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Property Acquisition - 2450, 2442-2446 Washington St._Chamberlain Copyright 2014 City of Dubuque Action Items # 8. ITEM TITLE: Bee Branch Creek Restoration Project Property Acquisition - 2450 Washington St and 2442 - 2446 Washington St. SUMMARY: City Manager recommending acquisition of 2450 Washington Street and 2442 - 2446 Washington Street for the Bee Branch Creek Restoration Project and for expansion of Comiskey Park. RESOLUTION Approving the Acquisition of Real Estate Owned by Patricia M. Chamberlain, in the City Of Dubuque SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt Resolution(s) ATTACHMENTS: Description Type ❑ Bee Branch Creek Restoration Property Acquisition-MVM Memo City Manager Memo ❑ Staff Memo Staff Memo ❑ Resolution Resolutions ❑ Purchase Agreement 2450 Washington Supporting Documentation ❑ Purchase Agreement 2442-2446 Washington Supporting Documentation ❑ Attachment Supporting Documentation THE CITY OF Dubuque U E I erica .i Masterpiece on the Mississippi 2007-2012-2013 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Bee Branch Creek Restoration, Property Acquisition DATE: August 12, 2015 City Engineer Gus Psihoyos is recommending acquisition of 2450 Washington Street and 2442-2446 Washington Street for $210,000 for the Bee Branch Creek Restoration Project and for expansion of Comiskey Park. In December of 2001, the City Council formally adopted the Drainage Basin Master Plan (DBMP) prepared by HDR Engineering (Omaha, Nebraska). Based on the study, approximately 1,150 homes and businesses in the Bee Branch watershed are at risk of flood damage. In December of 2004, the City Council established the alignment for the Bee Branch Creek Restoration Project, from 15th and Sycamore Street to 24th and Washington Street, establishing the properties to be acquired for the Bee Branch Creek Restoration Project. In May of 2011 the City Council authorized the purchase of four additional properties at the confluence of Comiskey Park, the Heritage Trail, and the Bee Branch Project. It was important to address the safety of pedestrians that will travel between the three attractions. The additional property was required to create a safer, attractive connection between Comiskey Park, the Heritage Trail, and the linear park that is the Bee Branch Creek Restoration Project. The Bee Branch Watershed Flood Mitigation Project includes improvements north of E. 24th Street on Washington Street adjacent to Comiskey Park. In fact, one of the Upper Bee Branch Creek Restoration Project objectives is to create a safer, attractive connection between Comiskey Park, the Heritage Trail, and the linear park that is the Bee Branch Creek Restoration Project. But the scope of the Bee Branch Watershed Flood Mitigation Project also includes the conversion of the alley that currently runs from 24th to 25 th Street between Washington Street and Elm Street into a green alley, including the reconstruction of the sanitary sewer and water main. The estimated cost of the green alley improvements (pervious pavement system, sanitary sewer, and water main), is $350,000.00. The reconstructed alley, sanitary sewer, and water main will provide service to just two houses and a duplex. One of the houses is owned by Morrison Brothers and it remains vacant. The other house (2450 Washington Street) and the duplex (2442-2446 Washington Street) are owned by Ms. Patricia Chamberlain who lives in one half of the duplex, renting the other half to a tenant. She rents the house to a family of seven. In addition to the vacant house, Morrison Brothers also owns vacant lots along Washington Street. The total assessed value of the property on Washington Street between 24th and 25th Street is slightly more than $226,000.00. If these properties were not acquired, the City would construct improvements totaling $350,000 to serve property valued at $226,000.00. Therefore, it is prudent to consider acquiring the two houses, the duplex, and the vacant property instead of constructing the improvements. In addition to the project savings that could be realized if the City acquired the properties along Washington between 24th and 25th Street, there are two additional public uses for the property. The Bee Branch Creek project corridor allows for very limited space for the multiple construction contractors to store materials and equipment, maneuver equipment, and actual construct the improvements as outlined in the plans. The construction contractors are currently competing with local residents for off-street parking spaces. Some of the area being used by contractors is within the ultimate footprint of the project. So as the work progresses, the demand for real estate will increase, especially so as the work moves towards E. 24h Street. Acquiring the Chamberlain property will result in more space available to the contractors and allow the public and area residents more use of area streets. Acquisition of the properties would allow for the complete removal of Washington Street between 24th and 25th Street and the removal of the alley that runs from 24h to 25th Street between Washington Street and Elm Street, all of which would result in the elimination of more impervious land cover than what would have been achieved through the reconstruction of the alley as a "green", pervious alley. This would also result in the elimination of the continued costs associated with maintaining the paved street and alley surfaces. Additional cost savings could also realized in that soil excavated as part of the creek construction project could be placed as fill over Washington Street between 24th and 25th Street versus hauling the material off site. Ultimately, following completion of the Bee Branch Creek Restoration Project, the additional green, pervious green space created by the removal of the acquired properties could be utilized to expand the limits and function of Comiskey Park. 2 For these reasons, it seems to be in the City's best interest to purchase the property along Washington Street between 24th and 25th Street owned by Ms. Patricia Chamberlain. Acquiring the property along Washington Street between E. 24th Street and E. 25th Street would result in an estimated $70,000.00 in project savings. I concur with the recommendation and respectfully request Mayor and City Council approval. 114.14 .. Mic ael C. Van Milligen'—� s MCVM:jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Teri Goodmann, Assistant City Manager Gus Psihoyos, City Engineer 3 THE CITY OF Dubuque All-America City DUB3 &kE 1 ' Masterpiece on the Mississippi 2007.2012.2013 TO: Michael C. Van Milligen, City Manager FROM: Gus Psihoyos, City Engineer DATE: August 11, 2015 SUBJECT: Bee Branch Creek Restoration, Property Acquisition INTRODUCTION The purpose of this memorandum is to seek authorization to acquire 2450 Washington Street and 2442-2446 Washington Street, all in Dubuque, Iowa (the Property) for the Bee Branch Creek Restoration Project. BACKGROUND In December of 2001, the City Council formally adopted the Drainage Basin Master Plan (DBMP) prepared by HDR Engineering (Omaha, Nebraska). Based on the study, approximately 1,150 homes and businesses in the Bee Branch watershed are at risk of flood damage. In December of 2004, the City Council established the alignment for the Bee Branch Creek Restoration Project, from 15th and Sycamore Street to 24th and Washington Street, establishing the properties to be acquired for the Bee Branch Creek Restoration Project. In May of 2011 the City Council authorized the purchase of four additional properties at the confluence of Comiskey Park, the Heritage Trail, and the Bee Branch Project. It was important to address the safety of pedestrians that will travel between the three attractions. The additional property was required to create a safer, attractive connection between Comiskey Park, the Heritage Trail, and the linear park that is the Bee Branch Creek Restoration Project. DISCUSSION The Bee Branch Watershed Flood Mitigation Project includes improvements north of E. 24th Street on Washington Street adjacent to Comiskey Park. In fact, one of the Upper Bee Branch Creek Restoration Project objectives