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Army Surplus Store WarrantyRESOLUTION NO. 55-00 A RESOLUTION ACCEPTING THE DEED TO CERTAIN REAL ESTATE IN DUBUQUE COUNTY, IOWA FROM DUBUQUE INITIATIVES WHEREAS, the City of Dubuque entered into a Purchase Agreement with Dubuque Initiatives for the following described real property in Dubuque County, Iowa: The South 25-5/12 feet of Lot 72; and Lot 72A in the City of Dubuque, Iowa, according to the United States Commissioners' Map of the Town of Dubuque, Iowa AND WHEREAS, the terms of the Purchase Agreement have now been met. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA, AS FOLLOWS: 1. The City of Dubuque hereby accepts the Deed from Dubuque Initiatives, a copy of which is attached hereto. 2. The City Clerk is hereby authorized and directed to record this Resolution and the Deed with the Dubuque County Recorder as provided in Iowa Code sec. 569.7 Passed, approved and adopted this 21st day of February, 2000. Terrance M. Duggan, Mayor Attest: Jeanne F. Schneider, City Clerk BARRY A. LINDAHL, ESQ. CORPORATION COUNSEL MEMO 2/15/007:08 AM To: Jeanne Re: Purchase of former Army Surplus store Attached is a resolution accepting the deed to the former Army Surplus store from Dubuque Initiatives. The resolution should be on the next City Council agenda. Also attached are the original Deed, Groundwater Hazard Statement, and Declaration of Value which you will need at the time of recording. The check for $172.00 payable to the recorder is for the revenue stamps which you will also need at the time of recording. The other two checks are for real estate taxes and should be delivered to Duane. Cc: Cindy Steinhauser . . ------------ . 2519 DUBUQUE INITIATIVES DUBUOUE, IA 52001 DUBUQUE BANK' TRUST DUBUOUE, IOWA 52004-0778 45-53-739 21912000 PAYTO THE ORDER OF $ -'72.00 ! DOLLARS' Dubuque Counly Recorder One Hundred Sevenly-Two and 001100 , , ~¡/.&L. J Dubuqua Counly R«order CounlyCourtl)ouse Dubuque, IA52001 MEMO 301 Main Closing "'0025.'1'" ':07:1'1005:15': .0 5b7 8'" DUBUQUE INITIATIVES 2519 172.00 Dubuqua County Recorder Legal And Professional 21912000 DB&T Chec~ng 301 Main Closing 172.00 . DUBUQUE INITIATIVES DUBUQUE, IA 52001 'AYTOTHE )RDER OF Dubuque County Treasurer One Thousand Ninety-Two and-OIJ/100" . Dubuque County Treasurer County Courthouse Oubuque, IA 52001 301 Main St2nd haW /1"0025108/1" 1:0?:¡<¡005:¡SI: BUQUE INITIATIVES Dubuque County Treasurer Tax:Property fI&T Checking 301 Main 5t 2nd haW DUBUQUE BANK & TRUST DUBUQUE, IOWA 52004-0778 45-53-739 2/912000 $ -1,092,00 2518 I ~ õ ~ DOLLARS i J ~_d-_~~_"! m 100 5b? 8/1" 2/912000 /'~ ç --,- c: .5 ¿?<::!:)-¿J5- 33Co-.-'/ , 2518 1,092,00 1,092,00 'y.- "~"-~ ,"",,"""""'~~"',"""',"',---," . / -'.,,"-, ...':b:.,;:~",~":"""~"'~~~"~'\"'.JD;;:';:;"./£~I>',. ',,' ""Z-:;;;"l.-'i!..:':'\~-_1:r..~;;:......"".""'t.<~'M<:"'Ii"""" ,J:;.o::f.;'~H"",""'.;"'t:.c1 I 2520 I DUBUQUE INITIATIVES DUBUQUE, IA 52001 DUBUQUE BANK & TRUST DUBUQUE, IOWA 52004-0778 45-53-739 21912000 AYTOTHE JRDER OF City Of Dubuque $ -1,345,50 ¡; ~ City Of Oubuque DOLLARS i i j One Thousand Three Hundred Forty-Five and 50/1 00'" 301 Main Closing /1"002520/1" 1:0?:¡<¡005:¡51: . !~wm ~-Ln_--~-_-------- IEMO ~O 51;? 