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STATE OF NEVADA DECLARATION OF VALUE FORM 1. Assessor Parcel Number s a 2. Type of Property a Vacant Land b Single Fam. Res. FOR RECORDER S OPTIONAL USE ONLY c Condo/Twnhse d 2-4 Plex Book Page e Apt. Bldg f Comm l/Ind l Date of Recording g Agricultural h Mobile Home Notes Other 3. Total Value/Sales Price of Property Deed in Lieu of Foreclosure Only value of property Transfer Tax Value Real Property Transfer Tax Due 4. If Exemption Claimed a* Transfer Tax Exemption per NRS 375. 090 Section b. Explain Reason for Exemption 5. Partial Interest Percentage being transferred The undersigned declares and acknowledges under penalty of perjury pursuant to NRS 375. 060 and NRS 375. 110 that the information provided is correct to the best of their information and belief and can be supported by documentation if called upon to substantiate the information provided herein* Furthermore the parties agree that disallowance of any claimed exemption or other determination of additional tax due may result in a penalty of 10 of the tax due plus interest at 1 per month. Pursuant to NRS 375. 030 the Buyer and Seller shall be jointly and severally liable for any additional amount owed* Signature Capacity SELLER GRANTOR INFORMATION REQUIRED Print Name Address City State Zip BUYER GRANTEE INFORMATION COMPANY/PERSON REQUESTING RECORDING required if not seller or buyer Escrow AS A PUBLIC RECORD THIS FORM MAY BE RECORDED/MICROFILMED. Bldg f Comm l/Ind l Date of Recording g Agricultural h Mobile Home Notes Other 3. Total Value/Sales Price of Property Deed in Lieu of Foreclosure Only value of property Transfer Tax Value Real Property Transfer Tax Due 4. If Exemption Claimed a* Transfer Tax Exemption per NRS 375. 090 Section b. Explain Reason for Exemption 5. If Exemption Claimed a* Transfer Tax Exemption per NRS 375. 090 Section b. Explain Reason for Exemption 5. Partial Interest Percentage being transferred The undersigned declares and acknowledges under penalty of perjury pursuant to NRS 375. Partial Interest Percentage being transferred The undersigned declares and acknowledges under penalty of perjury pursuant to NRS 375. 060 and NRS 375. 110 that the information provided is correct to the best of their information and belief and can be supported by documentation if called upon to substantiate the information provided herein* Furthermore the parties agree that disallowance of any claimed exemption or other determination of additional tax due may result in a penalty of 10 of the tax due plus interest at 1 per month. 060 and NRS 375. 110 that the information provided is correct to the best of their information and belief and can be supported by documentation if called upon to substantiate the information provided herein* Furthermore the parties agree that disallowance of any claimed exemption or other determination of additional tax due may result in a penalty of 10 of the tax due plus interest at 1 per month. Pursuant to NRS 375. 030 the Buyer and Seller shall be jointly and severally liable for any additional amount owed* Signature Capacity SELLER GRANTOR INFORMATION REQUIRED Print Name Address City State Zip BUYER GRANTEE INFORMATION COMPANY/PERSON REQUESTING RECORDING required if not seller or buyer Escrow AS A PUBLIC RECORD THIS FORM MAY BE RECORDED/MICROFILMED. .

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