EFTA01268590.pdf

HUD Settlement Statement Signatures
We, the undersigned, identified in Section D hereof and Seller in Section E hereof, hereby acknowledge receipt
of this completed Settlement Statement on December 13, 2019.
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I
have caused or will cause the funds to be disbursed in accordance with this statement.
Borrower(s)
Granite Reality LLC, By: Jeffrey W.
Roberts, Manager
Seller(s)
Richard Yospin, Trustee of the Richard
Yospin Family Trust
Settlement Agent: Date:
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EFTA01268590

Buyer/Seller
A. Settlement Statement Settlement Statement
B. Type of Loan
1. RI FHA 2. M RHS 3. rA• Cony. Unim 4. 0 VA 5. El Cony. Ins 6. M Cash 7. M Other
8. File Num 19. Loan Number 1 10. Mortgage Insurance Case Number
This form is furnished to give you a statement of actual senkmau costs. Amounts paid to and by the settlement agent arc shown. hems marked "(p.o.c.r were
C NOTE:
paid outside the closing, they are shown here for informational purposes and are not included in the totals.
D. NAME AND ADDRE.SS OF BUYER: Granite Reality LLC
155 Seaport Blvd. do Nutter McLennan & Fish I.I.P. Boston, MA 02210
E. NAME AND ADDRESS OF SELLER: Richard Yospin. Trustee of the Richard Yospin Family Trust
57 Royce Road. Newton. MA 02459
F. NAME AND ADDRESS OF LENDER: CASH
G. PROPERTY LOCATION: 338 East Washington Road. Bradford NH 03221
H. SETTLEMENT AGENT Hudldns Law PLLC
9 Newport Road, New London Nil 03257
PLACE OF SETTLEMENT
9 Newport Road, New London NH 03257
I. SETTLEMENT DATE: 12(1312019 DISBURSEMENT DATE 12/13/2019
J. Summary of Buyer's Transaction K. Summary of Seller's Transaction
100. Gross Amount Due From Buyer 400. Gross Amount Due To Seller
101. Contract Sales Price 1,070,750.00 401. Contract Sales Price 1,070,750.00
102. Personal Property 402. Personal Property
103. Settlement charges to buyer (line 1400) 11,863.55 403.
104. 404.
105. 405.
Adjustments for Items paid by seller In advance Adjustments for Items paid by seller In advance
106. City/Town taxes 12/13/2019 to 03/31/2020 6,630.44 406. City/Town taxes 12/13/2019 to 03/31/2020 6,630.44
107. County taxes 407. County taxes
108. 408.
109. Oil Proration - Main House 1,436.35 409. Oil Proration - Main House 1,436.35
110. Oil Proration-Guest Cottage 1,511.95 410. Oil Proration-Guest Cottage 1,511.95
III. Propane Adjustment - Main House 1,637.65 411. Propane Adjustment - Main House 1,637.65
112. Propane Adjustment - Equipment Barn 449.18 412. Propane Adjustment - Equipment Barn 449.18
120. Gross Amount Due From Buyer 1,094,279.12 420. Gross Amount Due To Seller 1,082,415.57
200. Amounts Paid By Or In Behalf Of Buyer 500. Reductions In Amount Due To Seller
201. Deposit or earnest money Four Seasons Sothebys
100.000.00 501. Excess deposit (see instroctions)
International Real Estate
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 58,368.50
203. Existing Icon(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Bradford Tax Collector - Taxes Due 12/17 11,375.00
205. 505. Law Office of Margaret A. Jacobs 350.00
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210. City/Town taxes 510. City/Town taxes
211. County taxes 511. County taxes
212. Assessments 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By/For Buyer 100.000.00 520. Total Reduction Amount Due Seller 70,093.50
300. Cash At Settlement From/To Buyer 600. Cash At Settlement Fronstio Seller
301. Gross Amount due from buyer (line 120) 1,094,279.12 601. Gross Amount due to Seller (line 420) 1,082,415.57
302. Less amounts paid by/for buyer (line 220) 100,000.00 602. Lea reductions in amount due seller (line 520) 70,093.50
303. CASH From Buyer 994.279.12 603. CASH To SELLER 1,012,322.07
We. the undersigned, identified in Section D hereof and Seller in Section E hereof hereby acknowledge receipt of this completed Settlement Statement (Pages 1 and 2) on December
13. 2019.
