HOLLISTER & BRACE

P.O. Box 630

1126 Santa Barbara St.

Santa Barbara, CA 93102
Tel. No.: (805) 963-6711
Fax No.: (805) 965-0329
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INFORMATION form

Anita Hunter, et al. v. Edward H. Okun, et al., Case No. 5:07-CV-02795-JW, United States District Court for the Northern District of California, 280 South First Street, Room 2112, San Jose, CA. 95113-3099
ADDITIONAL INFORMATION MAY BE VIEWED AT www.hbsb.com, UNDER “CLASS ACTION”
E-MAIL OR MAIL YOUR RESPONSES TO VICKY MUNOZ, CLAIMS ADMINISTRATOR AT HOLLISTER & BRACE
THIS IS FOR INFORMATION PURPOSES ONLY AND NOT AUTHORIZED BY THE COURT
IDENTITY OF CLAIMANT
Name Of Claimant:______
Street Address:______City: ______State: ____ Zip:______
Mailing Address:______City: ______State: ____ Zip: ______
Home No.:______Fax No.:______Work No.: ______Cell No. ______
E-Mail:______
REPRESENTING ATTORNEY, IF ANY
Attorney Name:______Firm Name:______
Street Address:______City: ______State: ____ Zip:______
Mailing Address:______City: ______State: ____ Zip: ______Office No.:______Fax No.: ______Cell No.:______
E-Mail:______Web Site:______
EXCHANGE COMPANY
Please mark an (X) next to the exchange accommodator:
1. 1031 Advance, Inc. ______2. Atlantic Exchange Company, LLC (AEC) ______3. Investment Exchange Group, LLC (IXG) ______
4. National Exchange Services, Ltd (NES) _____ 5. Real Estate Exchange Services, Inc. (REES) ______6.Security 1031 Services, LLC (SOS)____
Date entered Exchange Agreement:______
How did you receive a copy of the Exchange Agreement, i.e. in the mail? ______
______
Date of Deposit of Equity:______Amount Deposited:$______Amount of Loss:$______
Was a binding purchase agreement entered into to buy replacement property? Yes______No______
Explain other losses: ______
______
Amount of possible taxable gain if any: $______Amount of Tax liability $______
Other Comments:______
______
DAMAGES
Amount of Lost deposit, if any $______Amount of liability to seller of replacement property $______
Incurred accounting and attorneys fees relating to tax issues $______Tax liability to State $______
Tax liability to Federal $______Litigation cost associated with failure to purchase replacement property $______
RELIANCE ON FIDELITY BOND
Prior to depositing your equity did you rely on the representation that a Fidelity Bond was in place to protect your money? Yes____ No____
If so, how did you learn about the Fidelity Bond? ______
______
Did you see the evidence of insurance of Fidelity Bond Program Yes______No______
General Information
1. 1031 Advance, Inc. = 1031 Advanced Inc., 2. AEC = Atlantic Exchange Company, LLC, 3. IXG = Investment Exchange Group, LLC =IXG,
4. NES = National Exchange Services, Ltd., 5. REES = Real Estate Exchange Services, Inc., 6. SOS = Security 1031 Services, LLC.

Mail or e-mail this form to Vicky Munoz at Hollister & Brace at above address or e-mail address: