HomeMy WebLinkAboutFollow-Up NHC Notification and Transfer Request - Nick AndreTo: City of San Luis Obispo
Attn: Georgina Bailey
REQUEST FOR APPROVAL OF TRANSFER OF A LLC MEMBERSHIP INTEREST FROM AN INTERNAL
OWNER TO AN EXTERNAL OWNER
Internal Transferor: Nick Andre 3%NHC SLO LLC membership interest
Proposed External Transferee: Sylvan F. Dayspring
Age: 45
Date of Birth:
Marital Status: Unmarried woman.
Interest to be acquired: 3%NHC SLO LLC membership interest.
Reason for Transfer: Mr. Andre has decided to terminate his ownership interest in NHC SLO LLC
Transfer is conditioned upon City approval of proposed External Transferee.
Community Benefits Changes: None anticipated
As reflected in the enclosed, redacted, 2020 income tax return, The proposed transferee earned a
total of $during the last calendar year. Her income has remained virtually unchanged
through the current date, well below the City's published 2019 Median Household income standard
for a single person household ($61,250.00).
Respectfully Submitted
Form $$79
Ihb e'-Tile Signature Authorization CU NTCOPY
Rev. ilanuary 202 t) OMB No, 1545-0074
Department of the Treasury ®
ERO must obtain and retain completed Form t2ti7s,
Internal Revenue Service i Go to www,lrs.gov/Form8079 for the latest Information.
Submission Identification Number (SID)
Taxpayer's name Social security number
SYLVAN F DAYSPRING
Spouse's name Spouse's social security number
t
SCHEDULE C
Form 1040)
Department of the Treasury
Memo) Revenue 8oryloB (99)
Name of proprietor
SYLVAN F I
PrOTIt or Loss From Business OMB No. f545-007t
Sole Proprietorship) 2020
typo to www.Irs.gov/ScheduleC for instructions and the latest Information, Attachment
b Attach to Form 1040, 1040 SR, 1040goNR, or 1041, partnerships generally must file Form 1065, Sequence No, 09
Social security number (SSN)
YSPRING
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
ALL OTHER PERSONAL SERVICES 812990
C Business name. if no separate business name, leave blank, D Employer ID no, (EIN) (see Instr.i
SYLVAN F DAYSPRZNG
E Business address (including suite or room no,) 2 5 9 0 GREENWOOD AVE
City, town or post office, state, and ZIP code MORRO BAY CA 93442
F Accounting method; (1) Cash (2) QAccrual (3) Other (specify) W _
G Did you "materially participate" in the operation of this business during 2020'7 It "No," see instructions for limit on losses • , • . , , Yes No
H If you started or acquired this business during 2020, check here •,,,,,,,••, kill • psi •„•„•,,,,,,,,. trial ,,,0 6"
i Did you make any payments in 2020 that would require you to file Forms) 1099? See Instructions lot Ito Is • • • l i • $ • • $ • i • • Yes No
JIf"Yos;'did you or will you file required Form(s)1099?...,..•.,,•.,.,,,,,,,,•,,,,,,,,,,,,,,,,,,•,,,.,.•.•,,fill Yes No
SCHEDULE SE SeIfemidEmployment Tax OMB No. 1545-0074
Form 1040) 2020
Dopartnlmil of the Treasury Y Go to www.irs.gov/SchaduleSE for instructions and the latest information, Attachment
Internal Rovenue Service (99) Attach to Form 1040, 1o40-SR, or 1040-NR. Sequence No, 17
Name of person with self-employment Income (nsahown on Form 10401loan-Sp, or1o40-NF) Social security number of person SYLVAN
F DAYSPRING with self-employmentlncome t> 7212
orm $gg5 UUaIIfIea business Income Deduction OMB No. 1545-2294
Simplified Computation 2020
ment of b Attach to your tax return, Attachment
niarttal Revanuto SorvlreurY b Go to www.irs.gov/Porm6996 for instructions and the latest information. Sequence No, 55
Names) shown on return I Your taxpayer Identification number
Ngte. Ycu can clahtt the qualified business Income deduction only If you hava qualH(ed business income from a qualllfed trade or
business, real estate Investment trust dividends, publicly traded partnership Income, or a domestic production activities deduction
passed through from an agricultural or horticultural cooperative. See Instructions•
Use this form if your taxable income, before your qualified business Income deduction, Is at or below $163,300 ($326,600 if married
filing jointly), and you aren't a patron of an agricultural or horticultural cooperative.
86951 aW 1040 Form 5uiiware Copyright IR96- 2021 HRa Tax Group, Inc,
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W-2 HELIOS N1ADIAGMENT GROUP LLC
10991ll-IG UNEMPLOYIKENT INSURANCE INTEGRITY
TOTAL TO k"ORM 1040/1.040-SR LINE 25p
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