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L. SETTLEN1ENT CHARGES
700. Total Real Estate Broker Fees Paid From Paid From
Division of commission (line 700) as follows: Buyer's Seller's
701. 550,287.50 to Four Seasons Sothebys International Real Estate Fund. al Fumy al
702. 5.00 to Four Seasons Sothebys International Real Estate Seldemem Stillman
703. Commission paid at settlement 50,28730
704.
705.
706.
800. Items Payable In connection with Loan
801. Loan Origination Fee to CASH
802. Loan Discount to CASH
803.
804.
805.
806.
900. Items Required By Lender To Be Pahl In Advance
901. Interest from From 12/13/2019 To 01/131/2020
902. Mortgage insurance premium
903. Hazard Insurance premium
904.
905.
1000. Reserves Deposited With Lender
1001. Hazard Insurance
1002. Mortgage Insurance
1003. City property taxes
1004. County property taxes months
at pa month
1005. Annual assessments
1006.
1007.
1008. Aggregate Adjustments
1100. Tlde Charges
1101.
1102.
1103.
1104.
1105.
1106.
1107. Attorney's fees to Hudkins Law PLLC 1,250.00
1108. Title Insurance to Stewart Title Guaranty Company 2,537.00
1109. Undet's coverage fie 5 .00
1110. Owner's coverage 51,070,750.00 §5 2,537.00
MI.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recording fees: Deed 545.55 Mortgage Releases 45.55
1202. City/county tax/stamps Deed Mortgage
1203. State tax/stamps: Deed 516,062.00 Mortgage 8,031.00 8,031.00
1204.
1205.
1300. Additional Settlement Charges
1301. to
1302.
1303. Comer/Wire/Fedex Fee to Hudkins Law PLLC 50.00
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES 11,86335 58,36830
We, the undersigned. identified in Section D hereof and Seller in Section E hereof. hereby acknowledge receipt of this completed Settlement Statement (Pages 1 and 2) on December
13, 2019.
CONFIDENTIAL SDNY_GM_C0012677
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SURVEY COVERAGE AFFIDAVIT
STEWART TITLE GUARANTY COMPANY
I/We Richard Yospin, Trustee of the Richard Yospin Family Trust being first duly sworn, depose and say as follows:
1. That I/We are the true and lawful owners in the fee of the premises situated in the City/Town of Bradford County of Merrimack State
of New Hampshire Known as: 338 East Washington Road, Bradford, NH 03221.
2. Uwe have owned the property now being sold or mortgaged by me/us continuously for years Iasi past, and my/our
enjoyment thereof has been peaceable and undisturbed and the title to said property has never been disputed or questioned to my/our
knowledge, nor do I/we know of any facts by reason which the title to, or possession of, said property might be disputed or questioned, or
by reason of which any claim to any of said property might be asserted adversely against me/us.
3. That within the last one hundred and twenty (120) days, no person or business entity has furnished any labor, services or materials in
connection with the construction or repair of any buildings or improvements on the Property except (if none, state "none"):
4. That there are no present tenants, lessees or other parties in possession of the Property except (if none, state "none").
5. That during the time of ownership of the premises above described. Uwe have conveyed no portion of the premises nor done any act
or allowed any act to be done which has changed or could change the boundaries of the Property.
6. That Uwe have not allowed, nor do Uwe have knowledge of, any encroachments onto the Property by any adjoining land owners nor
have Uwe created, allowed or maintained any encroachments upon any property of adjoining land owners.
