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HomeMy WebLinkAbout2017-811-10/2/2017 (RECORDED)111111111111111111111111111111111111111 11111111111111111111111111111111111111 Doc ID 008276810002 Ty e GEN Recorded 1 /15/2017 at 04:15 17 PM Fee Amt: $12.00 Page 1 of 2 Black Hawk County Iowa SANDIE L. SMITH RECORDER F11e2018-00008611 Prepared by LeAnn M. Even, Deputy City Clerk, City of Waterloo, 715 Mulberry Street, Waterloo, IA 50703, (319) 291-4323. RESOLUTION NO. 2017-811 RESOLUTION AUTHORIZING THE SALE AND CONVEYANCE OF THE NORTHEASTERLY PORTION OF A PORTION OF MARIGOLD DRIVE TO MARCUS PRATT FOR $1.00 AND THE SOUTHWESTERLY PORTION OF A PORTION OF MARIGOLD DRIVE TO THE BOSNIAN ISLAMIC ASSOCIATION OF WATERLOO FOR $770.00, AND DIRECTING THE MAYOR AND CITY CLERK TO EXECUTE SAID DOCUMENTS. WHEREAS, the City of Waterloo, Iowa is the owner of a portion of Marigold Drive right-of-way in the City of Waterloo, Iowa, as describe below, and WHEREAS, an offer to purchase the northeasterly portion of a portion of Marigold Drive right-of-way, in the amount of $1.00, has been made by Marcus Pratt, and WHEREAS, an offer to purchase the southwesterly portion of a portion of Marigold Drive right-of-way, in the amount of $770.00, has been made by the Bosnian Islamic Association of Waterloo, and WHEREAS, a public hearing was held on October 2, 2017 at 5:30 p.m. in the Harold E. Getty Council Chambers, City Hall, Waterloo, Iowa, as provided by law, by the Council of the City of Waterloo, Iowa, on the proposal to vacate, sell and convey a portion of Marigold Drive right-of-way owned by the City of Waterloo, Iowa, to Marcus Pratt and the Bosnian Islamic Association of Waterloo, and WHEREAS, it is the opinion of this council that said sale and conveyance should be made as proposed. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF WATERLOO, IOWA, AS FOLLOWS: 1. The northwesterly and southwesterly portion of Marigold Drive right-of-way, as fully described in the published notice in the Waterloo Courier on September 22, 2017, is not presently needed and will not be needed in the foreseeable future for municipal purposes, and its ownership is serving no municipal purpose. 2. That the offer of Marcus Pratt to purchase the northeasterly portion of a portion of Marigold Drive right-of-way for the sum of $1.00, and the offer of the Bosnian Islamic Association of Waterloo to purchase the southwesterly portion of a portion of Marigold Drive right-of-way for the sum of $770.00 is hereby accepted for the real property described as follows: DESCRIPTION — CONVEYANCE TO PRATT: THE NORTHEASTERLY '/ OF THAT PORTION OF MARIGOLD DRIVE LYING SOUTHERLY OF A LINE DRAWN BETWEEN THE MOST NORTHERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS NOW VACATED AND THE NORTHWESTERLY CORNER OF TRACT S CEDAR HILLS, AND LYING NORTH OF A LINE DRAWN BETWEEN THE SOUTHWESTERLY CORNER OF TRACT S CEDAR HILLS AND THE MOST EASTERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS 5S°ox (la) Resolution 2017-811 Page 2 NOW VACATED, SUBJECT TO THE RETENTION OF AN UTILITY EASEMENT OVER, UNDER AND ACROSS THE ABOVE DESCRIBED PROPERTY. DESCRIPTION — CONVEYANCE TO BOSNIAN ISLAMIC ASSOCIATION: THE SOUTHWESTERLY '6 OF THAT PORTION OF MARIGOLD DRIVE LYING SOUTHERLY OF A LINE DRAWN BETWEEN THE MOST NORTHERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS NOW VACATED AND THE NORTHWESTERLY CORNER OF TRACT S CEDAR HILLS, AND LYING NORTH OF A LINE DRAWN BETWEEN THE SOUTHWESTERLY CORNER OF TRACT S CEDAR HILLS AND THE MOST EASTERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS NOW VACATED, SUBJECT TO THE RETENTION OF AN UTILITY EASEMENT OVER, UNDER AND ACROSS THE ABOVE DESCRIBED PROPERTY. 