identifying letter from Part I and describe the specific item. See instructions. •
Signature of taxpayer (donor) • Date •
Part III Declaration of Appraiser
1 declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or
married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the transaction, I performed the majority of my
appraisals during my tax year for other persons.
Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications as described in the
appraisal, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based on a percentage of the appraised property
value. Furthermore, I understand that a false or fraudulent overstatement of the property value as described in the qualified appraisal or this Form 8283 may subject me to
the penalty under section 6701(a) (aiding and abetting the understatement of tax liability). In addition, I understand that a substantial or gross valuation misstatement
resulting from the appraisal of the value of the property that I know, or reasonably should know, would be used in connection with a return or claim for refund, may subject
me to the penalty under section 6695A. I affirm that I have not been barred from presenting evidence or testimony by the Office of Professional Responsibility.
Sign
Here I Signature • Title • Date P.
Business address (including room or suite no.) Identifying number
City or town, state, and ZIP code
Part IV Donee Acknowledgment — To be completed by the charitable organization.
This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property as described
in Section B, Part I, above on the following date •
Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B. Part I (or any
portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donor a copy of that
form. This acknowledgment does not represent agreement with the claimed fair market value.
Does the organization intend to use the property for an unrelated use? ■ ❑ Yes ❑ No
Name of cnaritable organization (donee) Employer identification number
Address (number, street, and room or suite no.) City or town, state, and ZIP code
Authorized signature Title Date
® Printed on Recycled Paper Form 8283 (Rev. 12 -2006)