7. That Uwe have not allowed, nor do I/we have knowledge of, any easements, rights of way, continuous driveway usage, drain, sewer.
water, gas or oil pipeline or other rights of passage to others over the Property by any other persons or entities.
8. That Uwe have no knowledge of any old highways. abandoned roads, lanes, cemetery or family burial grounds. springs, streams.
rivers, ponds. or lakes bordering or running through the Property.
9. That Uwe have no knowledge of any taxes or special assessments which are not shown as existing liens by the public records other
than as shown in the current Municipal Lien Certificate and/or as reflected in the Closing Settlement Statement.
10. That I/we have not created and have no knowledge of any violation of any covenants, restrictions, agreements. conditions or zoning
ordinances affecting said premises.
II. That I/we make this Affidavit for the purpose of inducing a purchase or lease of said premises, and/or for the purpose of inducing the
granting of a mortgage on said premises, and for the purpose of inducing STEWART TITLE GUARANTY COMPANY, in reliance upon
this Affidavit, to issue a policy or policies of title insurance covering the Property and I/we hold harmless and indemnify Stewart Title
Guaranty Company from loss or damage incurred due to any misrepresentation made in this affidavit.
Executed on December 13. 2019.
Richard Yospin, Trustee of the Richard Yospin Family Trust
State ofN ew Hampshire
Merrimack. ss.
On December 13, 2019, before me, the undersigned notary public, personally appeared the above-named and proved to me through
satisfactory evidence of identification, which was a driver's license, to be the person whose name is signed on the preceding or attached
document, and acknowledged to me that he/she/they signed it voluntarily for its stated purpose.
Notary Public:
My Commission Expires:
CONFIDENTIAL SONY_GM_0001 2678
EFTA_00 I 2332 1
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CERTIFICATION OF NON-FOREIGN STATUS
(Entity)
Section 1445 of the Internal Revenue Code provides that a transferee of U.S. real
property interest must withhold tax if the transferor is a foreign entity. To inform the transferee
that withholding of tax is not required upon our disposition of a U.S. real property interest, I
hereby certify the following.
1. Richard Yospin Family Trust is not a foreign entity for purposes of U.S. income
taxation.
2. The company Federal Tax ID number is:
TIN#:
Company mailing address is:
Newton MA 02459
I understand that this certification may be disclosed to the Internal Revenue Service by the
transferee and that any false statement I have made herein could be punished by fine,
imprisonment, or both.
Under penalties of perjury, I declare that I have examined this certification to the best of
my knowledge and believe it is true, correct and complete.
Richard Yospin Family Trust
By:
Richard Yospin
Dated: December 13, 2019
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•
IIIIIIII II
New Hampshire
Department of CD-57-S
Revenue Administration
S0C057S15:1.8475S
REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR)
STEP 1 - SELLER Grantor/ Assignor 'Transferor (use new mailing address)
®
0 0 ®Trust 0 LLC ,-, Original Return
Entity Type - (Check One) q Individual Joint 0 Partnershlp Corporation I w
Amended Return
Seller 1 • Last Name / Entity First Name FEIN ISSN
Richard Yospin Family Trust
Seller 2 • Last Name / Entity First Name FEIN ISSN
Street No. Street Name Apt Unit Phone Number
City State Zip Code + 4 (or Canadian Postal Code)
Newton MA 02459
STEP 2 - PURCHASER Grantee !Assignee / Transferee (use new mailing address)
Last Name / Entity First Name
Granite Reality LLC
Last Name / Entity First Name
STEP 3 - REAL ESTATE
Municipality County
Bradford Merrimack
Street No. Street Name Apt / Unit
338 East Washington Road
Multi Town Sale? II Yes, list municipalities:
q Yes No
STEP 4 - DEED Transfer Date Recording Date Book Na Page No.
