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Home My WebLink AboutMontgomery, Lola 02.17.2022 (RECORDED) .) 1IIIIIII IIIIII III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII Doc ID: 010395740001 Type: GEN Recorded: 02/24/2022 at 03:35:37 PM Fee Amt: $12.00 Page 1 of 1 Revenue Tax: $0.00 Black Hawk County Iowa SANDIE L. SMITH RECORDER File2022_00017099 0.I c( C.,,_,t..e-1 I II Prepared by Martin M.Petersen,City Attorney, 715 Mulberry,Waterloo,IA,50703,telephone(319)291-4327 TAX STATEMENT: Lola Montgomery,1217 Sycamore Street,Waterloo,Iowa 50703 SPACE ABOVE THIS LINE FOR RECORDER QUIT CLAIM DEED For the consideration of Five Hundred Forty-nine and 12/100 ($549.12) Dollar(s) and other valuable consideration,plus costs CITY OF WATERLOO, IOWA does hereby Quit Claim to Lola Montgomery, all our right, title, interest, estate, claim and demand in the following-described real estate in Black Hawk County, Iowa: The Southeasterly 22 feet of the Northwesterly 56 feet of the Southeasterly 64 feet of Lots 7 and 10 of Block 47 of the Original Plat of Waterloo East. This transaction exempt from Documentary Stamp and Declaration of Value per Iowa Code§428A.2(6)(2020). Each of the undersigned hereby relinquishes all rights of Glower,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 masculine or feminine gender,according to the context. Dated: February 17, 2022 CITY OF WATERLOO, IOWA Quentin Hart, Mayor ATTEST: ii()" :0'76, NANCY HIGBY 61-)2—N--- Kelley Felche, i Clerk = ; COMMISSION N0.7138229 MY COMM SSION EXPIRE O so,- .�.�-� 6- Zyam. STATE OF IOWA, COUNTY OF BLACK HAWK ) ss On this 17th day of February,2022,before me,the undersigned,a Notary Public in and for the State of Iowa, personally appeare Quentin Hart and Kelley Fefchle,to me personally known, and who,being by me duly sworn, did say that they are t e Mayor and City Clerk, respectively, of the City of Waterloo, Iowa; that the seal affixed to the f egoing instrum nt is the corporate seal of the corporation, and that the instrument was signed and sealed on behalf o the corporatiinjby authority of its City Council as contained in the Resolution adopted by the City Council,under 0 cil Actio`P14o. 106882 of the City Council on the 18th day of January, 2022, and that Quentin Hart and Kelley *4c1;4e ac1c S wrledgd the execution of the instrument to be their voluntary act and deed and the voluntary act and 4d of the'` potation,by it voluntarily executed. ,‘At \t,i '_rri , j 5 k �. 't•- a-- H 1 4 ' `' Notary Public ' and .�,the to f Iowa t�Q w rt ( la) IIUI II 011101011111Ull I II lID 1101 I II .�� Doc010395750002Kind: GROUNDWATERHAZAR e: GWH D STATEMENT Recorded: 02/24/2022 at 03:36:22 PM Fee Amt: $0.00 Pape 1 of 2 Black Hawk County Iowa SANDIE L. SMITH RECORDER File9998-00021521 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 City,Town or P.O. State Zip TRANSFEREE: Name Lola Montgomery Address 1217 Sycamore Street, Waterloo, Iowa 50703 Number and Street or RR Giy, I own or H.U. State Lip Address of Property Transferred: Empty lot adjacent to Buyer's property at 1217 Sycamore Street Number and Street or RR City,Town,or H.O. Stale Lip Legal Description of Property: (Attach if necessary) The Southeasterly 22 feet of the Northwesterly 56 feet of the Southeasterly 64 feet of Lots 7 and 10 of Block 47 of the Original Plat of Waterloo East. 1. Wells (check one) X 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) )4' 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. 0 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 642-0960 (July 18, 2012) 5. Private Burial Site(check one) X 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) XAll 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 inspectors 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 TH THE N 1 MATION STATED ABOVE IS TRUE AND CORRECT. Signature: • ' Telephone No.: (319 ) 291-4366 T ns ror or Agent --Tim Andera for City of Waterloo, Iowa FILE WITH RECORDER DNR form 542-0960(July 18, 2012)