3. That the City of Waterloo, Iowa conveys said parcels of real property described above to Marcus Pratt and the Bosnian Islamic Association of Waterloo by quit claim deed. 4. That the Mayor and City Clerk are authorized and directed to execute said quit claim deeds. 5. That the original of said quit claim deeds, fully executed and acknowledged, are hereby approved and confirmed by this Council. 6. That the City Attorney is authorized and directed to deliver said quit claim deeds to Marcus Pratt upon receipt of $1.00 and the Bosnian Islamic Association of Waterloo upon receipt of $770.00. PASSED AND ADOPTED this 2nd day of October 2017. ATTEST: Kelley Felch City Clerk Quentin Hart, Mayor CER1JFICATE I, Kelley Felchle City Clerk of the City of Waterloo, Iowa, do hereby certify that the preceding is a true and complete copy of Resolution 2017-811, as passed and adopted by the Council of the City of Waterloo, Iowa, on the 2nd day of October 2017. Witness my hand and seal of office this 2nd day of October 2017. I Kelley Fe City Clerk 1111111111111111111111111111111111111111111111111111111111111111111111111111111 Doc ID 008276820002 Type: GEN Recorded: 11/15/2017 at 04:17:01 PM Fee Amt: $17.00 Page 1 of 2 Revenue Tax: $0.00 Black Hawk County Iowa SANDIE L. SMITH RECORDER Flle2018_00008612 0* -1J J Prepared by David R. Zellhoefer, City Attorney, 715 Mulberry, Waterloo, IA, 50703, telephone (319) 291-4327 TAX STATEMENT: For the consideration and other valuable does hereby Quit Marcus Pratt, 3306 Parkridge Road, Waterloo, Iowa 50701 SPACE ABOVE THIS LINE FOR RECORDER QUIT CLAIM DEED of ($1.00) One Dollar(s) consideration, plus costs CITY OF WATERLOO, IOWA Claim to MARCUS D. PRATT, all our right, title, Black Hawk County, interest, estate, claim Iowa: See attached Legal Description, from Documentary Stamp hereby relinquishes all rights ..herein, including acknowledgment the context. 2 = 2017 - __, and demand in the following -described real estate in marked Exhibit "A". and Declaration of Value per Iowa Code §428A2(6) (20I6). of dower, homestead and distributive share in and to the real estate. hereof, shall be construed as in the singular or plral number, and as masculine or CITY OF WATERLOO, IOWA This transaction exempt ` Eiioh:.o4�the;undersigned Wdcrrs andfplrsase -,fctitinMe gender, ac'coi'dmg,to . DatedOcober �r i - . ATTEST: 1lei -- CIJ2-JW6-0_ A -c -c\ Quentin Hart, Mayor Kelley STATE Iowa, personally sworn, did affixed to sealed on Council, Quentin the voluntary Fel e, City Clerk OF IOWA, COUNTY OF BLACK On this £ day of October, 2017, HAWK ) ss before me, the undersigned, a Notary Public in and for the State of Kelley Felchle, to me personally known, and who, being by me duly City Clerk, respectively, of the City of Waterloo, Iowa; that the seal seal of the corporation, and that the instrument was signed and of its City Council as contained in the Resolution adopted by the City of the City Council on the 2nd day of October, 2017, and that say that the foregoing behalf of under Council Hart and act appeared Quentin Hart and they are the Mayor and instrument is the corporate the corporation by authority Action No. 146044 Kelley Felchle acknowledged and deed of the corporation, the execution of the instrument to be their voluntary act and deed and by it voluntarily executed. -o -Ir -4Z ~'"` A•T- * 0 w * NANCY HIGBY COMMISSION NO.788229 MY COMMISSION MIRES .— 3 _ t s. Notary • blic in .., •, fir t St e of Iowa 0* -1J F LA n 0 4 P co_ y o q m C th y 0 -3 oo o LH p a a 0 n CD $ nag s rollpny $ aa3 s,Jop1oaag > a C C7 of Black Hawk County Records. tit papoaar putt 0 0 x stip Jottpny a 0 Filed for record, indexed and delivered to County aC7 Entered upon transfer books and for taxation this aaaa Allyn Imo Exhibit "A" — Pratt Legal Description Description — vacate: That portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property, except The Southwesterly 1/2 of that portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property. 