Change of Control Real Estate Request

CHANGE OF CONTROL REAL ESTATE REQUEST

Requesting Party:     Contact Phone:

Recipient/Holder:     Contact Phone:

PROPERTY IDENTIFICATION

CHANGE OF CONTROL DETAILS

Type of change (check all that apply): Transfer of ownership Sale of membership/stock interest Merger / Acquisition Assignment of lease Other   If Other, describe:

Proposed Effective Date of Change:     Percentage of interest changing hands:

FINANCIAL, LEASE, AND SECURITY MATTERS

Are there any outstanding monetary defaults under the lease or related agreements? Yes No

Security deposit status:     Proposed treatment of security deposit:

Mortgage, deed of trust, or lien affecting property? Yes No

ATTACHMENTS

Documents submitted with this request (check all that apply): Certificate of formation / incorporation Corporate / LLC resolution approving transfer Assignment or assignment agreement Financial statements of transferee Background check / credit report Estoppel certificate

DISCLOSURES

The Requesting Party certifies the following (check Yes or No for each):

1. Pending litigation affecting the property: Yes No

2. Known environmental hazards (e.g. contamination, underground storage tanks): Yes No

3. Prior structural damage or repairs material to habitability: Yes No

4. Lead-based paint disclosure applicable: Yes No

REPRESENTATIONS, WARRANTIES, AND INDEMNITY

The Requesting Party represents and warrants to the Recipient that, as of the date of this Request: (a) the facts and disclosures set forth in this Request and accompanying documents are true, complete and accurate; (b) the proposed transfer will not result in a breach or default under the lease, mortgage, deed of trust, or other material agreements affecting the Property; and (c) the Requesting Party has the authority to submit this Request. The Requesting Party shall indemnify, defend and hold harmless the Recipient from and against any liabilities, claims, losses, costs and expenses (including reasonable attorneys' fees) arising out of any misrepresentation or breach of these representations.

The Requesting Party acknowledges that the Recipient may require reasonable additional documentation, background checks, financial information, and execution of instruments of assumption, indemnity, or estoppel as conditions to any consent.

CONDITIONS TO CONSENT; PROCESSING FEES

The Recipient may withhold consent if: (i) the transferee does not meet reasonable creditworthiness standards; (ii) the transferee does not provide requested documentation; (iii) the Requesting Party is in uncured default under the lease; or (iv) the transfer would violate applicable law or materially increase risk to the Recipient. Consent, if granted, may be conditioned on payment of reasonable processing and legal review fees, completion of an estoppel certificate, and execution of an assumption agreement.

NOTICES

GOVERNING LAW; MISCELLANEOUS

This Request shall be governed by and construed in accordance with the substantive laws of the state in which the Property is located, without regard to conflicts of law principles. This Request, together with any attachments, constitutes the entire understanding between the parties with respect to the matters addressed herein and supersedes all prior negotiations and agreements. No amendment shall be effective unless in writing and signed by both parties. If any provision is held invalid, the remainder shall continue in full force and effect.

CERTIFICATION

By signing below, the Requesting Party certifies under penalty of perjury that the information provided in this Request and any attached documents is true and correct to the best of the Requesting Party's knowledge, that the Requesting Party has authority to submit this Request, and that the Requesting Party will comply with the conditions and requirements stated herein.

RECIPIENT RESPONSE (TO BE COMPLETED BY RECIPIENT)

Consent Decision: Consent Granted Consent Denied Granted with Conditions

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