12132019
0
Deed Type rria Warranty 0 Quitclaim 0 Mortgage O Sheriff's Tax 0 Foreclosure
(Check One) In O 0
I—I Commissioners 0 Fiduciary Probate In Lieu of Foreclosure
Granite Reality LLC 155 Seaport Blvd
Bradford 12132019
•
CO-57-S
Flay3.008i2017 •
CONFIDENTIAL SDNY_GM_0001P2Mel °I 3
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•
New Hampshire
Department of CD-57-S
Revenue Administration
SIOCD5 7S1.5284 758
REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR)
STEP 5 - TAX AMOUNT
id Full mina or concideraton for the real sista@ 1070750.00
h) Divide I ine 5fal by 510Q 10707.50
c) Tax rate per $100 al time of transfer 0.75
0) Subtotal of Sellers lax (Minimum of $20 for all consideraliors $4.000 or less. per RSA 78-B:11 8031
e) Total lax paid to County on behalf of Seller and Purchaser 16062
Are you claiming tax
DO NOT file form CD-57-S for transfers specifically exempted from taxation under RSA 78.8:2. except transfers exempted by
exemption under 0 Yes E No RSA 78.82.IX. Form CD-57-S must be flied for non-contractual transfers although exempted under RSA 78-b:2. IX.
RSA 78.B:2?
STEP 6 • TAXPAYER'S SIGNATURE 84 INFORMAT1ON(Sellers Signature is Required)
Under penalties of perjury. I declare that I have examined this return and to the best of my belief it is true. correct and complete.
Seller 1 Signature MMDDYYYY
Seller 1 Printed Name
Richard Yospin, Trustee of the Richard Yospin Family Trust
Seller 2 Signature MMDDYYYY
Seller 2 Printed Name
Witness Signature MMDDYYYY
Witness Printed Name
taJ
It II
r;,
E 1111
Granite Reality LLC 155 Seaport Blvd
Bradford 12132019
•
CO-5Y-S
Rey 3.0 06/2017 Paeo 2 013
•
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iii
ll HI •
New Hampshire
Department of CD-57-S
Revenue Administration
*00357S1.5384-5
REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR)
STEP 7 - PREPARER'S SIGNATURE & INFORMATION (If prepared by someone other than the Seller)
Power of Attorney (POA): By checking this box and signing Step 6. you authorize the preparer fisted on this return to act on your behalf for this return
only. including entering the bock and page numbers and filing this return electronically.
Under penalties of perjury. I declare that I have examined this return and to the best of my belief it is true. correct and complete. (II prepared by a person other
than the taxpayer. this declaration is based on all information of which the preparer has knowledge.)
Preparefs Signature (it other than taxpayer) MMDDYYYY
12/13/2019
Preparefs Printed Name (required it POA box is checked)
Rebecca Russo
Entity
Hudkins Law PLLC
Last Name First Name
Russo Rebecca
Street No. Street Name Apt / Unit Phone Number
PO Box
9 Newport Road
719
City State Zip Code + 4 (or Canadian Postal Code)
New London NH 03257
I
illtJ I
rYT I I H
Granite Reality LK 155 Seaport Blvd
Eviadford 12132019
• C047 S •
Rev 3 006,2017 P.303 c• 3 •
CONFIDENTIAL SDNY_GM_00012682
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Attorneys
H • loqutime M. Nairn • Mat Prizio • AsInitlid to MM.'', & MA
HUDKINS LAW,. • Wrenn l Percy Peen° T. Muous • S k A i d m n : it a te n d ! t t o o P Pr r a a n n n ia e • i in n v M r A & & M R A I
LAW • two /A lomzello Dort* P Vadlon. M 'sl l a n n it te u d d I to R Pr a ia n ti a v in N M H A
[mkt C Coming • (andie At O'Neil. II( caguel
bthord G. Anienod Gee; Raki
Property Tax Disclaimer and Re-Proration Agreement
In order to complete the HUD Settlement Statement, it was necessary for Hudkins Law PLLC to obtain information
concerning real estate property taxes and other municipal charges such as water, sewer, municipal assessments or
betterments, insurance, electric, gas, oil or condominium fees as applicable ("Third Party Information"). Although every
effort was made to obtain accurate information, we the undersigned Buyer and Seller hereby agree to hold Hudkins Law
PLLC harmless for the accuracy of any and all Third Party Information obtained by Hudkins Law PLLC or provided to
Hudkins Law PLLC.
