HomeMy WebLinkAboutShaw, Edward L. - 3/1/201911
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Doc ID 009528870001 Type GEN
Recorded: 04/23/2019 at 01:17:12 PM
Fee Amt: $12.00 Page 1 of 1
Revenue Tax: $0.00
Black Hawk County Iowa
SANDIE L. SMITH RECORDER
F11e2019-00015723
''k
Prepared by David R. Zellhoefer, City Attorney, 715 Mulberry, Waterloo, IA, 50703, telephone (319) 291-4327
TAX
does
STATEMENT: Edward L. Shaw, 935 W. Mullan Ave., Waterloo, Iowa 50701 SPACE ABOVE THIS LINE FOR
RECORDER
QUIT CLAIM DEED
For the consideration of ($3,000.00) Three Thousand Dollar(s) and other good and
valuable consideration,
CITY OF WATERLOO, IOWA
hereby Quit Claim to
EDWARD L. SHAW, a single person,
all our right, title, interest, estate, claim and demand in the following -described real estate in
Black Hawk County, Iowa:
This
Each
Words
feminine
Dated:Mareh=1:,„201,9.
ATThS1I,
The Northeasterly 13 feet of Lot 8 and the Southwesterly 26 feet of
Lot 9, Block 14, Whitney's Subdivision in the City of Waterloo,
Black Hawk County, Iowa.
transaction exempt from Documentary Stamp and Declaration of Value per Iowa Code §428A.2(6) (20B).
of the undersigned hereby relinquishes all rights of dower, homestead and distributive share in and to the real estate.
and phrases -herein, including acknowledgment hereof, shall be construed as in the singular or plural number, and as masculine or
gender, according to the context.
CITY OF WATERLOO, IOWA
Quentin Hart, Mayor
•
elle}
STATE
Iowa,
sworn,
affixed
sealed
Council,
and Kelley
act and
elchle ity Clerk
OF IOWA, COUNTY OF BLACK'HAWK ) ss
On this 1 s1- day of March, 2019, before me, the undersigned, a Notary Public in and for the State of
personally appeared Quentin Hart and Kelley Felchle, to me personally known, and who, being by me duly •
did say that they are the Mayor and City Clerk, respectively, of the City of Waterloo, Iowa; that the seal
to the foregoing instrument is the corporate seal of the corporation, and that the instrument was signed and
on behalf of the corporation by authority of its City Council as contained in the Resolutionadopted by -the City
under Council Action No. 145674 of the City Council on the 7th day of March, 2016, and that Quentin Hart
Felchle acknowledged the execution of the instrument to be their voluntary act and deed andif voluntary
deed of the corporation, by it voluntarily executed. � a : -'
A• • I( ::-.-- i-• ' ' ---ii `./--.
r
Notary Pic m and for the ' tate of Iowa " _ ' ' `
_
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Doc ID 009528880002 Type GWH
Kind GROUND WATER HAZARD STATEMENT
Recorded: 04/23/2019 at 01:19:12 PM
Fee Amt: $0.00 Pape 1 of 2
Black Hawk County Iowa
SANDIE L. SMITH RECORDER
F11e9998-00011886
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 Sbeet or RR City, Town or P.O. Slate Zip
TRANSFEREE:
Name EDWARD L. SHAW
Address 935 W. MULLAN, WATERLOO, IOWA 50701
Number and Street or HR Gay. I own or P.O. Slate Lip
Address of Property Transferred:
Empty Lot - fka 927 W. Mullan, Parcel No. 8913-26-181-015
Number and Street or MR Uty. I awn, or P.U. Slate Zip
Legal Description of Property: (Attach if necessary) The Northeasterly 13 feet of Lot 8 and the
Southwesterly 26 feet of Lot 9, Block 14, Whitney's Subdivision in the City
of Waterloo, Black Hawk County, Iowa.
1. Wells (check one)
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. So}id Waste Disposal (check one)
A 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.
D 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.)
o 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. Prr ate Burial Site (check one)
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. F:irlyate 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 aterlo
/'
Signature:
s or Agent)
David R. Zellhoefer, City Atty
FILE WITH RECORDER
Telephone No.: (3 (ci ) a A
3Z-7
DNR form 6420960 (July 18, 2012)