11111131111111111111111111 D c 276830003 e GWH KondIDGROUND BWATER HAZARD pSTATEMENT Recorded: 11/15/2017 at 04:17:13 PM Fee Amt: $0.00 Page 1 of 3 Black Hawk County Iowa SANDIE L. SMITH RECORDER F11e9998-00007610 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 Zip TRANSFEREE: Name MARCUS D. PRATT Address 3306 PARKRIDGE ROAD, WATERLOO, IOWA 50701 Number and Street or HH Uty. town or P.O. Stale Zip Address of Property Transferred: SEE ATTACHED Number and Street or HH City, i own, or P.O. Stele lip Legal Description of Property: (Attach if necessary) SEE ATTACHED LEGAL DESCRIPTION 1. Wells (check one) M 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) i 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) 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, cisterns 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) IN There are no known private burial sites on this property. O 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. n 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. Signature (Trans erof or Agent) Telephone No.: ( 319 ) 291-4366 FILE WITH RECORDER DNR form 542-0960 (July 18, 2012) Exhibit "A" — Pratt Legal Description Description — vacate: That portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property, except The Southwesterly % of that portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property. iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii ii Doc ID 008276840002 Type GEN Recorded 1/15/2017 at 04:17:42 PM Fee Amt: $ 2.00 Page 1 of 2 Black Hawk County Iowa SANDIE L. SMITH RECORDER F11e2018-00008613 Prepared by LeAnn M. Even, Deputy City Clerk, City of Waterloo, 715 Mulberry Street, Waterloo, IA 50703, (319) 291-4323. RESOLUTION NO. 2017-811 RESOLUTION AUTHORIZING THE SALE AND CONVEYANCE OF THE NORTHEASTERLY PORTION OF A PORTION OF MARIGOLD DRIVE TO MARCUS PRATT FOR $1.00 AND THE SOUTHWESTERLY PORTION OF A PORTION OF MARIGOLD DRIVE TO THE BOSNIAN ISLAMIC ASSOCIATION OF WATERLOO FOR $770.00, AND DIRECTING THE MAYOR AND CITY CLERK TO EXECUTE SAID DOCUMENTS. WHEREAS, the City of Waterloo, Iowa is the owner of a portion of Marigold Drive right-of-way in the City of Waterloo, Iowa, as describe below, and WHEREAS, an offer to purchase the northeasterly portion of a portion of Marigold Drive right-of-way, in the amount of $1.00, has been made by Marcus Pratt, and WHEREAS, an offer to purchase the southwesterly portion of a portion of Marigold Drive right-of-way, in the amount of $770.00, has been made by the Bosnian Islamic Association of Waterloo, and WHEREAS, a public hearing was held on October 2, 2017 at 5:30 p.m. in the Harold E. Getty Council Chambers, City Hall, Waterloo, Iowa, as provided by law, by the Council of the City of Waterloo, Iowa, on the proposal to vacate, sell and convey a portion of Marigold Drive right-of-way owned by the City of Waterloo, Iowa, to Marcus Pratt and the Bosnian Islamic Association of Waterloo, and WHEREAS, it is the opinion of this council that said sale and conveyance should be made as proposed. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF WATERLOO, IOWA, AS FOLLOWS: 1. The northwesterly and southwesterly portion of Marigold Drive right-of-way, as fully described in the published notice in the Waterloo Courier on September 22, 2017, is not presently needed and will not be needed in the foreseeable future for municipal purposes, and its ownership is serving no municipal purpose. 