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Escrow or Exchange No. <br /> OSA-7376481 <br /> Remitter name SSN,ITIN, FEIN,CA corp no.,or CA SOS file no. <br /> First American Title Company 95-2295073 <br /> Part V Buyer/Transferee Information <br /> Complete this part if you checked box 11 in Part IV for an installment agreement. <br /> First name/Grantor Initial Last name/Grantor SSN or ITIN <br /> Spouse's/RDP's first name(if jointly purchased) Initial Last name Spouse's/RDP's SSN or ITIN <br /> Business/Nan raptor Trust name(if applicable) ®FEIN E]CA Corp no. [:]CA SOS file no. <br /> THRIVE Santa Ana, Inc. 82-0724453 <br /> Address(apt. ste room,PO box or PMB no. <br /> 1907 W. Mlnut St. Suite 10 <br /> City(If you have a foreign address,see instructions.) State ZIP code Tele hone number <br /> Santa Ana CA 92703 (714) 425-5562 <br /> Principal Amount of Promissory Note Installment Amount Interest Rate Repayment Period <br /> Number of months <br /> Buyer's/Transferee's Acknowledgment to Withhold <br /> Read the"Buyer/Transferee"Information below. <br /> I acknowledge that I am required to withhold on the principal portion of each installment payment to the seller/transferor for the above shown <br /> California real property either at the rate of 3 1/3%(.0333)or the Alternative Withholding Calculation,as specified by the seller/transferor on Form <br /> 593, Real Estate Withholding Statement,of the principal portion of each installment payment.I will complete Form 593 for the principal portion of <br /> each installment payment and send one copy of each to the Franchise Tax Board(FTB)along with Form 593-V,Payment Voucher for Real Estate. <br /> Withholding,the withholding payment,and give one copy of Form 593 to the seller/transferor.I will send each withholding payment to the FTB by <br /> the 20th day of the month following the month of the installment payment.If the terms of the installment sale, promissory note,or payment <br /> schedule change,I will promptly inform the FTB.I understand that the FTB may review relevant escrow documents to ensure withholding <br /> compliance.I also understand that I am subject to withholding penalties if I do not withhold on the principal portion of each installment payment and <br /> do not send the withholding along with Form 593 to the FTB by the due date,or if I do not send one copy of Form 593 to the seller/transferor by the <br /> due date.Go to Side 3,complete the perjury statement and sign. <br /> Part VI Computation <br /> Complete this part if you checked and certified box 3 in Part III,or to calculate an alternative withholding calculation amount. <br /> 13.Selling price........................................................................................................................................................................ Oe 13 <br /> 14.Selling expenses........................................................................................................................................................................ 14 <br /> 15.Amount realized.Subtract line 14 from line 13 ................................................................................................................... 15 <br /> 16.Enter the price you paid to purchase the property(see instructions, How to Figure Your Basis.) ........... 16 <br /> 17.Seller[Transferor-paid points....................................................................................... 17 <br /> 18. Depreciation................................................................................................................. 18 <br /> 19.Other decreases to basis............................................................................................. 19 <br /> 20.Total decreases to basis.Add line 17 through line 19................................................................................. 20 <br /> 21.Subtract line 20 from line 16........................................................................................................................ 21 <br /> 22.Cost of additions and improvements......................................................................Q 22 <br /> 23.Other increases to basis.........................................................................................0 23 <br /> 24.Total increases to basis.Add line 22 and line 23 ....................................................................................... 24 <br /> 25.Adjusted basis.Add line 21 and line 24............................................................................................................................�j. 25 <br /> 26. Enter any suspended passive activity losses from this property................................................................ 26 <br /> 27.Add line 25 and line 26 ............................................................................................................................................................. 27 <br /> 28. Estimated gain or loss on sale. Subtract line 27 from line 15 and enter the amount here. <br /> If you have a loss or zero gain,skip lines 29 and 30. Certify on Side 3.Withholding is not required. <br /> If you have a gain,go to line 29 to calculate your withholding ................................................................................... 28 <br /> Side 2 Form 593 2025 8602263 <br />