CM-2015-899 - 9/11/2015Form 8283 (Rev. 12-2014)
Name(s) shown on your Income tax return M I NOR I I LLC
Identifying number
2
1 72-1539177
Section B. Donated Property Over $5,000 (Except Publicly Traded Securities) - Complete this section for one item (or one group
of similar items) for which you claimed a deduction of more than $5,000 per item or group (except contributions of publicly traded securities
reported in Section A). Provide a separate form for each property donated unless it is part of a group of similar items_ An appraisal is generally
required for property listed in Section B. See instructions.
Information on Donated Property - To be completed by the taxpayer and/or the appraiser.
4 Check the box that describes the type of property donated;
a Art` (contribution of S20,000 or more) d Art' (contribution of less than $20,000) g Collectibles" J ❑ Other
b Qualified Conservation Contribution e X Other Real Estate Intellectual Property
c Equipment f Securities i Vehicles
'Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antiques, decorative arts, textiles, carpets, silver, rare manuscripts, historical memorabilia, and
other similar objects.
"Collectibles Include coins, stamps, books, gems. jewelry. sports memorabilia, dolls, etc., but not art as defined above.
Note. In certain cases, you must attach a qualified appraisal of the property. See Instructions.
5
(a) Description of donated properly (if you need
more space, attach a separate statement)
(b) If tangible property was donated, give a brief summary of the overall
physical condition of the property at the time of the gift
(c) Appraised fair
market value
A
LAND AND REAL PROPER'T'Y
VERY GOOD CONDITION
2,100 000.
B
C
D
(d) Date acquired (e) How acquired by (f) Donor's cost or
by donor (me., yr.) donor adjusted basis
(g) For bargain sales, enter See Instructions
amount received (h) Amount claimed as a (I) Date of contribution
deduction
A
01/01/2008 PURCHASE 252,000.
1,600,000. 500,000.
.06/11/2014
B
C
D
EM Taxpayer (Donor) Statement - List each item included in Part I above that the appraisal identifies as having
a value of $500 or less. See instructions.
I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than 5500
(per Item). Enter identifying letter from Part I and describe the specific item. See Instructions. I>
Signature of taxpayer (donor) > Date
Declaration of At3oraiser
I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or
mace to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the Iransection. I performed the majority of my
appraisals during my lax year for other persons.
Also, l declare that I perform appraisals on a regular basis; and that because of my qualifications as described in the appraisal, I am qualified to make appraisals of the type of property
being valued. I certify that the appraisal fees were not based on a percentage of the appraised property value. Furthermore. I understand that a false or fraudulent overstatement of the
property value as described In the qualified appraisal or this Form 8283 may subject me to the penalty under section 6701(a) (aiding and abetting the understatement of tax liability).
In addition, I understand that I may be subject to a penally under section 6695A if I know. or reasonably should know, that my appraisal is to be used In connection with a return or
claim for refund and a substantial or gross valuaWn misstatement results from my appraisal. I affirm that I have not been barred from presenting evidence or testimony by the office
of Professional Responsibility.
Sign I
Here I Signature 0- Title D Date 0) --
Business address (including room or suite no.) Identifying number
City or town. state, and ZIP code
Donee Acknowled ment - To be completed bv the charitable organization.
This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property as described
in Section B. Part I, above on the following date ® 06/11/2014
Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B, Part I (or any
portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donor a copy of that
farm. This acknowledgment does not represent agreement with the claimed fair market value.
Does the organization intend to use the property for an unrelated use? . . . . . . . . . . . . . . . . . Yes No
Na of haritable c aniz-'' 6(donee) �� Employer i ontification number
, 0 { DG 1 G(. _74 G 0 `S
Address (nurhber, st4t, and room or suite no.) City or town, state, and ZIP code
221 EAST MAIN RTREET CITY OF ROUNDROCK TX 78664
Au 'g at re Title Date
Iva- RA
C atA
J8AI Form 8 2 8 3 (Rev. 12-2014)
4Xs410MW QJN;AV& 2785 V14 -6.6F HF'M0008
i-2oIs-9 1761
1
City of Round Rock
T° A"s°ROC` Agenda Item Summary
Agenda Number:
Title: Consider executing Form 8283 acknowledging City of Round Rock's
receipt of donated property from Minori, LLC.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 9/18/2015
Dept Director: Steve Sheets
Cost: $0.00
Indexes:
Attachments: 00342197.PDF, 00342193.PDF
Department: Legal Department
Text of Legislative File CM -2015-899
Consider executing Form 8283 acknowledging City of Round Rock's receipt of donated property from
Minori, LLC.
Staff recommends approval.
City of Round Rock
Page 1
Printed on 9/14/2015