2. That the offer of Marcus Pratt to purchase the northeasterly portion of a portion of Marigold Drive right-of-way for the sum of $1.00, and the offer of the Bosnian Islamic Association of Waterloo to purchase the southwesterly portion of a portion of Marigold Drive right-of-way for the sum of $770.00 is hereby accepted for the real property described as follows: DESCRIPTION — CONVEYANCE TO PRATT: THE NORTHEASTERLY 'A OF THAT PORTION OF MARIGOLD DRIVE LYING SOUTHERLY OF A LINE DRAWN BETWEEN THE MOST NORTHERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS NOW VACATED AND THE NORTHWESTERLY CORNER OF TRACT S CEDAR HILLS, AND LYING NORTH OF A LINE DRAWN BETWEEN THE SOUTHWESTERLY CORNER OF TRACT S CEDAR HILLS AND THE MOST EASTERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS Resolution 2017-811 Page 2 NOW VACATED, SUBJECT TO THE RETENTION OF AN UTILITY EASEMENT OVER, UNDER AND ACROSS THE ABOVE DESCRIBED PROPERTY. DESCRIPTION — CONVEYANCE TO BOSNIAN ISLAMIC ASSOCIATION: THE SOUTHWESTERLY 'A OF THAT PORTION OF MARIGOLD DRIVE LYING SOUTHERLY OF A LINE DRAWN BETWEEN THE MOST NORTHERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS NOW VACATED AND THE NORTHWESTERLY CORNER OF TRACT S CEDAR HILLS, AND LYING NORTH OF A LINE DRAWN BETWEEN THE SOUTHWESTERLY CORNER OF TRACT S CEDAR HILLS AND THE MOST EASTERLY CORNER OF LOT 19 OF THAT PART OF CEDAR HILLS NOW VACATED, SUBJECT TO THE RETENTION OF AN UTILITY EASEMENT OVER, UNDER AND ACROSS THE ABOVE DESCRIBED PROPERTY. 3. That the City of Waterloo, Iowa conveys said parcels of real property described above to Marcus Pratt and the Bosnian Islamic Association of Waterloo by quit claim deed. 4. That the Mayor and City Clerk are authorized and directed to execute said quit claim deeds. 5. That the original of said quit claim deeds, fully executed and acknowledged, are hereby approved and confirmed by this Council. 6. That the City Attorney is authorized and directed to deliver said quit claim deeds to Marcus Pratt upon receipt of $1.00 and the Bosnian Islamic Association of Waterloo upon receipt of $770.00. PASSED AND ADOPTED this 2nd day of October 2017. d- 7, ATTEST.:. elley Fele City Clerk Quentin Hart, Mayor CERTIFICATE I, Kelley Felchle City Clerk of the City of Waterloo, Iowa, do hereby certify that the preceding is a true and complete copy of Resolution 2017-811, as passed and adopted by the Council of the City of Waterloo, Iowa, on the 2nd day of October 2017. -fitness myhand and seal of office this 2nd day of October 2017. • .00 Kelley Fele City Clerk 1111110111111111111111111111IIA IIIA IIII II11 Doc ID: e: GEN Recorded: 111/15/2017 70atT04:18:31 PM Fee Amt: $17.00 Page 1 of 2 Revenue Tax: $0.00 Black Hawk County Iowa SANDIE L. SMITH RECORDER Fi1e2018_04008614 04 C-(vc� 17_ L) - Prepared by David R. Zellhoefer, City Attorney, 715 Mulberry, Waterloo, IA, 50703, telephone (319) 291-4327 TAX STATEMENT: For the consideration and other valuable does hereby Bosnian Islamic Association of Waterloo, Inc., 728 W. 2d, Waterloo, IA 50701 SPACE ABOVE THIS LINE FOR RECORDER QUIT CLAIM DEED of ($770.00) Seven Hundred Seventy Dollar(s) consideration, plus costs CITY OF WATERLOO, IOWA Quit Claim to BOSNIAN ISLAMIC ASSOCIATION OF WATERLOO, INC., all our right, Black Hawk title, interest, estate, claim County, Iowa: See attached Legal Description, exempt from Documentary Stamp hereby relinquishes all rights herein, including acknowledgment to The context. 