We, Buyer and Seller acknowledge that Hudkins Law PLLC obtains Third Party Information through oral dialogue with
various municipal employees and that in many cases, a written statement for Third Party Information is not available.
We, Buyer and Seller further acknowledge that it is common for a municipal tax collector to provide "estimated"
property tax amounts due. Even if an actual tax bill is available, it could be an estimate of the tax payment that will
ultimately be due for the current tax year and actual tax bills could contain errors or may not include penalties that
could be attributed to the parcel being conveyed from the Seller to the Buyer. Current Use penalties may not be
assessed until after the date of closing and may or may not be attributable to the Seller.
After the date of closing, in the event that such Third Party Information proves to be inaccurate or outdated, or if tax or
other obligations or penalties are assessed after the closing date that may be attributable to the Seller, it shall be the
responsibility of the Buyer and Seller to cooperatively re-adjust or re-prorate any amounts due or credited. If it is
determined that the Buyer, Seller or Hudkins Law PLLC has made a disbursement or payment that should have been
attributed to another party (a "Responsible Party"), the Responsible Party shall pay restitution to the party that made
the payment on behalf of the Responsible Party.
Notwithstanding the provisions herein, the Buyer and Seller further represent and agree to the following:
1. The payments, pro-rations and adjustments which have been computed and set forth on the Settlement
Statement represent the good faith effort of the parties to allocate all items adjusted accordingly.
2. Any prorated item which has been incorrectly adjusted in the computation of the pro-rations, upon delivery of
such omission or error, shall be promptly readjusted.
3. The undersigned parties agree to hold the Lender, (if applicable), the title insurance company and Hudkins Law
PLLC harmless therefrom.
4. The Seller agrees to be responsible for any outstanding water or sewer liens and charges as of the date of
closing, and any subsequent final readings.
S. In the event that there are any outstanding real estate taxes, water or sewer liens and charges as of the date of
closing, seller agrees to pay them forthwith upon receipt of a bill from the municipality.
6. We, the undersigned Buyer and Seller, agree to indemnify and hold harmless Hudkins Law PLLC, the Buyer's
Lender (if applicable), for any adjustments or pro-rations which were made between the Buyer and Seller.
Buyer and Seller agree that neither Hudkins Law PLLC or a Lender (if applicable), takes responsibility for these
adjustments as they were negotiated.
7. The provisions herein shall survive the delivery of the deed and the closing.
The Buyer and Seller have read and hereby acknowledge the understanding memorialized in this Property Tax
Disclaimer and Re-Proration Agreement and agree to its terms.
Buyer/Borrower Date Seller Date
Buyer/Borrower Date Seller Date
WINDHAM, NH 603434.1770 CONCORD, NH 603.4341770 NEW LONDON, NH 603-526-2660 NORWICH, VI 802-649-9A , quaky, 978-2484111
25 Islica Pock bid, PO Box 719. 03087 r. FIA 114, Use 201. AO Box 11710,0551"401•41516fleart Suile 201, 01810
(*Karim' 511'4 mt CYN Fri) de N31—
EFTA 00123326
EFTA01268598

Attorneys
H •lecqselise M. Hudkins • Martha I. Priiie • Adnuulm Pradiet n Nil & MA
HUDKINS LAW • Asirtituil Prann i“746 MA
• Beceomin E. Percy Remo T. &roue • mnintd nflAt RI
• burn M. hone& Oar P Wm. Adntttecl uo Pram., NII
LAW A.Initted In 1'raM1u+n MA
Emily I Goering • Condke O'Ner
Piked G. Anderson' Greg kaki'
Compliance Agreement and Privacy Policy
Compliance Agreement
We, the undersigned Buyer and Seller hereby agree to sign, execute and/or resign and re-execute any and all
closing documents to correct errors, or to make changes due to mistake or misinformation.
