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Home My WebLink AboutBetha Johnson - Quit Claim Deed - 1420 Byron Ave-1/23/2017I11111111111111111111111111 1111111111111111II11111111111IIIIIIIIIIIIIIIIIIIIIII Doc ID. 007545870001 Type GEN Recorded: 01/30/2017 at 03:56:32 PM Fee Amt: $12.00 Page 1 of 1 Revenue Tax: $0.00 Black Hawk County Iowa SANDIE L. SMITH RECORDER Fi1e2017-00013685 tlinulj W (J ) At Prepared by David R. Zellhoefer, City Attorney, 715 Mulberry, Waterloo, IA, 50703, telephone (319) 291-4327 TAX STATEMENT: Bertha M. Johnson, 521 Fowler Street Waterloo, IA 50703 SPACE ABOVE THIS LINE FOR RECORDER QUIT CLAIM DEED For the consideration of ($5,000.00) Five Thousand and no/100 Dollar(s) and other valuable consideration, plus costs CITY OF WATERLOO, IOWA does hereby Quit Claim to BERTHA M. JOHNSON, Individually, all our right, title, interest, estate, claim and demand in the following -described real estate in Black Hawk County, Iowa: Lot 7, Block 1, Russell Heights in the City of Waterloo, Iowa. Parcel #8913-36-151-003 known locally as 1420 Byron Avenue, Waterloo, Iowa. This transaction exempt from Documentary Stamp and Declaration of Value per Iowa Code §428A.2(6) (20B). Each of the undersigned hereby relinquishes all rights of dower, homestead and distributive share in and to the real estate. Words and.phrases•herein, 'including acknowledgment hereof, shall be construed as in the singular or plural number, and as masculineor femininegeIlder, ascuidingto the. context. Dated:. aniaiy,, 2017 CITY OF WATERLOO, IOWA : O P^- f. J{/(1 -. Quentin Hart, Mayor ATTEST:-. .. '° p� Kelley Felche; City Clerk STATE OF IOWA, COUNTY OF BLACK HAWK ) ss On this 23rd day of January, 2017, before me, the undersigned, a Notary Public in and for the State of Iowa, personally appeared Quentin Hart and Kelley Felchle, to me personally known, and who, being by me duly sworn, did say that they are the Mayor and City Clerk, respectively, of the City of Waterloo, Iowa; that the seal affixed to the foregoing instrument is the corporate seal of the corporation, and that the instrument was signed and sealed on behalf of the corporation by authority of its City Council as contained in the Resolution adopted by the City Council, under Cour4G,eh tI q, 14.969 of the City Council on the 23rd day of January, 2017, and that Quentin Hart and I< tleyf e h1e acicrtn w1ecged the execution of the instrument to be their voluntary act and deed and the voluntary act r>' r ._dee °of t1`i ..GP':*r tion; by it voluntarily executed. ,Sr:.: kr;• CUo,n 1. ...,.t— ► �, , o. rr'.,' ot. Public in efr d for the State of Iowa tlinulj W (J ) 11111111111111111111111111111111111111111111111111111111111111101 Doc ID 007545890002 Type GWH K d GROUND WATER HAZARD STATEMENT R corded: 01/30/2017 at 03:58:15 PM F e Amt: $0.00 Page 1 of 2 Black Hawk County Iowa SANDIE L. SMITH RECORDER F11e9998-00004804 REAL ESTATE TRANSFER -GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name City of Waterloo, Iowa Address 715 Mulberry Street, Waterloo, Iowa 50703 Number and Street or RR TRANSFEREE: Name Bertha M. Johnson City. Town or P.O. State at, Address 521 Fowler Street, Waterloo. Iowa 5QZ03 Number and Street or NN Uty, 1 own or P. Address of Property Transferred: 1420 Byron Avenue,Waterloo, Iowa 50702 Number and Seet or NR Lily, town. or N.U. State dp State 4p Legal Description of Property. (Attach if necessary) Lot No. 7, Block 1, Russel Heights in the City of Waterloo. Iowa 1. Wells (check one) 21 There are no known wells situated on this property. ❑ There is a well or wells situated on this property. The type(s), location(s) and legal status are stated below or set forth on an attached separate sheet, as necessary. 2. Solid Waste Disposal (check one) N There is no known solid waste disposal site on this property. ❑ There is a solid waste disposal site on this property and information related thereto is provided in Attachment #1, attached to this document. 3. Hazardous Wastes (check one) N There is no known hazardous waste on this property. ❑ There is hazardous waste on this property and information related thereto is provided in Attachment #1, attached to this document. 4. Underground Storage Tanks (check one) There are no known underground storage tanks on this property. (Note exclusions such as small farm and residential motor fuel tanks, most heating oil tanks, cistems and septic tanks, in instructions.) ❑ There is an underground storage tank on this property. The type(s), size(s) and any known substance(s) contained are listed below or on an attached separate sheet, as necessary. FILE WITH RECORDER DNR form 542-0960 (July 18, 2012) 5. Private Burial Site (check one) IC There are no known private burial sites on this property. ❑ There is a private burial site on this property. The location(s) of the site(s) and known identifying information of the decedent(s) is stated below or on an attached separate sheet, as necessary. 6. Private Sewage Disposal System (check one) ❑ All buildings on this property are served by a public or semi-public sewage disposal system. ❑ This transaction does not involve the transfer of any building which has or is required by law to have a sewage disposal system. ❑ There is a building served by private sewage disposal system on this property or a building without any lawful sewage disposal system. A certified inspector's report is attached which documents the condition of the private sewage disposal system and whether any modifications are required to conform to standards adopted by the Department of Natural Resources. A certified inspection report must be accompanied by this form when recording. ❑ There is a building served by private sewage disposal system on this property. Weather or other temporary physical conditions prevent the certified inspection of the private sewage disposal system from being conducted. The buyer has executed a binding acknowledgment with the county board of health to conduct a certified inspection of the private sewage disposal system at the earliest practicable time and to be responsible for any required modifications to the private sewage disposal system as identified by the certified inspection. A copy of the binding acknowledgment is attached to this form. ❑ There is a building served by private sewage disposal system on this property. The buyer has executed a binding acknowledgment with the county board of health to install a new private sewage disposal system on this property within an agreed upon time period. A copy of the binding acknowledgment is provided with this form. ❑ There is a building served by private sewage disposal system on this property. The building to which the sewage disposal system is connected will be demolished without being occupied. The buyer has executed a binding acknowledgment with the county board of health to demolish the building within an agreed upon time period. A copy of the binding acknowledgment is provided with this form. [Exemption #9] ❑ This property is exempt from the private sewage disposal inspection requirements pursuant to the following exemption [Note: for exemption #9 use prior check box]: ❑ The private sewage disposal system has been installed within the past two years pursuant to permit number Information required by statements checked above should be provided here or on separate sheets attached hereto: I HEREBY DECLARE THAT I HAVE REVIEWED THE INSTRUCTIONS FOR THIS FORM AND THAT THE INFORMATION STATED ABOVE IS TRUE AND CORRECT. CITY OF WATERLOO, IOWA Signature: By :(CY (Transferor or Agent) FILE WITH RECORDER Telephone No.: ( 319 ) 291-4366 DNR form 542-0960 (July 18, 2012)