8/1" BUQUE INITIATIVES City Of Oubuque Tax: Property 21912000 2520 1,345,50 DB&T Checking 301 Main Closing 1,345,50 .. . 6\',,~:~~:r~T~;:-E,~:R ASSOCIATION I Da'id L. Clemen, ISBA # OBBO I '~:,:','o'i:::";o:::i~; ~;,;.'~~,~' :;;f~~:;ion David L. Clemm, 222 Fi"her Bid,., Dubuque, Iowa 52004-0239, (319) 556-8000 Phooo 10""""" Name SI"el Add".. City T¡¡: City of Dubuque, City Hall, 50 West 13th St.. Dubu:,ue, IA SPACE ABOVE THIS LINE WARRANTY DEED FOR RECORDER '" " (CORPORATE GRANTOR) "m" For the consideration of Ten and 00/100----------- Dollar(s) and other valuable consideration, Dubuque Initiati", fikla Dubuque In-Futuro- Inc. a corporation organized and existing under the laws of Iowa does hereby Convey to City of Dubuque, the following described real estate in Dubuque County, Iowa: The South 25-5112 fe" of Lot 72; and Lot 72A; in the City ofDubuque, Iowa, accmding to the United States Conum..ioners' Map of the Town ofDubuque, Iowa, The Corporalion hereby covenants with grantees, and successors in interest, that it holds the real estate by title in fee simple; that it has 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 it covenants to Warrant and Defend the real estate against the lawtul claims of a/l persons, except as may be above stated, Words and phrases herein, including acknowledgment hereof, shall be construed as in the singular or plural number, according to the context. Dubuque tnitiati"" fikla Dubuque In-Futuro, Inc, a(n) Iowa corporation Dated: ,~¡ / Y.J'~¡J'" BY"¥¿"""~ 'L~:" .~"',;,.,--- Kä:: E, , Pre"dent Hie By ~ I ~ ~/k..¿jJ~ Ann E, Michal,ki, Secretary Title STATE OF IOWA DUBUOUE COUNTY, sse On this IV day of ~ .1",,- before me, the undersigned, a Notary Public in and for said State, personally appeared Kath<vn E. Krie, and Ann E. Michal,ki to me personally known, who being by me duly sworn, did say that they are the President and Secreta", , respectively, of said corporation; that (no seal has been procured by the said) (Ino scBI .!fixcd thololo i. the seBI of 'Bid) corporation that said instrument was signed (and sealed) on behalf of said corporation by authority of its Board of Direclors; and that the said Kathryn E, Krie, and AnnE. Michabki a~ ~)aCknOWledged the execution of said instrument to be the voluntary act and deed of said co tl n, by it and by them voluntarily executed. " Notary Public II . ~~~~g:~ ~~:e_"oo 104 WARRANTY UEED (CORPORATE GRANroR) ---,,"" . . ------------ . . REAL ESTATETRANSFER-GROUNDWATER HAZARO STATEMENT Plaasa read tha filing instructions on tha ravarsa sida BEFORE complatlng this form, PART I - TO BE COMPLETED BY TRANSFEROR (Please Type or Print Legibly) ~o~C~~d~~~~~i~~~) '-fJ- -¡;{.rlfC) TRANSFEROR Name Dubuque Initiatives, fikl, Dubuque In-Futum, Inc. Address City Hall. 50 West 13th SITe", Dubuque, Iowa 52001 Numbor an' Strsst or RR City, Town or PO Stat, Zip TRANSFEREE Name City of Dubuque Social Security No. (or Federall.D, No,) Address City Hall, 50 West 13th Street, Dubuque, Iowa 52001 Numbor on' Stroot or RR City, Town or PO State Zip Address of Property Transfered 301 Main SITeet, Dubuque, Iowa 52001 Numbor on' Stre" or RR City, Town or PO Stat, Zip Legal Description of Property The South 25-5/12 fe" of Lot n and Lot 72k in the CitY ofDubuque Iowa, according to the United State, Comi"wnm' Mao of the Town of Dubuque, Iowa, 1, Wa/ls (chack onB) !