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upon this transfer, the undersigned swears, affirms and certifies the following as or on <br /> behalf of the Seller: <br /> A. Seller's legal name: Louis Augustus Fennell and wife,Nancy <br /> Jeffries Fennell <br /> B. Seller's address: 246 Brook Avenue, Southeast <br /> Concord,NC 28025 <br /> C. Seller is not a non-resident alien (if individual) or a foreign <br /> corporation, foreign partnership, foreign trust or foreign estate (as <br /> those terms are defined in the Internal Revenue Code and Income Tax <br /> Regulations). <br /> D. Seller's Tax Identification Number: This <br /> Tax Identification number is being provided in connection with a real <br /> estate transaction. <br /> E. Seller is not a domestic partnership, domestic trust, or domestic estate <br /> of which gain from this sale is allocable to a foreign person who is a <br /> partner or beneficiary of such partnership, trust, or estate or is <br /> allocable to a portion of the trust treated as owned by a foreign <br /> person. <br /> F. Seller is not a domestic corporation, which is a U.S. real property <br /> holding corporation distributing property to a foreign shareholder (as <br /> those terms are defined in the Internal Revenue Code and Income Tax <br /> Regulations). <br /> G. Seller is not a domestic or foreign partnership, trust or estate <br /> distributing property to a foreign shareholder (as those terms are <br /> defined in the Internal Revenue Code and Income Tax Regulations). <br /> 3. The undersigned understands that this certificate may be disclosed to the Internal <br /> Revenue Service by the Purchaser, and that any false statement contained herein may <br /> be punished by fine, imprisonment, or both. <br /> 4. Under penalties of perjury, I declare that I have examined this certification and to the <br /> best of my knowledge and belief it is true, correct and complete, and I further declare <br /> that I have the authority to sign this document as or on behalf of the Seller, and that <br /> the number shown on this statement is the Seller's correct TIN. <br /> 6. Seller states that this instrument is given for the purpose of inducing the Purchaser to <br /> purchase the Property. This affidavit is made with full understanding of the law regarding <br /> liability for any misrepresentation herein. <br /> This the day of , 2017. <br /> Page 25 of 27 <br /> Attachment number 1 \n <br /> G-4 Page 156 <br />