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(Corporate seal if applicable)

(Title)

WARNING: Section 1418 of the Housing and

Urban Development Act of 1968 (82 Stat.

598, 15 U.S.C. 1717) provides: "Any person

who willfully violates any of the provisions

of this title or of the rules and regulations

or any person who willfully, in a statement

of record filed under, or in a property report

issued pursuant to, this title, makes any

untrue statement of a material fact ***,

shall upon conviction be fined not more

than $5,000 or imprisoned not more than 5

years, or both."

INSTRUCTIONS FOR COMPLETION OF STATEMENT

OF RECORD

A. 'These instructions must be followed in

completing the Statement of Record. All

spaces in the specified format must be com-

pleted. The format must not be changed in

any respect, except as follows:

1. Spaces provided in the format may be

enlarged or extended for the purpose of pro-

viding a comprehensive explanation.

2. In addition to the information expressly

required to be stated in the statement of

record, there shall be added such further

material information, documentation, and

certifications, if any, as may be necessary in

the public interest and for the protection of

purchasers or necessary in order to make

the statements in the light of the circum-

stances under which they are made, not

misleading.

3. If a filing is to be consolidated pursuant

to § 1710.22, the developer shall answer spe-
cifically each question in the Statement of
Record and submit a new Property Report.
The developer shall not incorporate by ref-
erence the answers to questions or support-
ing documentation in the previous filing,
except that supporting documentation may
be incorporated by reference in those in-
stances where it is applicable specifically to
both the original filing and to the addition-
al lots to be offered. This shall be accom-
plished by placing after the applicable part
or subpart in the format the OILSR number
of the previous filing identifying the appro-
priate part, subpart, exhibit, and page
number. In all other respects the consoli-
dated Statement of Record shall conform to
the format requirements of an initial State-

ment of Record filed under these regulations.

4. Amendments, including preeffective and posteffective amendments to the statement of record and property report, shall be prepared and filed in accordance with the procedure set forth in § 1710.23(b).

B. To facilitate proper filings, statements of record shall be bound and filed on good quality, unglazed, white paper, approximately 81⁄2 by 13 inches in size, with a 2-inch margin at the top and a 11⁄2-inch margin on each side. They shall be in black ink in standard elite or pica type. They may be printed, lithographed, mimeographed, or typewritten; but the standard size of elite or pica type must be used. Deeds, title policies, subdivision maps or plats, and other supporting documents may be on different size paper but should be folded to the 82-by 13inch size. A copy of the Property Report containing the text in its entirety as it is intended to be reproduced for delivery to prospective purchasers shall be attached to the Statement of Record. Statements of Record shall be properly signed and dated. The developer shall include the date of typing or preparation of the page in the lower right hand corner of each page of the statement of record.

C. In the upper right hand corner, the developer shall give his employer's IRS number as well as that of the owner of the subdivision, if the developer is not the owner. The name at the heading of the Statement of Record shall be the common promotional name used for the subdivision. The name and address of the authorized agent shall be the name and address of the party designated by the developer to receive correspondence and to receive service of process or notice of any action taken by OILSR. In all filings, including filings by foreign developers, the authorized agent shall be a resident of the United States.

D. The supporting documents required by the various parts of these instructions shall be attached as exhibits at the back of the Statement of Recor 1. Each exhibit shall be identified by affixing a tab on the right side of the cover sheet of the exhibit and by identifying thereon the applicable part and subpart by Roman numeral, letter and Arabic number. The pages of each exhibit shall be numbered beginning with the number one for the first page in each exhibit and numbering the remaining pages in the exhibit sequentially. If, at a later time, additional data is furnished to be incorporated into, or to amend, an exhibit, the pages of the additional data shall be numbered beginning with the number following the last page number in the exhibit and following sequentially therefrom. If the information in an exhibit is applicable to more than one part, the developer may incorpo

rate that information by reference to the appropriate exhibit and to the applicable page or pages within that exhibit.

E. If an item in the Statement of Record is supported by information in an exhibit, place the appropriate exhibit and page number in the right margin immediately adjacent to the item. Whenever the Statement of Record requires a summary or statement of terms or items, such summary or statement must be presented in a clear and concise manner.

F. Where the documentation required by the Statement of Record cannot be obtained, a letter stating the reasons, therefor must be furnished by the developer, along with the best alternative assurance available. However, the documentation required by the following parts must be provided before the filing will be considered to constitute a statement of record:

Part I.D.1.,

Part II.D.1.,

Part IV E. 1. and 2.
Part V.,

Part VI. C. 1. and 3., and
Part XIV.

The documentation required by the remainder of the parts of the statement of record must be provided if the developer includes statements, either in the statement of record or property report, evidencing an obligation or commitment on the part of a third party or action by a public official relating to the subdivision. Lacking such documentation appropriate disclosures must be made in both the statement of record and property report.

G. Proposals (as opposed to amenities already provided) may not be included in the statement of record unless the developer has clearly stated that they are merely proposals and disclosed any conditions of completion (such as successful sale of lots) and whether he will be obligated or who will be obligated, if anyone.

H. The following instructions correspond to the part and subpart letters and numbers set forth in the Statement of Record format.

PART I. ADMINISTRATIVE INFORMATION

A. Identification and filing information. 1. State whether the filing is an initial filing with the Office of Interstate Land Sales Registration on the subdivision or an additional offering of lots to be consolidated with a Statement of Record previously filed for lots offered under the same common promotional plan. If the filing is to be consolidated, identify the OILSR filing number assigned to the original Statement of Record.

2. Do you intend to make subsequent filings for additional lots within the subdivision?

3. Are you submitting documentation to support a request for an exemption? B. General information.

1. Name the State, Commonwealth, territory, or possession of the United States or the country in which the subdivision is located.

2. Name the county or counties or other political subdivision or subdivisions within which the subdivision is located.

3. State the number of lots in this offering. Consolidated filings shall state the additional lots being offered and shall state the total number of lots included in previous filings on that subdivision. The Secretary must be able to reconcile the number stated in your answer to this item with the statements made in the title evidence, the lots delineated on the plat maps and the disclosure made on item 2. b. of the property report.

4. If more than one offering of lots in the subdivision has been made or will be made, state the number of lots to be offered in the entire subdivision. See instruction D.2 of this part.

5. State the number of acres included in this offering.

6. If more than one offering of lots in the subdivision has been made or will be made, state the number of acres owned, the number of acres under option or other similar arrangement for acquisition of title to the land and the total number of acres to be offered pursuant to the same common promotional plan.

7. State whether any lots have been sold in this subdivision since April 28, 1969, and prior to registering with this office. If they were sold pursuant to an exemption, identify the exemption provision and state whether an exemption advisory opinion, exemption order, or exemption determination was obtained with respect to those lot sales. State the OILSR number of the request for exemption, if any.

C. Filings with U.S. Securities and Exchange Commission and State authorities.

1. If a Statement of Record or similar instrument for the subdivision has been filed in any State or States, list the State or States.

2. If any of the States listed in answer to figure 1 above has not permitted the filing to become effective or has suspended the filing, give reasons cited by the State and also the developer's reasons, if different from those cited by the State.

3. List the States in which you plan to offer your subdivision. State whether you have registered or plan to register with each of these States.

4. State whether the developer has made or intends to make a filing with U.S. Securities and Exchange Commission (SEC), which is related in any way to the subdivision. If a filing has been made with the SEC, give the SEC identification number; identify the prospectus by name; date of filing and state the page number of the prospectus upon which the specific reference to the subdivision is made.

5. State whether any of the persons named in part II. A. or B. of this statement of record other than those listed in C.4. above, have filed or been the subject of a filing related in any way to the subdivision with the SEC since April 28, 1969. If so, identify the person and state the date of filing and SEC identification number.

6. State whether any disciplinary action has been taken by the SEC with respect to any person identified with filings mentioned in subparts C.4. or C.5. above. If so, describe the action. Include in your description the names and addresses of the parties involved, the date of the action and the status and disposition thereof.

D. Supporting documentation.

1. General plan including a map or plat showing the total land owned or under option or other similar arrangement for acquisition of title to the land. Delineate thereon the land included in this offering, and the land upon which recreational and/ or other common facilities will be located.

2. Copy of the property report, subdivision report, offering statement, or similar document filed with the State or States listed in C.1. at ɔve.