¥There are no known wells situated on this property, 0 There is a well or wells situated on this property. The type(s), location(s) and legal status are stated below. . 2- So/ld Waste DIsposal (check one) @-There is no known solid wasle disposal site on this property, 0 There is a solid waste disposal site on this property, but no notice has been received from the Department of Natural Resources that the site is deemed to be potentially ha2ardous, 0 There is a solid waste disposal site on this property which has beBn deemed to be potentially hazardous by the Department of Natural Resources, The location(s) of the site(s) is stated below, 3, tI'9'8'"dous Wastes (chack one) 0 There is no known hazardous waste on this property. 0 There is hazardous waste on this property and it is being managed in accordance with Department of Natural Resources rules, 4, Undarground Storage Tanks (check on B) [o/Îhere are no known underground storage tanks on this property, (Note exclusions such as small farm and residBntial motor fuel tanks, most heating oil tanks, cisterns and septic tanks, in instructions,) 0 There 15 an underground storage tank or tanks on this property. The type(s), size(s) and any known substance(s) contained are described below. Information, if any, required by statements checked above: 5, Private Burial Site (check one) _L-rhe" are no known private burial ,ites on thi, property, - The" i, a povate burial ,ite on thi, property. The locatlon(s) of the ,ite(5) i, ,tate below, The known ideutifying ------------ infonnation of the decedent is "aled below, Attachment for Additional Information? Y I@ If 50, number of pages - I HEREBY DECLAR AND CORRECT, Signature: INFORMATION CONTAINED IN PART I OF THIS STATEMENT IS TRUE Telephone Number: _j't'ý-r--r7 p~ - - -- - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- . PART /I - TO BE COMPLETED BY RECORDER Date of Instrument Bookll.D, page/l.D, Date of Recording Deed 0 Contract 0 City or Township County -------------------------------------------------------------------------------------------- DNR form (SEPT, 96) FILE WITH RECORDER (See Instructions, #5) REAL ESTATE TRANSFER - DECLARATION OF VALUE ~ . PleaBe read the filing Instructions on the reverBe side BEFORE completing this form, If this transaction is exempt, you may not be required to complete this form, PART I - TO BE CDMPLETED BY BUYER. SELLER OR AGENT ... - (Please Type or Print Legibly) Social Security No, SELLER .- Nama Dubu:n¡e Initiatives. flk;,; """'C]J'~ Tn-"',,",~ (or Fedarall.D, No.) 42-116'i790 Addrass City Hall, 50 West 13th Street, Dubuque, Iowa 52001 Name cttÿ":;'f'D~b~qO;:;~ "",_o,'~'o'" ~~~:~~;~Iu~t~~r'" Addrass City Hall, 50 West 13th Street, Dubuque, Iowa 52001 Addrass 01 Property conveye:"""":i'öì' M:;j'~""street, Dubuq;;'~ :-r~;:;~"5 2 0 0 1 ,"moo,""","..",'oo"", C~,'~",,""'O"'œ ,,' Legal Description 01 Property '1"'~ "m'T" ? 'i-'i;P r~~T nr T,nr 7?' ,nn T,nT 72A' ; n Tn" ci tv of Dubuque, Iowa, accordinq to the United States Commissioners' Map of the Town of Dubuque, Iowa, It this is a sale of AGRICULTURAL LAND to one at the following persons or entities, please check fhe appropriate box, 0 Corporation 0 Trust 0 Alien 0 Non-Resident Alien 0 Limited Partnership ....................................................................,.. Declaration of Value Statement BUYER ~ ".~ 1. Total Amount Paid""""""""""""""""""""""""""""" ,,$ 2, Amount Paid for Personal Property (See Instructions)", , $ 3, Amount Paid for Real Property Only (1 minus 2)"""". ,,$ 4, Contract Sale Information - Please See Instructions Down Payment $ Âlnterest Rate - % Â Monthly Payment $ Length of Contract years'" Ba/loon Payment Date (if applicable) SALES CONDITIONS /67. .. Â Â Chock 1-'1 ALL ,Ith, loll~,"g coo',"oo, "" "ply to th" halo DS,'o Botw"o F,mUy M,mb.., fS" lo"'octioo,) DAha'gom"totCoot"ctlE,p','oB"ow) 0 Aoct"o S,lo DS,'otoibyPo,,;,Ut"Uy DS"ot<>ibyE"mptO,g"",tioo 0 Coo"m,","m S,I, DCoort 0"""5", 0 OoU C"'m 0", 0 PotOhahaotA'io'mog Lao' DFoltillm"totP';OIy,..Cootroct DS,'otolbyG",mm"t 0 L,,'tob,Op"""'" ,UoU DTron,lorotPa,tialln..,"st DSh"'ff OIT" 5,10 0 FOIc" S"'IE'pl,'o e"owl DE,ch,ng' fOlOth" Prop'rty ("T,,"') DCo~o"" Mo""'01 R"'g"""oo 0 MobUo Hom, 0 ~tscv~I1!~°i'N~'gM~~o~~~~'u~tõ~ogp"!~I~"~~'gt~ó'~ tg¡,{¿i'!.:'~t~'N'b~~ b,\'m~,'J~ f~¿, ~~~'S~~~Of Sa" or T,,",fe' . ~D ( HEREBY D Signature: Date of Instrument Date of Recording D DeedO ~Contract 0 ORMATION CONTAINED IN PART 1 OF THIS FORM IS TRUE AND CORRECT Telephone Number ( ) jrt - ð""'~ PART /I-TO BE COMPLETED BY RECORDER ==~, c=J ~ ~:!~£::~, c=J ~ II~ II~ ~ City or Township County Real E"ala Transler Ta, Paid PART tit - TO BE CDMPLETED BY ASSESSOR Classification of PropBrty (1) 0 Urban AGRICULTURAL REALTY T T (11 Dlmp"""'~ DOwo"'og (2) 0 Rural ------------ COMMERCIAL (,)DB",'"" (4IDOIh"-1 (2)DOff", (5IDv","6Idg. (3)DAp'rtmo" (610""'" Lot INDUSTRIAL I I ,,)DLo<&Bldg, 12IDvo""aldg'. (31 DV"", Lot RESIDENTIAL I1JD S,"g,,-F,mlly Owlg 12)0 T~-Fom"y Owlg (3)0 Imp'. "',," Lot 14)DUolmp' """'Lot I5ID"""'Owlg SIOOHgI AgooI""'" SALES CONDITIONS 0 Lot Assessed as Unplatted Land 0 Fulfilfmenl 01 Prior Year Contract 0 Assignm6ntof Contract 0 Partial Assessmant 0 Sala 01 Portion 01 Proparty ("SpIi1') 0 Other (Explain Below) 0 Change in Usa (Explain Below) IJ IK I L IF 1M IA IG " IH K; ID IE . (For Depo. 01 Revenue and Finance Use Only) NOTE: ASSESSED VALUE SHOWN Asse,smen1 Dala MUST 6E AS OF JANUARY 1, OF THE CJ YEAR IN WHICH THE SALE LAND $ BL'iGS. r;--¡ OCCURRED - ~ \ASS"SO' Common" ~ """",,.,,"',-, DEPARTMENT OF REVENUE AND FINANCE . . Dubuque County T"",u,,, 720 C.nual Dubuqu., lA 52001-7062 ----------- -- LDCATIOII: 301 MAIN DISTRICL DUDA PARCEL: 10-25-240-011 DUBUQUE IN FUTURO INC CITY MALL 13TH & CENTRAL DUBUQUE IA 52001 . T~ Due: "ARCII 31,2000 IllIm~WllllllruJl"IIIIIIIII"II~11111 TAX BILL #: 748964 GROUP 10: 000064.90 s..