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Home My WebLink AboutQuit Claim Deed - Habitat for Humanity-3/20/2017Prepared by David R. Zellhoefer, City Attorney, 715 Mulberry, Waterloo, IA, 50703, telephone (319) 291-4327 TAX STATEMENT: Iowa For the consideration Dollar(s) and other does hereby Quit Habitat for Humanity, 803 W. 5111 Street, Waterloo, Iowa 50702 SPACE ABOVE THIS LINE FOR RECORDER QUIT CLAIM DEED of ($130,000.00) One Hundred Thirty Thousand and no/100 valuable consideration, plus costs CITY OF WATERLOO, IOWA Claim to IOWA HEARTLAND HABITAT FOR HUMANITY, all our right, title, Black Hawk County, interest, estate, claim and demand in the following-described real estate in Iowa: 101 feet of Lots Nos. 7 and 10 in Block 24, except the Northeasterly 35 feet 50 feet, in the Original Plat on the East Side of the Cedar River in the City Hawk County, Iowa. from Documentary Stamp and Declaration of Value per Iowa Code §428A.2(6) (2015). hereby relinquishes all rights ofdower, homestead and distributive share in and to the real estate. including acknowledgment hereof, shall be construed as in the singular or plural number, and as masuline or to the context. CITY OFWATERLOO, IOWA LALrLs TFC 7 The Northwesterly of the Northwesterly of Waterloo, Black This transaction exempt • 'Each of the undersigned Words and phrases herein, feminine gender, according Dated: March 2p-,-.4o17 ATTEST,',-;:c Quentin Hart, Mayor Kelley Felchity Clerk STATE OF IOWA, COUNTY OF BLACK HAWK ) ss On this 20th day of March, 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 swom, 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„ooruorption by authority of its City Council as contained in the Resolution adopted by the City Council, under ,..QiiiirtiokiketicreWO. 146179 of the City Council on the 20th day of March, 2017, and that Quentin Hart ands -6 lerF, lie°acknowledged 6 4n cjeed%l i¢ cgporation, 0, :, ,...„; e> , Er ,... t; " n the execution of the instrument to be their voluntary act and deed and the voluntary by it voluntarily executed. an_ : attic of Public in nd for the State of Iowa '�opry,q;np, Intl „• CTRL # • C O Y Y Y Y M M##### 1 1 1 1 1110 11111 99 1 1 REAL ESTATE TRANSFER - DECLARATION OF VALUE Please read the instructions comprised in form 57-011 before completing and filing this form. Part I - TO BE COMPLETED BY BUYER, SELLER OR AGENT 1 1 1 ■ Date of Instrument (MMDDYYYY) 0 3 2 0 1 7 Enter the number matching your selection in the box at the end of the line: Deed (1) Contract (2) 1 Seller: CITY OF WATERLOO, IOWA Phone Number:319-291-4429 Seller Address: 620 MULBERRY STREET City: WATERLOO State:IOWAZip:50703 email: _ Buyer: IOWA HEARTLAND HABITAT FOR HUMANITY Phone Number._. Buyer Address: 803 W. FIFTH STREET Nv TM mm m^T State: IOWA ZIp.50702 email: Address of Property Conveyed: 1003 LAFAYETTE STREET City: WATERLOO City: WATERLOO State: IOWA zip: 50703 Legal Description: NEIy 101 ft of Lots 7 & 10 in Blk 24, exc Nely 35 ft of Nwly 50 ft in the Original Plat Enter the number corresponding to your selection in the box at the end of the Vine, if applicable. Type of Sale: Sale between related parties/family (1); Sale of partial interest (2); Trade (3); Quit Claim Deed (4); Auction (5) 3 Was this a sale of agricultural land to: Corporation (1); Trust (2); Alien (3); Non-resident Alien (4); Limited Partnership (5) DECLARATION OF VALUE STATEMENT 1. Total Amount Paid 1 3 0 0 0 0 .00 2. Amount Paid for Personal Property .00 3. Amount Paid for Real Property 1 3 0 . 0 0 0 .00 I hereby declare that the information contained in Part I of this form is true and correct. Printed Name: Rudy Jones, Community Development Phone Number: 319-2914429 Signature: Effective On or Before 07/01/16 Buyer Page 1 or Seller or Agent or Attorney 57-006a (03/15/16) Real Estate Transfer — Declaration of Value, Page 2 ® Part II - TO BE COMPLETED BY THE ASSESSOR Assessed values must be as of January 1 of the year in which the sale occurred. SECTION A: SINGLE CLASSIFICATION Primary Classification: Residential (4); Commercial (5); Industrial (2); Agricultural (1); Multi -residential (7) City/Township: Primary Parcel Number: .,__. Occupancy: Year Built: Class Land Building Dwelling Res .00 .00 .00 Com .00 .00 MultiRes Ind .00 .00 Ag .00 .00 .00 MultiRes .00 .00 .00 Subtotal .. SECTION B: DUAL CLASSIFICATION Primary Classification: Commercial (5); City/Township: Primary Parcel Number: Industrial (2); Multi -residential (7) Occupancy: Year Built: .00 Class Land Building Dwelling Com .00 .00 Ind .00 .00 MultiRes .00 .00 .00 Subtotal_ Total: Add Subtotal amounts from Sections A and B . Enter amount from Zine 3, page 1. Ratio: Divide Total amount by the amount on line 3, page 1 Comments: • Effective an or before 07/01/16 NUTC Jurisdiction Page 2 57-006b (03/15/16) .00 .00 .00 • REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name City of Waterloo Address 715 Mulberry Street, Waterloo, Iowa 50703 Number and Street or RR City. Town or P.O. State Zp TRANSFEREE: Name Iowa Heartland Habitat for Humanity Address 803 W. 5th Street, Waterloo, Iowa 50702 Number and Street or HR pity. town or Y.U. State dp Address of Property Transferred: 1103 Lafayette Street, Waterloo, Iowa 50703 Number and Street or Nk Lity. I own, or P.U. State Lip Legal Description of Property: (Attach if necessary) The Northwesterly 101 feet of Lots Nos. 7 and 10 in Block 24, except the Northeasterly 35 feet of the Northwesterly 50 feet, in the Original Plat on therEast Side of the Cedar River in the City of Waterloo, Black Hawk County. Towa! 1. Wells (check one) XI 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) M 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) ❑ 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) (3 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) 4] 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) 5 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 Signature: BY: Telephone No.: ( 319 ) 291-4429 (Transferor or Agent) FILE WITH RECORDER DNR form 542-0960 (July 18, 2012)