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ORANGE COUNTY TRANSPORTATION AUTHORITY <br />FULL ACQUISITION OFFSET STATEMENT <br />(Fano k) <br />EXHB,T <br />8 -EX -18A (Rev. 6/95) <br />PERSONAL INFORMATION NOTICE <br />Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices Act of 1977 (Civil Code Sections 1798, at seq.), notice is <br />hereby given for time request of personal information by this form. The requested personal information is voluntary. The principal purpose of <br />the voluntary information is to facilitate the processing of this form. The failure to provide all or any part of the requested information may <br />delay processing of this fort. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the <br />IPA of 1977. Each individual has the right upon request and proper identification, to inspect all personal information in any record <br />maintained on the individual by an identifying particular. Direct any inquiries on information maintenance to your IPA Office. <br />PROJECT: <br />PARCEL NO.: <br />WHEREAS, The Orange County Transportation Authority (OCTA) seeks to acquire fee -simple title to <br />certain lands and buildings, including that certain building known as <br />and, <br />(Address) <br />WHEREAS, OCTA and the owner of said building are negotiating a sale of said building.. <br />NOW, THEREFORE, The undersigned makes the following statement of facts and represents to, OCTA <br />that each of said facts is hue and correct in every detail. <br />That the undersigned are the tenants in possession corder the terms of. <br />1. () An oral lease from month-to-month <br />O A written lease for a term ending at a monthly rental of <br />$ and that the undersigned has paid all rents to and including the day of <br />20_, and has paid no rents beyond said date except <br />2. That the last rental payment was made to and that the next rental payment of $ will be <br />due and payable on the day of '20 <br />3. ( ) that no offsets are claimed by the undersigned tenants and/or lessees against any rents which have <br />been paid of which may hereafter become due. <br />( ) That the following offsets are claimed by the undersigned tenants ( ), lessees ( ), against future <br />rents: <br />