is to create a safer, attractive connection between Comiskey Park, the Heritage Trail, and the linear park that is the Bee Branch Creek Restoration Project. But the scope of the Bee Branch Watershed Flood Mitigation Project also includes the conversion of the alley that currently runs from 24th to 25th Street between Washington Street and Elm Street into a green alley, including the reconstruction of the sanitary sewer and water main. The estimated cost of the green alley improvements (pervious pavement system, sanitary sewer, and water main), is $350,000.00. The reconstructed alley, sanitary sewer, and water main will provide service to just two houses and a duplex. One of the houses is owned by Morrison Brothers and it remains vacant. The other house (2450 Washington Street) and the duplex (2442-2446 Washington Street) are owned by Ms. Patricia Chamberlain who lives in one half of the duplex, renting the other half to a tenant. She rents the house to a family of seven. In addition to the vacant house, Morrison Brothers also owns vacant lots along Washington Street. See Attachment A. The total assessed value of the property on Washington Street between 24h and 25th Street is slightly more than $226,000.00. Under the current plan, the City would construct improvements totaling $350,000 to serve property valued at $226,000.00. Therefore, it is prudent to consider acquiring the two houses, the duplex, and the vacant property instead of constructing the improvements. In addition to the project savings that could be realized if the City acquired the properties along Washington between 24th and 25th Street, there are two additional public uses for the property. The Bee Branch Creek project corridor allows for very limited space for the multiple construction contractors to store materials and equipment, maneuver equipment, and actual construct the improvements as outlined in the plans. The construction contractors are currently competing with local residents for off-street parking spaces. Some of the area being used by contractors is within the ultimate footprint of the project. So as the work progresses, the demand for real estate will increase, especially so as the work moves towards E. 24h Street. Acquiring the Chamberlain property will result in more space available to the contractors and allow the public and area residents more use of area streets. Acquisition of the properties would allow for the complete removal of Washington Street between 24th and 25th Street and the removal of the alley that runs from 24h to 25th Street between Washington Street and Elm Street, all of which would result in the elimination of more impervious land cover than what would have been achieved through the reconstruction of the alley as a "green", pervious alley. This would also result in the elimination of the continued costs associated with maintaining the paved street and alley surfaces. Additional cost savings could also realized in that soil excavated as part of the creek construction project could be placed as fill over Washington Street between 24th and 25th Street versus hauling the material off site. Ultimately, following completion of the Bee Branch Creek Restoration Project, the additional green, pervious green space created by the removal of the acquired properties could be utilized to expand the limits and function of Comiskey Park. For these reasons, it seems to be in the City's best interest to purchase the property along Washington Street between 24th and 25th Street owned by Ms. Patricia Chamberlain. 2 The property negotiations with Ms. Chamberlain have been on a volunteer basis. The discussions have centered on the idea that she is open to the sale of her property as long as she can purchase replacement properties and retain her current tenants. She has been very happy with her tenants and has been charging them rent below the market rate in order to retain them. Ms. Chamberlain has agreed to sell her two properties, 2442-2446 and 2450 Washington Street at a total cost of$210,000.00. She has also agreed to offer to rent the replacement properties to her current tenants at their current levels for 42 months. As a result, the $210,000.00 cost for the City to acquire her property corresponds to the costs the City would incur if the Chamberlain property was acquired through the eminent domain process. An Offer to Buy Real Estate and Acceptance is attached for both 2442-2446 Washington Street and for 2450 Washington Street (the Offers). In accordance with the Offers, the City will purchase 2450 Washington Street for a total cost of$107,500.00 and purchase 2442-2446 Washington Street for a total cost of$102,500.00. RECOMMENDATION I recommend that the City acquire 2442-2446 Washington Street and 2450 Washington Street for the Bee Branch Creek Restoration Project per the terms of the attached Offers. BUDGETIMPACT The purchase price is within the budget established for the property. It will be funded from the FY2013 appropriation of$2,723,388 for property acquisitions for the Bee Branch Creek Restoration Project (CIP# 7201654). Acquiring the property along Washington Street between E. 24h Street and E. 25th Street would result in an estimated $70,000.00 in project savings. REQUESTED ACTION I respectfully request that the City Council adopt the attached Resolution approving the two Offers to Buy Real Estate and Acceptance and authorizing acceptance of the Warranty Deed and any other related steps necessary to carry out the terms of the two attached Offers. Attach. cc: Barry Lindahl, City Attorney Maureen Quann, Assistant City Attorney Gus Psihoyos, City Engineer Steve Brown, Project Manager 3 C c E 25TH ST } MORRISON BROTHERS s MORRISON BROTHERS Ij la MORRISON BROTHERS i MORRISON BROTHERS BROTHERS TH _ MORRISON ERS MORRISON BROTHERS n - ` v� m _ IA TRICIA A CHAMBERLAI V e[ n O Comiskey Q A PATRICIA A CHAMBERLAIII e y z z� ~ Park PATRICIA�'� s� I � � A CHAMBERLAIN • Washington1-"' IIt -- 2442Washington f I MORRISON BROTHERSy' � r Bee Branch Creek RESOLUTION NO. 291-15 RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY PATRICIA M. CHAMBERLAIN, IN THE CITY OF DUBUQUE Whereas, the City of Dubuque intends to acquire certain real estate as necessary for the Bee Branch Creek Restoration Project (the Project) for stormwater mitigation activities as recommended in the 2001 "Drainage Basin Master Plan"; and Whereas, this certain real estate is not currently part of or located within the Bee Branch Creek Restoration Project; and Whereas, Ms. Patricia M. Chamberlain (the Owner) of this certain real estate has voluntarily agreed to sell to the City of Dubuque the certain real estate legally described as follows (the Property): North 1/2 of Lot Dubuque, Iowa South 1/2 of Lot Dubuque, Iowa South 1/2 of Lot Dubuque, Iowa 19 O.S. Langworthy's Addition, in the City of 19 O.S. Langworthy's Addition, in the City of 18 O.S. Langworthy's Addition, in the City of Whereas, the Bee Branch Creek project corridor allows for very limited space for the multiple construction contractors to store materials and equipment, maneuver equipment, and actual construct the improvements as outlined in the plans; and Whereas, the construction contractors are currently competing with local residents for off-street parking spaces and the demand for real estate will increase as the work moves towards E. 24th Street; and Whereas, acquiring the Property will result in more space available to the contractors and allow the public and area residents more use of area streets; and Whereas, following the construction of the Bee Branch Creek project, the Properties can be utilized to expand the limits and the function of Comiskey Park; and Whereas, the acquisition of this real estate is a voluntarily negotiated purchase by the City of Dubuque under Section 6B.1A of the Code of Iowa, and is not an acquisition by the City of Dubuque through its exercise of the power of eminent domain under Chapter 6B of the Code of Iowa; and Whereas, the Owner has agreed to sell her two properties, a duplex at 2442- 2446 Washington and a single family home at 2450 Washington Street for a total cost of $210,000.00 and has agreed to rent replacement properties to her current tenants at their current rent for 42 months; and Whereas, the $210,000.00 cost for the City to acquire the Owner's property corresponds to the costs the City would incur if the properties were acquired through the eminent domain process; and Whereas, purchase agreements have been finalized with the owner of the real estate scheduled for acquisition and Acknowledgments of Voluntary Negotiation have been executed by the Owner; and Whereas, it is in the best interest of the City to acquire the Properties, subject to review of the updated abstracts and title opinions by the City Attorney's Office. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: Section 1. That the City Council of the City of Dubuque, Iowa hereby approves the Offer to Buy Real Estate and Acceptance attached hereto subject to review of the updated abstracts and title opinions by the City Attorney's Office. Section 2. That the City of Dubuque be and is hereby authorized to accept a Warranty Deed from the owner, conveying the owner's interest to the City of Dubuque, Iowa for the herein described real estate. Section 3. That the City Clerk be and is hereby authorized and directed to cause said Warranty Deed to be recorded in the office of the Dubuque County Recorder, together with a certified copy of this Resolution. Passed, approved and adopted this 17th day of A gust, 2015. Roy D. Buo layor Attest: Kevi Firnstahl, City Ierk OFFER OFFER TO BUY REAL ESTATE AND ACCEPTANCE TO: Patricia A. Chamberlain (Seller) SECTION 1. REAL ESTATE DESCRIPTION. The undersigned BUYER hereby offers to buy and the undersigned SELLER by his acceptance agrees to sell the real estate situated in Dubuque, Iowa, locally known as 2450 Washington Street, Dubuque, IA 52001 and legally described as: South %2 of Lot 18 O.S..Langowrhty's Addition, in the City of Dubuque, Iowa (Real Estate); . legal description to be confirmed per continued abstract per Section 10, together with any easements and appurtenant servient estates, but subject to the following: A. Any easements of record for public utilities or roads; B. Any zoning restrictions and other ordinances; and C. Any covenants of record. SECTION 2. PURCHASE PRICE. The purchase price shall be $107,500, payable in cash at the closing. SECTION 3. REAL ESTATE TAXES. Seller shall pay any unpaid real estate taxes payable for fiscal year 2014-2015 and prior years. Seller shall also pay real estate taxes for fiscal year 2015-2016 prorated through the date of closing. Buyer shall pay all subsequent real estate taxes due and payable after the date of closing. SECTION 4. SPECIAL ASSESSMENTS. Seller shall pay all special assessments which are a lien on the Real Estate as of the date of acceptance of_this 'Offer. All other special assessments shall be paid by Buyer. SECTION 5. RISK OF LOSS AND INSURANCE. Seller shall bear the risk of Toss or damage to the Real Estate prior to closing or possession, whichever first occurs. Seller agrees to maintain existing insurance and Buyer may purchase additional insurance. In the event of substantial damage or destruction prior to closing, this Offer shall be null and void; provided, however, Buyer shall have the option to complete the closing and receive insurance proceeds regardless of the extent of damages. The property shall be. deemed substantially damaged or destroyed if it cannot be restored to its present condition on or before the closing date. SECTION 6. CARE AND MAINTENANCE. The Real Estate shall be preserved in its present condition and delivered intact at the time of possession is delivered to Buyer, provided, however, if there is loss or destruction of all or any part of the Real Estate from causes covered by the insurance maintained by Seller, Buyer agrees to accept such damaged or destroyed Real Estate together with such insurance proceeds in lieu of the Real Estate in its present condition and Seller shall not be required to repair or 1 replace same. SECTION 7. POSSESSION AND CLOSING. 7.1 If Buyer timely performs all obligations, possession of the Real E stte delivered to Buyer on or before September 11, 2015, or such earlier date as the hall be may agree in writing, with any adjustments of rent, insurance, and interest to be males as of the date of transfer of possession. de. 7.2 Closing shall occur after the approval Estate by Seller, but prior to possession by Buyer. by el Buyer and vacation of the Real inspect the Real Estate within seventy-two (72) hours prior to closing top sto urte hat tuer e premises are in the condition required by this Offer. If possession is given on at the other than closing, the parties shall make a separate agreement with;adjustmentsday the date of possession. as of 7.3 This transaction shall be considered closed upon the delivery of the documents to Buyer and receipt of all funds then due at closing from Buyer title under the Offer. SECTION 8. USE OF PURCHASE PRICE. At time of settlement Purchase Price may be used to pay taxes and other liens and t acquire i funds ofthe interests, if any, of others; o ac outstanding q SECTION 9. FIXTURES. 9.1 Included with the Real Estate shall be all fixtures that integrally belong specifically adapted to, or are a part.: of the Real Estate from a structural icturalto are standpoint, whether attached or detached.' ntegrity 9.2 The following items shall not be included: N/A SECTION 10. ABSTRACT AND TITLE. Buyer, at Buyer's expense, obtain an abstract of title to the Real Estate. It shall show marketable titleshall promptly in in conformity with this Offer, Iowa law, and title standards of the Iowa StateleBar Association. Seller shall make every reasonable effort to promptly perfect title. If closing is delayed due to Seller's inability to provide marketable title, this Offer shall continue in force and effect until either party rescinds the Offer after giving ten (10 days' written notice to the other party. The abstract shall become the property Buyer r when the Purchase Price is paid in full. Seller shall pay the costs of any additional abstracting and title work due to any act or omission of Seller, including the death of Seller or Seller's assignees. Unless stricken, the abstract shall be obtained from an abstracter qualified by the Guaranty Division of the Iowa Housing Finance Authority. SECTION 11. DEED. Upon payment of the Purchase Price, Seller shall convey the Real Estate to Buyer by Court Officer's Deed, free and clear of all liens, restrictions, and encumbrances, except as provided in this Offer. General warranties of the title shall extend to the time of delivery of the deed excepting liens and encumbrances suffered or permitted by Buyer. SECTION 12. CONTRACT BINDING ON SUCCESSORS IN INTEREST. This Offer shall apply to and bind the successors in interest of the .parties. This Offer shall survive the closing. SECTION 13. RIGHTS OF INSPECTION, ENVIRONMENTAL TESTING, AND REVIEW. 13.1 Buyer, its counsel, accountants, agents, and other representatives, shall have full and continuing access to the Real Estate and all parts thereof, upon reasonable notice to Seller. ` Buyer and its agents and representatives shall also have the right to enter, upon the Real Estate at any time after the execution and delivery hereof for any purpose whatsoever, including inspecting, surveying, engineering, test boring, performance of environmental tests, and such other work as Buyer shall consider appropriate, provided that Buyer shall hold Seller harmless and fully indemnify Seller' against any damage, claim, liability, or cause of action arising from or caused by the actions of Buyer, its agents, or representatives upon the Real Estate (except for any damage, claim, liability, or cause of action arising from conditions existing prior to any such entry upon the Real Estate), and shall have the further right to make such inquiries of governmental agencies and utility companies, etc. and to make such feasibility studies and analyses as it considers appropriate. 