PART II. DEVELOPERS AND HOLDERS OF OWNERSHIP INTERESTS IN LAND, VIOLATIONS, BANKRUPTCIES AND LITIGATION

A. List the name and address and the type and extent of interest of each holder of any ownership interest in the land included in this offering. (Individual lot owners or lessees who have purchased or leased lots from the developer need not be listed.) If the holder is other than an individual, name the type of legal entity and list the interest and the extent thereof, of each principal. For the purposes hereof, "principal" shall mean any person or entity having a 10 percent or more financial interest.

B. If the developer does not own an interest in the land, list name and address of each individual or entity having an ownership interest in the developer. If the developer is other than an individual, name the type of legal entity and list the interest, and the extent thereof, of each principal. For the purposes hereof, principal shall mean any person or entity having a 10 percent or more financial interest.

C. Violations, bankruptcies and litigation.

1. State whether any of the persons named in A. or B. have been disciplined, debarred, or suspended by any governmental body or agency or indicted or convicted by any court for violation of a Federal, State, or local law or regulation in connection with activities relating to land sales, land investment, securities sales, construction or sale of homes or home improvements or any other similar or related activity for which such official action was charged. If so, describe the action. Include in your description the names and addresses of the parties involved, the type and date of the action, and the status and disposition thereof.

2. State whether within the last 13 years any of the persons named in A. or B. above has filed a petition in bankruptcy or has had an involuntary petition in bankruptcy filed against him or been an officer or director of a company which has become insolvent or has voluntarily or involuntarily filed in bankruptcy. If so, describe the action. Include in your description the petition number, names, and addresses of petitioners, trustee and counsel, the name and address of any other parties involved, the date of the action, the name and location of the court where the proceeding took place or is being held and the status or disposition thereof.

3. List all current litigation of which the developer is aware which, individually or in the aggregate, may have a material effect upon the developer or subdivision. Describe each such action with particularity. Every development during the course of such litigation which may effect a material adverse change with respect to the developer or subdivision promptly should become the subject of an amendment.

D. Supporting documentation:

1. If the developer is a corporation, submit a copy of the articles of incorporation, with all amendments, and a list of the officers and directors of the corporation.

If the developer is a partnership, unincorporated association, joint stock company, or any other form of organization, submit copies of articles or partnership or association and all other documents relating to its orgar.ization.

If the holder of any ownership interest in the land being offered is a person or entity other than the developer, submit copies of the above documents for such holders. (For purposes of this subpart D.1., it is not necessary to include the sales agent, if the sales agent is a legal entity other than a holder of an ownership interest in the land.)

2. Submit a copy of the documents involved in the litigation or other action listed in paragraph C. above, if any. This includes but is not limited to copies of the following: 1. Complaint.

2. Answer.

3. Decision or other disposition.

PART III. IDENTITY OF INTEREST IN MORE THAN ONE FILING

A. Are any of the following directly or indirectly involved in any other subdivision: The holders of an ownership interest in the land; the developer; principals or officers in the holder or developer. If so, identify by subdivision name and location. If registered with OILSR, give the OILSR number or numbers.

B. State whether the developer is a subsidiary corporation. If so, identify the parent company by name and address and state whether the parent company or any of its subsidiaries are directly or indirectly involved in any other subdivision which has been filed with the Office of Interstate Land Sales Registration. If so, identify by subdivision name, location, OILSR number or numbers and date of filing. If not applicable, state "None."

C. Has a suspension order been issued by the Office of Interstate Land Sale Registration with respect to any statement of record identified in subpart A or B above? If so, identify the statement of record by its OILSR number. (Do not list suspension notices on preeffective statements of record and amendments.)

PART IV. TOPOGRAPHY, CLIMATE, NUISANCES, SUBDIVISION MAP, PERMITS AND LICENSES

A. Topography and physical characteristics.

1. Describe the general topography and physical characteristics of the subdivision; for example, level, hilly, rocky, etc.; loose sand, alkaline soil, etc.

2. State whether any of the lots or portions thereof, in the offering are covered by water at any time during the year or are subject to floods, hurricanes, tornadoes, earthquakes, mudslides, brushfires, forest fires, avalanches, volcanic eruptions, or other natural hazards.

