HomeMy WebLinkAboutIowa Heartland Habitat for Humanity - QUIT CLAIM DEED-2/27/2017Prepared by David R. Zellhoefer, City Attorney, 715 Mulberry, Waterloo, IA, 50703, telephone (319) 291-4327
TAX STATEMENT: Iowa
For the consideration
does hereby Quit
Heartland Habitat for Humanity, 803 W. Street, Waterloo, IA 50702 SPACE ABOVE THIS LINE FOR
RECORDER
QUIT CLAIM DEED
of ($1.00) One Dollar and other good and valuable consideration,
CITY OF WATERLOO, IOWA
Claim to
Iowa Heartland Habitat for Humani
all our right, title,
Black Hawk County,
interest, estate, claim
Iowa:
4 in Block 66 in The
Black Hawk
No. 8913-24-303-013)
from Documentary Stamp and
hereby relinquishes all rights
including acknowledgment
to the context.
27, 2017
and demand in the following -described real estate in
Cooley Addition to
County, Iowa.
Declaration of Value per Iowa Code §428A.2(6).
of dower, homestead and distributive share in and to the real estate.
hereof, shall be construed as in the singular or plural numberand as masculine or
CITY OF WATERLOO, IOWA
- -ar
Lot
Waterloo,
(Parcel
This transaction exempt
Each of the undersigned
Words and phrases herein,
feminine gender, according
Dated: February
ATTEST:
Quentin Hart, Mayor
Kelley Felc r` le,
STATE OF IOWA, COUNTY
On this 27th
personally appeared
say that they are the
the foregoing instrument
behalf of the corporation
under Council Action
Hart and Kelley Felchle
voluntary act and deed
ityClerk
OF BLACK HAWK
day of February, 2017,
Quentin Hart and Kelley
Mayor and Deputy City
is the corporate seal
by authority of its
No. j 4 10 12.`1
) ss
before me, the undersigned, a Notary Public in and for the State of Iowa,
Felchle, to me personally known, and who, being by me duly sworn, did
Clerk, respectively, of the City of Waterloo, Iowa; that the seal affixed to
of the corporation, and that the instrument was signed and sealed on
City Council as contained in the Resolution adopted by the City Council,
of the City Council on the 27th day of February, 2017, and that Quentin
execution of the instrument to be their voluntary act and deed and the
it voluntarily executed.
acknowledged the
of the corporation, by
S3tiIdX3 NOISSIININO0 MN y *
6ZZ88L'ON NOISSIVW O0
ABOIH AONVN �' T.td+'
.'
Notary 'ublic in .. for the to of Iowa
TRANSFEROR:
N
A
T
Name
Aaldress
A
me City
REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
TO BE COMPLETED BY TRANSFEROR
of Waterloo
dress 715
Mulberry Street, Waterloo, Iowa 50703
NSFEREE:
Iowa
Number and Street or RR City. Town or P.O. State Zip
Heartland Habitat for Humanity
8J3
W. 5th Street, Waterloo, Iowa 50702
dress of
acant
Number and Sneer or KR Lely. 1 own or Y.U. State Gp
Property Transferred:
Lot (former 425 Almond Street)
L gal Desorption
Lot 4
Plumper and Street or RR Uty. I own, or P.U. State Lip
of Property: (Attach if necessary)
in Block 66 The Cooley Addition to Waterloo,
Black
dawk County, Iowa.
1.
2.
3.
4.
Wells (check
$.I Thee
❑ Thee
stat
Solid W
® The
❑ The
Attachment
Hazard
N The
❑ The
Atta
Underg
3 The
sm-II
ins
❑ The
sub
one)
are no known wells situated on this property.
is a well or wells situated on this property. The type(s), location(s) and legal status are
below or set forth on an attached separate sheet, as necessary.
ste Disposal (check one)
e is no known solid waste disposal site on this property.
e is a solid waste disposal site on this property and information related thereto is provided in
#1, attached to this document.
us Wastes (check one)
e is no known hazardous waste on this property.
e is hazardous waste on this property and information related thereto is provided in
hment #1, attached to this document.
ound Storage Tanks (check one)
e are no known underground storage tanks on this property. (Note exclusions such as
farm and residential motor fuel tanks, most heating oil tanks, cistems and septic tanks, in
ctions.)
- is an underground storage tank on this property. The type(s), size(s) and any known
tance(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)
It The e are no known private buriat sites on this property.
O Th-
ide
ne.
6. Private
El All
❑ Thi
ha
re is a private burial site on this property. The location(s) of the site(s) and known
tifying information of the decedent(s) is stated below or on an attached separate sheet, as
ssary.
Sewage Disposal System (check one)
.uildings on this property are served by a public or semi-public sewage disposal system.
transaction does not involve the transfer of any building which has or is required by law to
a sewage disposal system.
❑
Threis a building served by private sewage disposal system on this property or a building
wit out any lawful sewage disposal system. A certified inspector's report is attached which
do uments 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
ce ified inspection report must be accompanied by this form when recording.
❑ Threis a building served by private sewage disposal system on this property. Weather or
oth-r temporary physical conditions prevent the certified inspection of the private sewage
dis.osal system from being conducted. The buyer has executed a binding acknowledgment
wit the county board of health to conduct a certified inspection of the private sewage disposal
sys em 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
bin. ing acknowledgment is attached to this form.
❑
Threis a building served by private sewage disposal system on this property. The buyer has
exe uted a binding acknowledgment with the county board of health to install a new private
se age disposal system on this property within an agreed upon time period. A copy of the
bin. ing acknowledgment is provided with this form.
❑
Threis a building served by private sewage disposal system on this property. The building to
whi h the sewage disposal system is connected will be demolished without being occupied. The
buy -r has executed a binding acknowledgment with the county board of health to demolish the
builing within an agreed upon time period. A copy of the binding acknowledgment is provided
wit this form. [Exemption #9]
❑ Thi property is exempt from the private sewage disposal inspection requirements pursuant to
the oliowing exemption [Note: for exemption #9 use prior check box]:
❑ Th- private sewage disposal system has been installed within the past two years pursuant to
pe it number
Infonnatio required by statements checked above should be provided here or on separate
sheets att ched hereto:
City
Signature:
1 HEREBY DECLARE THAT I HAVE REVIEWED THE INSTRUCTIONS FOR THIS
FORM
AND THAT THE INFORMATION STATED ABOVE IS TRUE AND CORRECT.
of Waterloo
By:
(Transferor or Agent)
Telephone No.: ( 319 ) 291-4366
FILE WITH RECORDER DNR form 542-0960 (July 18, 2012)