2, 20,1 -;,,.' ; ,° ter,• v; a- . , and demand in the following -described real estate in marked Exhibit "A". and Declaration of Value per Iowa Code §428A.2(6) (20B). of dower, homestead and distributive share in and to the real estate hereof, shall be construed as in the singular or plural number, and as masuline or CITY OF WATERLOO, IOWA This transaction Each of the undersigned Words and phrases Feminine gender, according Dated , October' ATTEST:- dd99� n Quentin Hart, Mayor elley STATE Iowa, sworn, affixed sealed Council, Quentin the voluntary Fele OF IOWA, On this personally did say to the foregoing on behalf under Hart and act e, City Clerk COUNTY OF BLACK % day of October, HAWK ) ss 2017, before me, the undersigned, a Notary Public in and for the State of Kelley Felchle, to me personally known, and who, being by me duly City Clerk, respectively, of the City of Waterloo, Iowa; that the seal corporate seal of the corporation, and that the instrument was signed and of its City Council as contained in the Resolution adopted by the City of the City Council on the 2nd day of October, 2017, and that appeared Quentin Hart and that they are the Mayor and instrument is the of the corporation by authority Council Action No. 146044 Kelley Felchle acknowledged and deed of the corporation, the execution of the instrument to be their voluntary act and deed and by it voluntarily executed. � *"` • r;} « ,",, NANCY HIGBY COMMISSION NO.7882291. MY COMMISSION Eg RES Notary Public dd for`-' ate of Iowa r 17_ F LA n 0 4 P co_ y o q m C th y 0 -3 oo o LH p a a 0 n CD $ nag s rollpny $ aa3 s,Jop1oaag > a C C7 of Black Hawk County Records. tit papoaar putt 0 0 x stip Jottpny a 0 Filed for record, indexed and delivered to County aC7 Entered upon transfer books and for taxation this aaaa Allyn Imo Exhibit "A" - Bosnian Islamic Association of Waterloo, Inc. Description — vacate: That portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property, except The Northeasterly 1/2 of that portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property. SUM ii iii iii iiiii ii i ikI ill i MEW! iiiii IIIA iiiii ilii VIII ii i ilii Doc ID: 008276860003 Typ GWH Kind GROUND WATER HAZARD STATEMENT Recorded: 11/15/2017 at 04:18:47 PM Fee Amt: $0.00 Page 1 of 3 Black Hawk County Iowa SANDIE L. SMITH RECORDER F11e9998-00007611 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 Zip TRANSFEREE: Name BOSNIAN ISLAMIC ASSOCIATION OF WATERLOO, INC. Address 728 W. 2nd STREET, WATERLOO, IOWA 50701 Number and Street Or Hk eity. town or P.O. State dp Address of Property Transferred: SEE ATTACHED Number and Street or kR city, !own, or P.O. State dp Legal Description of Property: (Attach if necessary) SEE ATTACHED. 1. Wells (check one) El 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) it] 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) p§ 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) Ii 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, cisterns 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) l There are no known private burial sites on this property. O 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. O 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. O 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. U 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] O 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. Signetur`�r `✓ t (TrA ransfamfbr ge Telephone No.: ( 319 ) 291-4366 FILE WITH RECORDER DNR form 542-0960 (July 18, 2012) Exhibit "A" - Bosnian Islamic Association of Waterloo, Inc. Description — vacate: That portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property, except The Northeasterly % of that portion of Marigold Drive lying Southerly of a line drawn between the most Northerly corner of Lot 19 of that part of Cedar Hills now vacated and the Northwesterly corner of Tract S Cedar Hills, and lying North of a line drawn between the Southwesterly corner of Tract S Cedar Hills and the most Easterly corner of Lot 19 of that part of Cedar Hills now vacated, subject to the retention of an utility easement over, under and across the above described property.