The existence severity and frequency of natural hazards should be fully explained. If any of the natural hazards of the type illustrated in this paragraph are present, state whether the area in which the subdivision is located has been formally identified by any Federal, State, or local agency as being in an area subject to a special natural hazard and whether the area is or will be subject to any special land use requirements which will restrict development or entail unusual development or maintenance expense. Include in your answer a statement of whether the subdivision is affected by a flood plain, including a 100 year flood plain, or is in an area designated to be flood prone as identified by the Federal Insurance Administration, U.S. Department of Housing and

Urban Development, Washington, D.C. Describe the effect which such a flood plain will have on the lots in the offering. Identify the lots affected. If in an identified area of special flood hazards, state whether flood insurance is available for new construction in the area and if available, the extent to which it may be required by Federal agencies. State the approximate range of the cost of such insurance.

3. Is any part of the subdivision subject to any type of flood control easements?

4. Describe any unstable or expansive soil condition which will necessitate the use of special construction techniques. Identify the lots affected.

5. What percentage of the land will require fill before construction? If any, describe plans for fill, including composition and estimated cost to lot buyer or lessee.

6. With the exception of fill, what percentage of the land in the subdivision will require corrective work before construction of a one-story residential structure? If any, describe type of work and plans for correction, and state the estimated cost to buyer or lessee.

7. State elevation of the highest and lowest lots in the subdivision.

B. Climate and temperature.

1. Describe general weather conditions of the area.

2. State temperature ranges for summer and winter, including high, low, and mean. 3. State annual average rainfall and, if applicable, snowfall, in inches.

C. Nuisances.

1. Describe any on-site and off-site land uses which may affect the subdivision. Any unusual or unpleasant noises, odors, polutants, or other nuisances should be specifically identified.

Examples of unusual noises which might affect the subdivision include proposed or existing industrial activity, airports or other transportation facilities, animal pens, entertainment centers, or the like. Examples of unpleasant odors include noxious smoke, chemical fumes, stagnant ponds or marshes, slaughterhouses, and sewage treatment facilities. Any such conditions should be accurately described and fully explained identifying their origin and location and whether they are proposed or existing. If they are existing, state whether temporary (estimate duration) or permanent.

2. Do you know of any unusual safety factors or of any proposed plans, private or governmental, for construction of any facility which may create a nuisance or adversely affect the use of the land? Examples of unusual safety factors which could affect the subdivision include physical hazards such as dilapidated or abandoned properties, unsafe construction, air or vehicular traffic haz

ards, danger from fire or explosion, and radiation hazards. Any such conditions should be accurately described identifying their origin and location and whether they are proposed or existing. If they are existing, whether temporary (estimate duration) or permanent.

D. Subdivision map, permits and licenses. 1. State whether a subdivision map has been filed with and accepted for recording by local authorities. If so, give recording data.

2. Has each lot in the subdivision been surveyed?

3. Has each individual lot been staked or marked so that the buyer can identify the boundary lines of his lot? If not, state estimated cost to purchaser or lessee to obtain a survey and to have boundary lines staked or marked.

4. Will all streets shown on the tract map, if any, be public streets?

5. Has legal access been provided to each of the individual lots within the subdivision? 6. State minimum width of legal access to the lots.

7. State whether lot purchasers will be required to obtain a building permit before they will be able to construct on their lot. If so, identify the agency or entity from which the permit must be obtained.

8. Identify the Federal, State, and local agencies or similar organizations which have the authority to regulate or issue permits or licenses which may have a material effect on the developers' plans with respect to the proposed division of the land, facilities, proposed facilities, common areas, improvements or proposed improvements to the subdivision. Your answer shall specifically address itself to the areas of Environmental Protection Agencies, environmental impact statements. Corps of Engineers permits to construct, dredge, bulkhead, affect the flow of, or otherwise change or affect bodies of water within or around the subdivision. Also, include any permits or licenses issued or required by Water Resources Boards or Pollution Control Boards, River Basin Commissions, Conservation Agencies, or other similar organizations or entities. If no agency regulates the proposed division of the land or issues a permit or license with respect to facilities or improvements in the subdivision, so state. If you are exempt from the provisions of a statute which normally requires a permit or license, cite the specific provision of the statute under which you are exempt and state whether you have obtained an advisory opinion or similar document from that agency.

E. Supporting documentation.-1. Copy of an accurate map prepared to scale showing the dimensions of the lots and their relation to existing streets and roads. (To comply with this requirement, supply a map or

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