We, the undersigned Buyer and Seller hereby agree to indemnify and hold Hudkins Law PLLC harmless for any
mistake or misinformation, whether obtained by Hudkins Law PLLC or provided to Hudkins PLI.0 from third
parties, used to calculate, pro-rate or otherwise charge, any and all items appearing on the HUD Settlement
Statement, including but not limited to the following: property taxes, hazard or homeowner insurance,
water, sewer or other municipal charges, fuel pro-rations, electricity pro-rations, or condominium
association dues pro-rations.
Privacy Policy
Hudkins Law PLLC collects nonpublic personal information about you from the following sources:
1. Information we receive from you, such as your name, address, telephone number and social security
number.
2. Information about your transaction from any of the following parties as they apply to your
transaction: your lender, Realtor, attorney, spouse, CPA or tax professional, home inspector or
various public records.
Hudkins Law PLLC does not disclose any nonpublic personal information about our clients, or buyers or
sellers of real estate, except as permitted or required by law or except as authorized by you.
Hudkins Law PLLC maintains physical, electronic and procedural safeguards that comply with relevant federal
and state regulations regarding privacy.
We, the undersigned have received and have reviewed Hudkins Law PLLCS Privacy Policy and Compliance
Agreement.
Buyer/Borrower Date Seller Date
Buyer/Borrower Date Seller Date
WINDHAM, NH 603434-1770 CONCORD, NH 603-434-1770 NEW LONDON, NH 603-526-2660 NORWICH, VI 802449-9200 ANDOVER, MA 978-2481111
15 Sat Red lei, PO be 719, OM COS Pkao, 57 Medi Sp Sul 101, 03301 Bawd bad, PO led00, 03257 316 Moo Street kite 701, PO Sox ibliqq,55Gektlegaree, Sufi 101, 11010
CONFIDENTIAL
EFTA 00123327
EFTA01268599

Substitute FORM 1099-S
Proceeds From Real Estate Transactions
For The Tax Year 2019
OMB No. 1545-0997
FILER'S name, street address, city or town, state or province, FILER'S federal identification 37.1528702
country, ZIP or foreign postal code, and telephone number number
Hudkins Law PLLC Account or escrow number (see 2019.2700
9 Newport Road instructions)
New London, NH 03257
Telephone: (603) 526-2660 Fax: (603) 434.7226
TRANSFEROR'S name, street address (including apt. no.), city TRANSFEROR'S identification
or town, state or province, country, and ZIP or foreign postal number(s)
code
Richard Yospin Family Trust
1 Date of closing 2 Gross Proceeds
December 13. 2019 51,070,750.00
3 Address or legal description (including city. state, and ZIP code) For Privacy Act and Paperwork
Reduction Act Notice, see the
338 East Washington Road. Bradford, NH 03221
2017 General Instructions for
Certain Information Returns.
4 Check here if the transferor 5 Check here if the transferor is a foreign 6 Buyers part of real estate tax
received or will receive property person (nonresident alien, foreign 6,630.44
or services as part of the partnership, foreign estate, or foreign trust)
consideration >>>>> q >»» q
This is important tax information and is being furnished to the internal revenue service. If you are required to file a return. a negligence
penalty or other sanction may be imposed on you if this item is required to be reported and the IRS determines that it has not been
reported.
You are required by law to provide Hudkins Law PLLC with your correct federal tax identification number. If you do not provide
Hudkins Law PLLC with your correct federal tax identification number, you may be subject to civil or criminal penalties imposed by law.