13.2 Seller warrants to the best of Seller's knowledge and belief that there are. no wells, solid waste disposal sites, hazardous wastes or substances, underground storage tanks, or burial sites located on the Real Estate, except as set out below. Seller further warrants that Seller has done nothing to contaminate or allow the contamination of the Real Estate andhas no knowledge of any contamination. Seller warrants that the Real Estate is not subject to any local, state, or federal judicial or administrative action, investigation, or order regarding its environmental condition or environmental compliance. Seller shall provide Buyer with a properly executed Groundwater Hazard Statement showing no wells, solid waste disposal sites, hazardous wastes, underground storage tanks, and private burial sites on the Real Estate which shall be considered a warranty and representation by Seller to Buyer. 13.3 Seller represents and warrants to Buyer that the Real Estate is not served by a private sewage disposal system, and there are no known private sewage disposal systems on the property. SECTION 14. ENCUMBRANCES. Seller warrants that the Real Estate will as of the date of closing be free and clear of all liens, security interests, and encumbrances. SECTION 15. TENANTS. The Seller will offer the current tenants of 2450 Washington 3 Street the property known as 757 Berkley Street as new replacement housing at the current monthly rent as 2450 Washington for 42 months. SECTION 16. NO REAL ESTATE AGENT OR BROKER. Neither party has used the service of a real estate agent or broker in connection with this transaction. SECTION 17. CERTIFICATION. Buyer and Seller each certify that they are not acting, directly or indirectly, for or on behalf of any person, group, entity, or nation named by any Executive Order or the United States Treasury Department as a terrorist, "Specially Designated National and Blocked Person", or any other banned or blocked person, entity, nation, or transaction pursuant to any law, order, rule, or regulation that is enforced or administered by the Office of Foreign Assets Control; and are not engaged in this transaction, directly or indirectly on behalf of, any suchperson, group, entity, or nation. Each party hereby agrees to defend, indemnify, and hold harmless the other party from and against anyand all claims, g damages, losses, risks, liabilities, and expenses (including attorney's fees and costs) arising from or related to breach of the foregoing certification. SECTION 18. REMEDIES OF THE PARTIES. 18.1 If Buyer fails to timely y perform this contract, Seller may forfeit it as provided in the Iowa Code, and all payments made shall be forfeited or, at Seller's option, upon thirty (30) days' written notice of intention to accelerate the payment of the entire balance because of such failure (during which thirty (30) days such failure, is not corrected) Seller may declare the entire balance immediately due and payable. Thereafter this contract may be foreclosed in equity and the Court may appoint a receiver. 18.2 If Seller fails to timely perform this contract, Buyer has the right to have all payments made returned to it. 18.3 Buyer and Seller also are entitled to utilize any and all other remedies or actions at law or in equity available to them and shall be entitled to obtain judgment for costs and attorney fees as permitted by law. SECTION 19. WAIVER. Failure to promptly assert rights herein shall not, however, be a waiver of such rights or a waiver of any existing or subsequent default. SECTION 20. NOTICE. Any notice under this Offer shall be in writing and be deemed served when it is delivered by personal delivery or mailed by certified mail, addressed to the parties at the addresses given below. Patricia A. Chamberlain 2442 Washington Street Dubuque, IA 52001 City of Dubuque 4 350 W. 6th Street, Suite 312 Dubuque, IA 52001 SECTION 21. TIME IS OF THE ESSENCE. In the performance of each part of this Offer, time shall be of the essence. SECTION 22. TIME FOR ACCEPTANCE. When accepted, this Offer shall become a binding contract. If this Offer is not accepted and delivered to Buyer on or before 5:00 p.m. on August 13, 2015, this Offer shall be null and void and all payments shall be returned immediately to the Buyer. SECTION 23. ENTIRE AGREEMENT. This Offer contains the entire agreement of the parties and shall not be amended except by a written instrument duly signed by Seller and Buyer. SECTION 24. PARAGRAPH HEADINGS AND CONSTRUCTION. Paragraph headings are for convenience of reference and shall not limit or affect the meaning of this Offer. Words and phrases herein shall be construed as in the singular or plural number, and as masculine, feminine, or neuter gender according to the context. SECTION 25. OTHER PROVISIONS. 25.1 Seller will provide Buyer with a signed Acknowledgment of Voluntary Negotiation and Purchase of Property at the time of closing. 25.2 This Offer is subject to the final approval of the City Council of the City of Dubuque, Iowa in its sole discretion. If the City Council of the City of Dubuque, Iowa does not approve this Offer, it shall become automatically void and neither party shall be bound by the terms and conditions set forth herein. Accepted : // 17 SELLER PATRICIA S. CHAMBERLAIN SS: , 2015 Dated:% By; -Patricia Jul`: Chamberlain , 2015 BUYER CITY OF DUBUQUE EI N: 42-6004 96 Li7 By: FZ'oy D uol, Mayor 5 LU HOPI( ACKNOWLEDGMENT OF VOLUNTARY NEGOTIATION AND PURCHASE OF PROPERTY Project (Address): 2450 Washington Street Parcel No.: 1013451007 As owner of real estate needed for the above referenced project and parcel, I acknowledge this is a voluntary negotiated purchase by The City of Dubuque, Iowa under Section 6b.1A of the Code of Iowa, and is not an acquisition by The City of Dubuque, Iowa through an exercise of the power of eminent domain under Chapter 6B of the Code of Iowa. This voluntary negotiated sale to The City of Dubuque, Iowa was made without any coercive action of any nature. Patricia A. Chamberlain, Seller Dat Notary Public in and for KRISTIN M FROM. Notary Public, State of Michigan Lee/anati County,, MI My Commission Expires 09-18-2019 Acting [n Lea. cw► County, II) OFFER TO BUY REAL ESTATE AND ACCEPTANCE TO: Patricia A. Chamberlain (Seller) SECTION 1. REAL ESTATE DESCRIPTION. The undersigned BUYER hereby offers to buy and the undersigned SELLER by his acceptance agrees to sell the real estate situated in Dubuque, Iowa, locally known as 2442-2446 Washington Street, Dubuque, IA 52001 and legally described as: North 1/2 of Lot 19 O.S. Langworthy's Addition, in the City of Dubuque, Iowa South '/2 of Lot 19 O.S. Langworthy's Addition, in the City of Dubuque, Iowa (Real Estate); legal description to be confirmed per continued abstract per Section 10, together with any easements and appurtenant servient estates, but subject to the following: A. Any easements of record for public utilities or roads; B. Any zoning restrictions and other ordinances; and C. Any covenants of record. SECTION 2. PURCHASE PRICE. The purchase price shall be $102,500, payable in cash at the closing. SECTION 3. REAL ESTATE TAXES. Seller shall pay any unpaid real estate taxes payable for fiscal year 2014-2015 and prior years. Seller shall also pay real estate taxes for fiscal year 2015-2016 prorated through the date of closing. Buyer shall pay all subsequent real estate taxes due and payable after the date of closing. SECTION 4. SPECIAL ASSESSMENTS. Seller shall pay all special assessments which are a lien on the Real Estate as of the date of acceptance of this Offer. All other special assessments shall be paid by Buyer. SECTION 5. RISK OF LOSS AND INSURANCE. Seller shall bear the risk of loss or damage to the Real Estate prior to closing or possession, whichever first occurs. Seller agrees to maintain existing insurance and Buyer may purchase additional insurance. In the event of substantial damage or destruction prior to closing, this Offer shall be null and void; provided, however, Buyer shall have the option to complete the closing and receive insurance proceeds regardless of the extent of damages. The property shall be deemed substantially damaged or destroyed if it cannot be restored to its present condition on or before the closing date. SECTION 6. CARE AND MAINTENANCE. The Real Estate shall be preserved in its present condition and delivered intact at the time of possession is delivered to Buyer, provided, however, if there is loss or destruction of all or any part of the Real Estate 1 from causes covered by the insurance maintained by Seller, Buyer agrees to accept such damaged or destroyed Real Estate together with such insurance proceeds in lieu of the Real Estate in its present condition and Seller shall not be required to repair or replace same. SECTION 7. POSSESSION AND CLOSING. 