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Disclosure of Beneficial Interests in Real Property Transaction First ChurchesDisclosure Statement: Acquisition or Disposition of Real Property For acquisition of disposition of Real Property by the City of Northampton the undersigned does hereby state, for the purposes of disclosure pursuant to M.G.L. Chapter 7, Section 40J, of a transaction of relating to real property as follows: Real Property Description: Property in the City of Northampton known as Center Street and Main Street road layouts where they abut the First Church of Christ in Northampton (First Church) in downtown Northampton Type of transaction: _XX__Sale ___Lease or rental for term: This is a boundary line agreement Seller(s) or Lessor(s): City of Northampton and First Church Buyer or Lessee: City of Northampton and First Church Names and addresses of all persons who have or will have a direct or indirect beneficial interest in the real property described above. Name: Residence NONE None of the above mentioned persons is an employee of the City of Northampton, the Division of Capital Asset Management, or an official elected to public office in the Commonwealth of Massachusetts except as noted below: Name: Title or Position: NONE This section must be signed by the individual(s) or organization(s) entering into this real property transaction with the public agency named above. If this form is signed on behalf of a corporation or other legal entity, it must be signed by a duly authorized officer of that corporation. The undersigned acknowledges that any changes or additions to item 3 or 4 of this form during the term of any lease or rental will require filing a new disclosure with the Division of Capital Asset Management within 30 days following the change or addition. The undersigned swears under the pains and penalties of perjury that this form is complete and accurate in all respects: Signature(s): ____________________________________________________________ Printed Name(s): Merle Taylor Peter P. Ives Title (s): Moderator Minister Date: October , 2003 Send the executed disclosure statement to: We will file with: Wayne Feiden Division of Capital Asset Management Office of Planning & Development Office of the Commissioner c/o Property Transactions Group City Hall, 210 Main Street One Ashburton Place Northampton, MA 01060 Boston, Massachusetts 02108