Under the penalty of perjury. Uwe certify that the number(s) shown above on this statement is/are my/our correct federal tax
identification number(s). I/we acknowledge receipt of a copy of this statement.
Richard Yospin Family Trust DATE
Sign and return a copy of this form immediately to Hudkins Law PLLC.
Instructions for Transferor
For sales or exchanges of certain real estate, the person responsible for closing a real estate transaction must report the real estate
proceeds to the IRS and must furnish this statement to you. To determine if you have to report the sale or exchange of your main
home on your tax return, see the instructions for Schedule D (Form 1040). If the real estate was not your main home, report the
transaction on Form 4797, Form 6252, and/or the Schedule D for the appropriate income tax form. If box 4 is checked and you
received or will receive like-kind property, you must file Form 8824.
Federal mortgage subsidy. You may have to recapture (pay back) all or part of a federal mortgage subsidy if all of the following
apply.
• You received a loan provided from the proceeds of a qualified mortgage bond or you received a mortgage credit certificate.
Your original mortgage loan was provided after 1990.
• You sold or disposed of your home at a gain during the first 9 years after you received the federal mortgage subsidy.
• Your income for the year you sold or disposed of your home was over a specified amount.
This will increase your tax. See Form 8828 and Pub. 523.
Transferor's taxpayer identification number. For your protection, this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN). or employer
identification number (EIN). However, the issuer has reported your complete identification number to the IRS.
Account number. May show an account or other unique number the filer assigned to distinguish your account.
CONFIDENTIAL SDNY_GM_00012685
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Box 1. Shows the date of closing.
Box 2. Shows the gross proceeds from a real estate transaction, generally the sales price. Gross proceeds include cash and notes
payable to you, notes assumed by the transferee (buyer), and any notes paid off at settlement. Box 2 does not include the value of
other property or services you received or will receive. See Box 4.
Box 3. Shows the address or legal description of the property transferred.
Box 4. If marked, shows that you received or will receive services or property (other than cash or notes) as part of the consideration
for the property transferred. The value of any services or property (other than cash or notes) is not included in box 2.
Box 5. If checked, shows that you are a foreign person (nonresident alien, foreign partnership. foreign estate, or foreign trust).
Box 6. Shows certain real estate tax on a residence charged to the buyer at settlement. If you have already paid the real estate tax for
the period that includes the sale date, subtract the amount in box 6 from the amount already paid to determine your deductible real
estate tax. But if you have already deducted the real estate tax in a prior year, generally report this amount as income on the "Other
income" line of the appropriate income tax form. For more information, see Pub. 523, Pub. 525, and Pub. 530.
Instructions for Filer
To complete Form 1099-S, use:
• the 2017 General Instructions for Certain Information Returns, and
• the 2017 Instructions for Form 1099-S.
To order these instructions and additional forms, go to www.ks.gov/form1099s.
Caution: Because paper forms are scanned during proceeding, you cannot file Forms 1096, 1097, 1098, 1099, 3921. 3922, or 5498
that you print from the IRS website.
Due dates: Furnish Substitute 1099-S to the transferor by February 16, 2018. File an official Form 1099-S with the IRS by February
28, 2018. If you file electronically, the due date is April 2, 2018. To file electronically. you must have software that generates a file
according to the specification in Pub. 1220. The IRS does not provide a fill-in form option.
Foreign transferors. Sales or exchanges involving foreign transferors are reportable on Form 1099-S. For information on the
transferee's responsibility to withhold income tax when a U.S. real property interest is acquired from a foreign person, see Pub. 515.
Need help? If you have questions about reporting on Form 1099-S. call the information reporting customer service site toll free at 1-
866-455-7438 or 304.263-8700 (not toll free). Person with a hearing or speech disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).
CONFIDENTIAL SDNY_GM_00012686
EFTA_00I 23329
EFTA01268601

CERTIFICATION FOR NO INFORMATION REPORTING
ON THE SALE OR EXCHANGE OF A PRINCIPAL RESIDENCE
This form may be completed by the seller of a principal residence. This information is necessary to determine whether the sale or
exchange should be reported to the seller, and to the Internal Revenue Service on Form 1099-5, Proceeds From Real Estate
Transactions. If the seller properly completes Parts I and III, and makes a "true" response to assurances (I) through (6) in Part II (or
a "not applicable" response to assurance (6)), no information reporting to the seller or to the Service will be required for that seller.
The term "seller" includes each owner of the residence that is sold or exchanged. Thus, if a residence has more than one owner, a
real estate reporting person must either obtain a certification from each owner (whether married or not) or file an information return
and furnish a payee statement for any owner that does not make the certification.
Part I. Seller Information
I. Name: Richard Yospin Family Trust
2. Address or legal description (including city, state, and ZIP code) of residence being sold or exchanged:
338 East Washington Road, Bradford, NH 03221
3. Taxpayer Identification Number (TIN):
Pan II. Seller Assurances
Check "true" or "false" for assurances (I) through (5), and "true", "false", or "not applicable" for assurance (6).
True False
(I) I owned and used the residence as my principal residence for periods aggregating 2 years or more during the
5-year period ending on the date of the sale or exchange of the residence.
(2) I have not sold or exchanged another principal residence during the 2-year period ending on the date of the
sale or exchange of the residence.
(3) I (or my spouse or former spouse, if I was married at any time during the period beginning after May 6, 1997,
and ending today) have not used any portion of the residence for business or rental purposes after May 6, 1997.
(4) At least one of the following three statements applies:
The sale or exchange is of the entire residence for $250,000 or less.
OR
I am married, the sale or exchange is of the entire residence for $500,000 or less, and the gain on the sale or
exchange of the entire residence is $250,000 or less.
OR
I am married, the sale or exchange is of the entire residence for $500,000 or less, and (a) I intend to file a joint
return for the year of the sale or exchange, (b) my spouse also used the residence as his or her principal
residence for periods aggregating 2 years or more during the 5-year period ending on the date of the sale or
exchange of the residence, and (c) my spouse also has not sold or exchanged another principal residence
during the 2-year period ending on the date of the sale or exchange of the principal residence.
q q (5) During the 5-year period ending on the date of the sale or exchange of the residence, I did not acquire the
residence in an exchange to which section 1031 of the Internal Revenue Code applied.
True False N/A
q q q (6) If my basis in the residence is determined by reference to the basis in the hands of a person who acquired the
residence in an exchange to which section 1031 of the Internal Revenue Code applied, the exchange to which
section 1031 applied occurred more than 5 years prior to the date I sold or exchanged the residence.
Pan III. Seller Certification
Under penalties of perjury, I certify that all the above information is true as of the end of the day of the sale or exchange.
Signature of Seller Date
SONY_GM_00012687
CONFIDENTIAL
File Number: 2019-2700
EFTA_00123330
EFTA01268602

No Mortgage Affidavit
Property Address: 338 East Washington Road, Bradford, NH 03221
l/We, the undersigned, are the current owner(s) of the referenced property do certify and swear that all
mortgages on this property have been paid, are discharged and there are no outstanding mortgages on
the property being refinanced/sold by us.
The Undersigned do so certify, swear and warrant.
Date: December 13, 2019
Richard Yospin, Trustee of the Richard Yospin Family Trust
State of New Hampshire
County of Merrimack, ss. December 13, 2019
Personally appeared the above named, Richard Yospin, Trustee of the Richard Yospin Family Trust,
acknowledged the foregoing instrument to be his free act and deed, before me
Notary Public —
CONFIDENTIAL SONY_GM_0001 2688
EFIA_00123331
EFTA01268603