7.1 If Buyer timely performs all obligations, possession of the Real Estate shall be delivered to Buyer on or before October 31, 2015, or such earlier date as the parties may agree in writing, with any adjustments of rent, insurance, and interest to be made as of the date of transfer of possession. 7.2 Closing shall occur after the approval of title by Buyer and vacation of the Real Estate by Seller, but prior to possession by Buyer. Seller agrees to permit Buyer to inspect the Real Estate within seventy-two (72) hours prior to closing to assure that the premises are in the condition required by this Offer. If possession is given on a day other than closing, the parties shall make a separate agreement with adjustments as of the date of possession. 7.3 This transaction shall be considered closed upon the delivery of the title transfer documents to Buyer and receipt of all funds then due at closing from Buyer under the Offer. SECTION 8. USE OF PURCHASE PRICE. At time of settlement, funds of the Purchase Price may be used to pay taxes and other liens and to acquire outstanding interests, if any, of others. SECTION 9. FIXTURES. 9.1 Included with the Real Estate shall be all fixtures that integrally belong to, are specifically adapted to, or are a part of the Real Estate from a structural integrity standpoint, whether attached or detached. 9.2 The following items shall not be included: N/A SECTION 10. ABSTRACT AND TITLE. Buyer, at Buyer's expense, shall promptly obtain an abstract of title to the Real Estate. It shall show marketable title in Seller in conformity with this Offer, Iowa law, and title standards of the Iowa State Bar Association. Seller shall make every reasonable effort to promptly perfect title. If closing is delayed due to Seller's inability to provide marketable title, this Offer shall continue in force and effect until either party rescinds the Offer after giving ten (10) days' written notice to the other party. The abstract shall become the property of Buyer when the Purchase Price is paid in full. Seller shall pay the costs of any additional abstracting and title work due to any act or omission of Seller, including transfers by or the death of Seller or Seller's assignees. Unless stricken, the abstract shall be obtained from an abstracter qualified by the Guaranty Division of the Iowa Housing Finance 2 Authority. SECTION 11. DEED. Upon payment of the Purchase Price, Seller shall convey the Real Estate to Buyer by Court Officer's Deed, free and clear of all liens, restrictions, and encumbrances, except as provided in this Offer. General warranties of the title shall extend to the time of delivery of the deed excepting liens and encumbrances suffered or permitted by Buyer. SECTION 12. CONTRACT BINDING ON SUCCESSORS IN INTEREST. This Offer shall apply to and bind the successors in interest of the parties. This Offer shall survive the closing. SECTION 13. RIGHTS OF INSPECTION, ENVIRONMENTAL TESTING, AND REVIEW. 13.1 Buyer, its counsel, accountants, agents, and other representatives, shall have full and continuing access to the Real Estate and all parts thereof, upon reasonable notice to Seller. Buyer and its agents and representatives shall also have the right to enter. upon the Real Estate at any time after the execution and delivery hereof for any purpose whatsoever, including inspecting, surveying, engineering, test boring, performance of environmental tests, and such other work as Buyer shall consider appropriate, provided that Buyer shall hold Seller harmless and fully indemnify Seller against any damage, claim, liability, or cause of action arising from or caused by the actions of Buyer, its agents, or representatives upon the Real Estate (except for any damage, claim, liability, or cause of action arising from conditions existing prior to any such entry upon the Real Estate), and shall have the further right to make such inquiries of governmental agencies and utility companies, etc. and to make such feasibility studies and analyses as it considers appropriate. 13.2 Seller warrants to the best of Seller's knowledge and belief that there are no wells, solid waste disposal sites, hazardous wastes or substances, underground storage tanks, or burial sites located on the Real Estate, except as set out below. Seller further warrants that Seller has done nothing to contaminate or allow the contamination of the Real Estate and has no knowledge of any contamination. Seller warrants that the Real Estate is not subject to any local, state, or federal judicial or administrative action, investigation, or order regarding its environmental condition or environmental compliance. Seller shall provide Buyer with a properly executed Groundwater Hazard Statement showing no wells, solid waste disposal sites, hazardous wastes, underground storage tanks, and private burial sites on the Real Estate which shall be considered a warranty and representation by Seller to Buyer. 13.3 Seller represents and warrants to Buyer that the Real Estate is not served by a private sewage disposal system, and there are no known private sewage disposal systems on the property. SECTION 14. ENCUMBRANCES. Seller warrants that the Real Estate will as of the 3 date of closing be free and clear of all liens, security interests, and encumbrances. SECTION 15. TENANTS. The Seller will offer the current tenants of 2446 Washington Street replacement housing at the current monthly rent of 2446 Washington for 42 months. SECTION 16. NO REAL ESTATE AGENT OR BROKER. Neither party has used the service of a real estate agent or broker in connection with this transaction. SECTION 17. CERTIFICATION. Buyer and Seller each certify that they are not acting, directly or indirectly, for or on behalf of any person, group, entity, or nation named by any Executive Order or the United States Treasury Department as a terrorist, "Specially Designated National and Blocked Person",or any other banned or blocked person, entity, nation, or transaction pursuant to any law, order, rule, or regulation that is enforced or administered by the Office of Foreign Assets Control; and are not engaged in this transaction, directly or indirectly on, behalf of, any such person, group, entity, or nation. Each party hereby agrees to defend, indemnify, and hold harmless the other party from and against any and all claims, damages, losses, risks, liabilities, and expenses (including attorney's fees and costs) arising from or related to breach of the foregoing certification. SECTION 18. REMEDIES OF THE PARTIES. 18.1 If Buyer fails to timely perform this contract, Seller may forfeit it as provided in the Iowa Code, and all payments made shall be forfeited or, at Seller's option, upon thirty (30) days' written notice of intention to accelerate the payment of the entire balance because of such failure (during which thirty (30) days such failure is not corrected) Seller may declare the entire balance immediately due and payable. Thereafter this contract may be foreclosed in equity and the Court may appoint a receiver. 18.2 If Seller fails to timely perform this contract, Buyer has the right to have all payments made returned to it. 18.3 Buyer and Seller also are entitled to utilize any and all other remedies or actions at law or in equity available to them and shalt be entitled to obtain judgment for costs and attorney fees as permitted by law. SECTION 19. WAIVER. Failure to promptly assert rights herein shall not, however, be a waiver of such rights or a waiver of any existing or subsequent default. SECTION 20. NOTICE. Any notice under this Offer shall be in writing and be deemed served when it is delivered by personal delivery or mailed by certified mail, addressed to the parties at the addresses given below. Patricia A. Chamberlain 2442 Washington Street 4 Dubuque, IA 52001 City of Dubuque 350 W. 6th Street, Suite 312 Dubuque, IA 52001 SECTION 21. TIME IS OF THE ESSENCE. In the performance of each part of this Offer, time shall be of the essence. SECTION 22. TIME FOR ACCEPTANCE. When accepted, this Offer shall become a binding contract. If this Offer is not accepted and delivered to Buyer on or before 5:00 p.m. on August 13, 2015, this Offer shall be null and void and all payments shall be returned immediately to the Buyer. SECTION 23. ENTIRE AGREEMENT. This Offer contains the entire agreement of the parties and shall not be amended except by a written instrument duly signed by Seller and Buyer. SECTION 24. PARAGRAPH HEADINGS AND CONSTRUCTION. Paragraph headings are for convenience of reference and shall not limit or affect the meaning of this Offer. Words and phrases herein shall be construed as in the singular or plural number, and as masculine, feminine, or neuter gender according to the context. SECTION 25. OTHER PROVISIONS. 25.1 Seller will provide Buyer with a signed Acknowledgment of Voluntary Negotiation and Purchase of Property at the time of closing. 25.2 This Offer is subject to the final approval of the City Council of the City of Dubuque, Iowa in its sole discretion. If the City Council of the City of Dubuque, Iowa does not approve this Offer, it shall become automatically void and neither party shall be bound by the terms and conditions set forth herein. Accepted : / SELLER PATRICIA M. CHAMBERLAIN SS: , 2015 Dated: �f y: Patricia M. Chamberlain BUYER CITY OF DUBUQUE EIN: 42-600 596 , 2015 By: Roy` Buol, Mayor 5 ACKNOWLEDGMENT OF VOLUNTARY NEGOTIATION AND PURCHASE OF PROPERTY Project (Address): 2442 and 2446 Washington Street Parcel No.: 1013451009 As owner(s) of real estate needed for the above referenced project and parcel, (I) (We) acknowledge this is a voluntary negotiated purchase by The City of Dubuque, Iowa under Section 6b.1A of the Code of Iowa, and is not an acquisition by The City of Dubuque, Iowa through an exercise of the power of eminent domain under Chapter 6B of the Code of Iowa. This voluntary negotiated sale to The City of Dubuque, Iowa was made without any coercive action of any nature. atricia A. Chamberlain, Seller ;20/6 Date Notary Public in and for Oixt THE CITY OF Dui E MEMORANDUM Masterpiece on the Mississippi CRENNA M. BRUMWELL, ESQ. ASSISTANT CITY ATTORNEY To: Ken TeKippe Finance Director DATE: September 10, 2015 RE: 2450 Washington Street We have closed on the above -referenced property. Attached please find: 1. The original Closing Statement. 2. A copy of the check payable to Dubuque County Treasurer for $1,280.53 (taxes). I delivered the check to the Treasurer and have attached the original receipt. 3. A copy of the check payable to Dubuque County Recorder for $171.20 (transfer tax). I delivered the check to the Recorder. 4. A copy of the warranty deed, groundwater hazard statement, and declaration of value. These documents were filed with the Recorder and the City Clerk's Office will be billed for the documents. 5. The original W-9 for Patricia Chamberlain. If you need further information, please let me know. Thank you. cc: Kevin Firnstahl, City Clerk Alvin Nash, Housing & Community Development Director Seller: Patricia Chamberlain 2442 Washington Street Dubuque, IA 52001 • Purchase Price Closing Statement 2450 Washington Street Closing Date: September 9, 2015 Buyer: City of Dubuque 50 West 13th Street Dubuque, IA 52001 Less items paid by City of Dubuque (deducted from purchase price) Property taxes for FY14-15 Property taxes through closing for first half of FY 15-16 (7/1/2015-9/9/2015) Real Estate Transfer Tax Total amount remaining for Patricia Chamberlain Checks the City of Dubuque will bring to and disburse after closing: 1. Check payable to Dubuque County Treasurer $1,280.53 (Property Taxes through September 10, 2015) 2. Check payable to Dubuque County Recorder $171.20 (Real estate transfer taxes) 3. Check payable to Patricia Chamberlain $106,048.27 I have reviewed the Closing Statement and agree to the above disbursements. SELLER: PATRICIA CHAMBERLAIN wyiedz7k atricia Chamberlain Date BUYER: City of Dubuque, Iowa &H1 G - A - IS Date $107,500.00 ($1,072.00) ($208.53) ($171.20) $106,048.27 CITY OF DUBUQUE CHECK NO 432176 AMOUNT 1,280.53 VENDOR 1691 DUBUQUE COUNTY TREASURER CHECK DATE 09/09/15 Activity/Project Account Purchase Order Invoice No Amount Description 3401654 73111 16002427 2450 WASHIN 1,280.53 PROPERTY TAXES THRO ZZZZ TOTAL 1,280.53 432176 0 0 w 0 0 0 m 0 0 0 z Masterpiece on the Mississippi City Hall 50 West 13th Street Dubuque, Iowa 52001 - DUBUQUE BANK & TRUST CO DUBUQUE, IOWA PAY ONE THOUSAND, TWO HUNDRED EIGHTY DOLLARS & 53 CENTS TO THE ORDER OF DUBUQUE COUNTY TREASURER 720 CENTRAL AVE DUBUQUE IA 52001-7061 45-53 739 Check No. 432176 Date 09/09/15 Amount 1,280.53 24 •e 2*1 , Authorized Signature 11'1,32L7611' x:0739005351: 00 0 L 3 211' /J:'i t± q /: 01 y:Treasurer 1 §:i 4 : R00194319 .� , 100 Tax Collections a&.n& Parcel: 1013451007 Partial Payment Owner: CHAMBERLAIN,PATRICIA A 282747 - 2014 1X1,&%q P.6 p~g28„E3 Remaining il :OC G/ b 2I2 ƒ O i ƒ 2 -Check 19qnq RRga 7R/) 2\.7 ! !: . ' _ ,noAlrr u� ± Cq CITY OF DUBUQUE CHECK NO 432175 AMOUNT 171.20 VENDOR 1688 DUBUQUE COUNTY RECORDER CHECK DATE 09/09/15 Activity/Project Account Purchase Order Invoice No Amount Description 3401654 73111 16002429 2450 WASHIN 171.20 REAL ESTATE TRANSFE ZZZZ TOTAL 171.20 432175 c w c 0 c m n 0 c THE CITY OF DUB E Masterpiece on the Mississippi City Hall 50 West 13th Street Dubuque, Iowa 52001 - DUBUQUE BANK & TRUST CO DUBUQUE, IOWA PAY ONE HUNDRED SEVENTY ONE DOLLARS & 20 CENTS TO THE ORDER OF 1111111"11111111111111"1111111{111111111111111" 111111111"11 DUBUQUE COUNTY RECORDER 720 CENTRAL AVE DUBUQUE IA 52001 45-53 739 Check No. 432175 Date 09/09/15 Amount 171.20 Authorized Signature �I'432L7So 1:0739005351: 00 0L3 20 THE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi CRENNA M. BRUMWELL, ESQ. s6 ASSISTANT CITY ATTORNEY G To: Kevin Firnstahl City Clerk DATE: September 21, 2015 RE: Original Documents Attached for your files are the following original documents: 1. Restrictive Covenants for Residential Real Estate — 2525 Windsor Avenue 2. Restrictive Covenants for Residential Real Estate — 1501-1503 Bluff Street 3. Warranty Deed — 2450 Washington Street 4. Groundwater Hazard Statement — 2450 Washington Street No further action on your part is necessary and our office will retain a copy of these documents. Thank you. CMB:jmg Attachments OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 589-4381 / FAX (563) 583-1040 / EMAIL cbrumwel@cityofdubuque.org 11 1 11 1 11 I 11 REAL ESTATE TRANSFER - DECLARATION OF VALUE Please read the instructions on the reverse side BEFORE completing and filing this form. Part I - TO BE COMPLETED BY BUYER, SELLER OR AGENT Date of Instrument: A Deed 1 ® Contract 2 ❑ A SELLER: Patricia Chamberlain Phone: (630) 687-2867 Seller Address: 2442 Washington St.. Dubuque, IA 52001 e-mail BUYER: City of Dubuque, Iowa Phone: (563) 683-8550 5 3 9 -Li 38 ) Buyer Address. 50 West 13th St., Dubuque, IA 52001 Address of Property Conveyed: 2450 Washington St., Dubuque, IA 52001 e-mail. Legal Description: The South one-half of Lot 18 in O.S. Langworthy's Subdivision in the City of Dubuque, Iowa, according to the Type of Sale: 0 Sale between related parties/family 0 Sale of partial interest 0 Trade 0 Quit Claim Deed 0 Auction Was this a sale of AG LAND to: 0 Corporation 0 Trust 0 Alien 0 Non -Resident Alien 0 Limited Partnership DECLARATION OF VALUE STATEMENT $ 107,500.00 1. Total Amount Paid 2. Amount Paid for Personal Property (see instructions) $ 3. Amount Paid for Real Property Only (1 minus 2) $ 107,500.00 A I HEREBY DECLARE THAT THE INFORMATION CONTAINED IN PART I OF THIS FORM IS TRUE AND CORRECT AS DETAILED ON THE BACK OF THIS FORM . Printed 1\13m aicia Chamberlain A / / /Signature Phone #: (630) 687-2867 0 Buyer or IXI Seller or 0 Agent or 0 Attorney PART II - TO BE COMPLETED BY THE ASSESSOR Primary Classification: 0 Res _4_ 0 Com _5_ 0 Ind _2_ 0 Ag _ 1_ 0 MultiRes _7_ City/Township A Primary Parcel Number YearBlt Occ NUTC Classification Land Building Dwelling Total Residential Commercial Industrial Agricultural Multi Residential Comments: Effective On or Before 09/01/14 Iowa Department of Revenue IS BA 57006a (07/23/14) Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific instructions on page 2. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. PATRICIA CHAMBERLAIN 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions ionentsion, instructions Exempt payee Exemption code (if any) (Applies to accounts (codes apply only to not individuals; see on page 3): code (If any) NI Individual/sole proprietor or C Corporation II S Corporation 1 Partnershipcertain p p ❑ p p 1 Trust/estate single -member LLC company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) -member LLC that is disregarded, do not check LLC; check the appropriate box in of the single -member owner. ► ► • Limited liability Note. For a single the tax classification from FATCA reporting the line above for 1 Other (see instructions) maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) rl6t 1/t)A(4 I A) 6 T()!L) TI , Requester's name and address (optional) 6Ci state, state, and ZIP code p 7 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Social security nu ber or Employer identification number Part 1 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Here Signature of U.S. person► General Instrlic//tions Date ► )qk Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer Identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: • Form 1099 -INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Fomi 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 10•:-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What Is FATCA reporting? on page 2 for further information. Cat. No. 10231X Form W-9 (Rev. 12-2014) 11011111111111111111114111111111111 Doc'ID: 008312260001 Type: GEN. Kind: WARRANTY DEED Recorded: 09/10/2015 at 02:16:31 PM Fee Amt: $183.20 Pape 1 of 1 - Revenue Tax: $171.20 Dubuque County Iowa John Murphy Recorder File2015-00011721 ©THE IOWA STATE BAR ASSOCIATION Benjamin J. Roth FOR THE LEGAL EFFECT OF THE USE OF Official Form No. 101 -August 2013 THIS FORM, CONSULT YOUR LAWYER Return To: Benjamin J. Roth, 1400 University Ave., Suite D, Dubuque, IA 52001 Preparer: Benjamin J. Roth, 1400 University Ave., Suite D. Dubuque, IA 52001. Phone: (563) 557-1611 Taxpayer: i • II , r . i . - . .. 1 , s _ 1 ...... G 11 . WARRANTY DEED For the consideration of Ten Dollar(s) and other valuable consideration, Patricia Chamberlain, a single person do hereby Convey to City of Dubuque, Iowa the following described real estate in Dubuque County, Iowa: The South one-half of Lot 18 in O.S. Langworthy's Subdivision in the City of Dubuque, Iowa, according to the recorded plat thereof Grantors do Hereby Covenant with grantees, and successors in interest, that grantors hold the real estate by title in fee simple; that they have good and lawful authority to sell and Convey the real estate; that the real estate is free and clear of all liens and encumbrances except as may be above stated; and grantors Covenant to Warrant and Defend the real estate against the lawful claims of all persons except as may be above stated. Each of the undersigned hereby relinquishes all rights of dower, 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, an5I as masculine or feminine gender, according to the context. Dated: y// lif7N- Patridia—aamberlain (Grantor) (Grantor) STATE OF IOWA , COUNTY OF I. DUBUQU This record was acknowledged before me thisiay of ,t ,1/ -) , by Patricia Chamberlain, a single person . SUSAN :.. . 11 TIGGIES /_► '' " % v r 4,, Commission Number 113436 Signature of Notary Publ ' My Co iesi•n Expi e (This form of acknowledgment for individual grantor(s) only) co-,/ Cie-r14. • 1111111111111111111111111111111iliiilii .Doc ID: 008312270002 Type: GWH Kind: GROUNDWATER HAZARD Recorded: 09/10/2015 at 02:22:19 PM Fee Amt: $0.00 Page 1 of 2 Dubuque County Iowa John Murphy Recorder File2015-00001587 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name Patricia Chamberlain Address 2442 Washington St,. Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th St., Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: 2450 Washington St., Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) The South one-half of Lot 18 in O.S. Langworthy's Subdivision in the City of Dubuque, Iowa, according to the recorded plat thereof 1. Wel s (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. Solid Waste Disposal (check one) ,/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) 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) ,VAII 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. Signature: AVP", 2Telephone No.: (630) 687-2867 (Tr eror or Agent) FILE WITH RECORDER DNR form 542-0960 (July 18, 2012) THE CITY OF DUB TE MEMORANDUM Masterpiece on the Mississippi CRENNA M. BRUMWELL, ESQ. ~tA\\,°\% ASSISTANT CITY ATTORNEY To: Ken TeKippe Finance Director DATE: September 29, 2015 RE: 2442-2446 Washington Street We have closed on the above -referenced property. Attached please find: 1. The original Closing Statement. 2. A copy of the check payable to Dubuque County Treasurer for $1,144.90 (taxes). I delivered the check to the Treasurer and have attached the original receipt. 3. A copy of the check payable to Dubuque County Recorder for $163.20 (transfer tax). I delivered the check to the Recorder and have attached the original receipt. 4. A copy of the warranty deed, groundwater hazard statement, and declaration of value. These documents were filed with the Recorder and the City Clerk's Office will be billed for the documents. If you need further information, please let me know. Thank you. cc: Kevin Firnstahl, City Clerk Alvin Nash, Housing & Community Development Director Seller: Patricia Chamberlain 2442 Washington Street Dubuque, IA 52001 Purchase Price Closing Statement 2442-2446 Washington Street Closing Date: September 29, 2015 Buyer: City of Dubuque 50 West 13th Street Dubuque, IA 52001 Less items paid by City of Dubuque (deducted from purchase price) Property taxes for FY14-15 Property taxes through closing for first half of FY 15-16 (7/1/2015-9/29/2015) Real Estate Transfer Tax Total amount remaining for Patricia Chamberlain Checks the City of Dubuque will bring to and disburse after closing: 1. Check payable to Dubuque County Treasurer $1,144.90 (Property Taxes through September 29, 2015) 2. Check payable to Dubuque County Recorder $163.20 (Real estate transfer taxes) 3. Check payable to Patricia Chamberlain $101,191.90 I have reviewed the Closing Statement and agree to the above disbursements. SELLER: PATRICIA CHAMBERLAIN BUYER: City of Dubuque, Iowa By .4)1/1/t (A766/./)(Ar qt2q115 Date $102,500.00 ($1,018.00) ($126.90) ($163.20) $101,191.90 City of Dubuque CHECK NO 426234 AMOUNT $1,144.90 VENDOR 1691 DUBUQUE COUNTY TREASURER CHECK DATE 09/24/2015 Activity/Project Account Purchase Order Invoice No Amount Description 3401654 73111 16002896 PROP TAXES 1,144.90 2442 WASHINGTON ZZZZ TOTAL $1,144.90 Masterpiece on the Mississippi City Hall 50 West 13th Street Dubuque, Iowa 52001 DUBUQUE BANK & TRUST Check No. 426234 DUBUQUE, IOWA Date 09/24/2015 Amount $1,144.90 PAY ONE THOUSAND ONE HUNDRED FORTY FOUR DOLLARS AND 90 CENTS******************************* TO THE DUBUQUE COUNTY TREASURER ORDER 720 CENTRAL AVE OF DUBUQUE, IA 52001 Authorizc¢ yygnature 011 26 2340 I:07390053Si: 00 0 L3 20 El -1,1 O/ ------ rniqA-h:. A OM .1 03 TO : TrenrEIT 3 TERM : R00214106 inn 77.1.4 W UAUi mirr,n1 A '1 71,17.1 NW.) n 1 1:17.1,7,-,rani- 1UjL.L V.J.j9,f t US r=. PIJAMT.rEll A k,rif,:rnTr fs, n 1771:1:07 _ Tj tY m LAUVW ILVI4 IfJA nvnn-vmn-14-= (.7 AO riCrdJaelL. U.J.VV IAA Tv ivV UA WIICLA....Uha ' ri7AP.ifnq P7-1opnt V ;Ani PATQ i".1 flwrer:1.11nrxt_LLA,Inl trithi.J_n flpnr-z:T Tv4 iw PrePuEnt: 63.90 Paid BY:EITY OF DIME 2Crieck 1144,90 REF426274 1-1.1-11 DEit ICI 1144„,90 ro 1 Tncper= 11A/ r,' 1 ...kin...N...1i .1.1-14„ A; ............ — t'n 1...OhNUL City of Dubuque CHECK NO 426235 AMOUNT $163.20 VENDOR 1688 DUBUQUE COUNTY RECORDER CHECK DATE 09/24/2015 Activity/Project Account Purchase Order Invoice No Amount Description 3401654 73111 16002897 TRNSFR TAX 163.20 2442 WASHINGTON ZZZZ TOTAL $163.20 Masterpiece on the Mississippi City Hall 50 West 13th Street Dubuque, Iowa 52001 DUBUQUE BANK & TRUST Check No. 426235 DUBUQUE, IOWA Date 09/24/2015 Amount $163.20 PAY ONE HUNDRED SIXTY THREE DOLLARS AND 20 CENTS*************************************************** TO THE DUBUQUE COUNTY RECORDER ORDER 720 CENTRAL AVE OF DUBUQUE, IA 52001 Authoy'd Signature ��'42E, 2 3 So 1:0 7 3900 5 3 5': 00 0 L 3 2" I RECEIPT OFFICE OF COUNTY RECORDER DUBUQUE CO. IOWA Dubuque, RECEIVED OF 1 0�-b cL� Iowa, l — Li 20 / 5 Ov-t k. JCil ,S i i( t QQ G . 2q- Dollars IL 3. 20 $ j�LVY For -tVCuN V it 100 By JOHN MURPHY, Recorder ll)Ai,1y JTHE IOWA STATE BAR ASSOCIATION Benjamin J. Roth FOR THE LEGAL EFFECT OF THE USE OF Official Form iNlo. 101 - August 2013 THIS FORM. CONSULT YOUR LAWYER Return To: Benjamin J. Roth, 1400 University Ave., Suite D, Dubuque, IA 52001 Preparer: Benjamin J. Roth, 1400 University Ave., Suite D, Dubuque, IA 52001, Phone: (563) 557-1611 Taxpayer: City of Dubuque. Iowa. 50 W. 13th St.. Dubuque. TA 52001 sTT r,� y H ,� y WARRANTY DEED SSOCi ac' - For the consideration of Ten Dollar(s) and other valuable consideration, Patricia Chamberlain, a single person do hereby Convey to city of Dubuque. Iowa the following described real estate in Dubuque County, Iowa: the recorded plat the real estate by that the real estate Covenant to above stated. share in and to the as in the singular Lot 19 in O.S. Langworthy's Subdivision in the City of Dubuque, thereof Grantors do Hereby Covenant with grantees, and successors in interest, title in fee simple; that they have good and lawful authority to sell and Convey is free and clear of all liens and encumbrances except as may be above Warrant and Defend the real estate against the lawful claims of all persons Each of the undersigned hereby relinquishes all rights of dower, homestead real estate. Words and phrases herein, including acknowledgment hereof, or plural number, and as masculine or feminine gender, according to the Dated: Iowa, according to that grantors hold the real estate; stated; and grantors except as may be and distributive shall be construed context. 6r ?-/.// ',/,, 1,,4 ,/q76— P cia`Chamberlain (Granton) STATE OF IOWA , COUNTY OF DUBUQUE (Grantor) , by Patricia_ This record was acknowledged before me this a \ day of �p t A- , LOIS Chamberlain, a single person . (This, form of Signature of Notary Pu is acknowledgment for individual grantor(s) only) 12-lbl `P Acknowledgments for Individuals STATE OF —LN-0k COUNTY OF .jut This record was acknowledged before me this `�', day of ,01.4"IN.dat"- a. )S by CCA-,\L1�w� Signature of Notary P is REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name Patricia Chamberlain Address 2442 Washington St,. Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th St., Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: 2442-2446 Washington St., Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) Lot 19 in O.S. Langworthy's Subdivision in the City of Dubuque, Iowa, according to the recorded plat thereof 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. Solid Waste Disposal (check one) 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) X 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) 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) 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. FILE WITH RECORDER ��C/Telephone No.: (630) 687-2867 DNR form 542-0960 (July 18, 2012) 11 1 11 11 11 REAL ESTATE TRANSFER - DECLARATION OF VALUE Please read the instructions on the reverse side BEFORE completing and filing this form. Part I - TO BE COMPLETED BY BUYER, SELLER OR AGENT Date of Instrument: ♦ Deed 1 ® Contract 2 ❑ • SELLER: Patricia Chamberlain Phone (630) 687-2867 Seller Address: "7447. Washington St.. Dubuque. Ik 5,001 e-mail: BUYER: City of Dubuque, Iowa Phone: (563) 589-4381 A Buyer Address. 50 West 13th St., Dubuque, IA 52001 e-mail Address of Property Conveyed: 2442-7446 Washington St.. Dubuque. IA 52001 Legal Description: Lot 19 in O.S. Lan worthy's Subdivision in the City of Dubuque Iowa according to the recorded plat thereof Type of Sale: 0 Sale between related parties/family 0 Sale of partial interest 0 Trade 0 Quit Claim Deed 0 Auction Was this a sale of AG LAND to: 0 Corporation 0 Trust 0 Alien 0 Non -Resident Alien 0 Limited Partnership • DECLARATION OF VALUE STATEMENT $ 102,500.00 1. Total Amount Paid 2. Amount Paid for Personal Property (see instructions) $ 3. Amount Paid for Real Property Only (1 minus 2) $ 102,500.00 A I HEREBY DECLARE THAT THE INFORMATION CONTAINED IN PART I OF THIS FORM IS TRUE AND CORRECT AS DETAILED ON THE BACK OF THIS FORM . Printed Name: Sign 1 re Primary Classification: Primary Parcel Number Chamberlain Phone #: (630) 687-'7867 0 Buyer or ® Seller or ❑ Agent or 0 Attorney PART II - TO BE COMPLETED BY THE ASSESSOR 0 Res _4_ 0 Com _5_ 0 Ind _2_ 0 Ag _ 1_ 0 MultiRes _7_ City/Township ♦ ♦ YearBlt Occ NUTC Classification Land Building Dwelling Total Residential Commercial Industrial Agricultural Multi Residential Comments: Effective On or Before 09/01/14 Iowa Department of Revenue ISBA 57006a (07;23/14) ►► ► ►t►tete►►►ori►► t►itit ttti ►t ► t► ► A►►►► ► ►►e ►►►►o►tto t ►ii t►t t Doc ID. 008322640001 Type: GEN Kind: WARRANTY DEED Recorded: 09/29/2015 at 01:50:22 PM Fee Amt: $175.20 Pape 1 of 1 Revenue Tax: $163.20 Dubuque County Iowa John Murphy Recorder File2015-00012595 ©THE IOWA STATE BAR ASSOCIATION Ben -1 amen J. Roth FOR THE LEGAL EFFECT OF THE USE OF Official Form No. 101 - August 2013 THIS FORM, CONSULT YOUR LAWYER Return To: Benjamin J. Roth. 1400 University Ave., Suite D. Dubuque, IA 52001 Preparer: Benjamin J Roth, 1400 University Ave., Suite D. Dubuque, IA 52001, Phone: (563) 557-1611 Taxpayer: City of Dubuque, Iowa, 50 W. 13th St., Dubuque, TA 52001 2'STATS 0 " WARRANTY DEED • 7 1 For the consideration of Ten Dollar(s) and other valuable consideration, Patricia Chamberlain, a single person do hereby Convey to City of Dubuque, Iowa the following described real estate in Dubuque County, Iowa: the recorded plat the real estate by that the real estate Covenant to above stated. share in and to the as in the singular Lot 19 m O.S, Langworthy's Subdivision in the City of Dubuque, thereof Grantors do Hereby Covenant with grantees, and successors in interest, title in fee simple; that they have good and lawful authority to sell and Convey is free and clear of all liens and encumbrances except as may be above Warrant and Defend the real estate against the lawful claims of all persons Each of the undersigned hereby relinquishes all rights of dower, homestead real estate. Words and phrases herein, including acknowledgment hereof, or plural number, and as masculine or feminine gender, according to the Iowa, according to that grantors hold the real estate; stated; and grantors except as may be and distributive shall be construed context. Dated: z , 74ke i (e. ,t --i' 4 (-' Z- - / 7 g,/,//qG 2 76-- Prcia` hamberlain (Grranto6 STATE OF IOWA COUNTY OF DUBUQUE (Grantor) , by Patricia This record was acknowledged before me this `a day of j n-466,1 , 1.S" Chamberlain, a single person , tjjff.., ,`Iorrn of ` 1 ,Signature of Notary Pu is acknowledgment for individual grantor(s) only) " 00 100®C C.IL 1111111111111131111111111111 Doc ID 008322650002 Type: GWH Kind GROUNDWATER HAZARD Recorded: 09/29/2015 at 01:50:27 PM Fee Amt: $0.00 Pape 1 of 2 Dubuque County Iowa John Murphy Recorder File2015-00001704 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name Patricia Chamberlain Address 2442 Washington St,. Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th St., Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: 2442-2446 Washington St., Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) Lot 19 in O.S. Langworthy's Subdivision in the City of Dubuque, Iowa, according to the recorded plat thereof 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. olid Waste Disposal (check one) 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. H zardous 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) DL C — 1dt 5 I.5 5. Private 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. Private Sewage Disposal System (check one) X 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. Signature: /, Transferor or Agent) FILE WITH RECORDER e/y 1 elephone No.: (630) 687-2867 DNR form 542-0960 (July 18, 2012)