# "~3I MAKE CHECKS PAYABLE TO: Eric Stierman Dubuque County Treasurer Dubuque County Courthouse Dubuque, IA 52001-7062 BARRY A. LINDAHL, ESQ, CORPORATION COUNSEL MEMO 2/15/007:08 AM To: Jeanne Re: Purchase of former Army Surplus store Attached is a resolution accepting the deed to the former Army Surplus store from Dubuque Initiatives, The resolution should be on the next City Council agenda, Also attached are the original Deed, Groundwater Hazard Statement, and Declaration of Value which you will need at the time of recording, The check for $172,00 payable to the recorder is for the revenue stamps which you will also need at the time of recording, The other two checks are for real estate taxes and should be delivered to Duane, Cc: Cindy Steinhauser RESOLUTION NO. 55-00 A RESOLUTION ACCEPTING THE DEED TO CERTAIN REAL ESTATE IN DUBUQUE COUNTY, IOWA FROM DUBUQUE INITIATIVES WHEREAS, the City of Dubuque entered into a Purchase Agreement with Dubuque Initiatives for the following described real property in Dubuque County, Iowa: The South 25-5/12 feet of Lot 72; and Lot 72A in the City of Dubuque, Iowa, according to the United States Commissioners' Map of the Town of Dubuque, Iowa AND WHEREAS, the terms of the Purchase Agreement have now been met. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, lOW A, AS FOLLOWS: 1. The City of Dubuque hereby accepts the Deed from Dubuque Initiatives, a copy of which is attached hereto. 2. The City Clerk is hereby authorized and directed to record this Resolution and the Deed with the Dubuque County Recorder as provided in Iowa Code sec. 569.7 Passed, approved and adopted this 21st day of February, 2000. Terrance M. Duggan, Mayor Attest: Jeanne F. Schneider, City Clerk CERTIFICATE OF CITY CLERK STATE OF IOWA COUNTY OF DUBUQUE I, Jeanne F. Schneider, do hereby certify that I am the duly appointed, qualified, and acting Clerk of the City of Dubuque, Iowa in the County aforesaid, and as such Clerk I have in my possession or have access to the records of the proceedings of the City Council. I do further state that the hereto attached Resolution No, 55-00 is a correct copy of the original Resolution No. 55-00 approved and adopted by the City Council of the City of Dubuque, Iowa, at a session held by said Council on the 7th day of February, 2000, In Testimony Whereof, I hereunto set my hand and official seal of the City of Dubuque, Iowa. Dated at Dubuque, Iowa this 21st day of February, 2000, Jeanne F, Schneider City Clerk City of Dubuque, Iowa (SEAL) RESOLUTION NO. 55-00 A RESOLUTION ACCEPTING THE DEED TO CERTAIN REAL ESTATE IN DUBUQUE COUNTY, IOWA FROM DUBUQUE INITIATIVES WHEREAS, the City of Dubuque entered into a Purchase Agreement with Dubuque Initiatives for the following described real property in Dubuque County, Iowa: The South 25-5/12 feet of Lot 72; and Lot 72A in the City of Dubuque, Iowa, according to the United States Commissioners' Map of the Town of Dubuque, Iowa AND WHEREAS, the terms of the Purchase Agreement have now been met. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, lOW A, AS FOLLOWS: 1. The City of Dubuque hereby accepts the Deed from Dubuque Initiatives, a copy of which is attached hereto. 2. The City Clerk is hereby authorized and directed to record this Resolution and the Deed with the Dubuque County Rccorder as provided in Iowa Code sec. 569.7 Passed, approved and adopted this 21st day of February, 2000. Terrance M. Duggan, Mayor Attest:, Jeanne F. Schneider, City Clerk CERTIFICATE OF CITY CLERK STATE OF IOWA COUNTY OF DUBUQUE I, Jeanne F, Schneider, do hereby certify that I am the duly appointed, qualified, and acting Clerk of the City of Dubuque, Iowa in the County aforesaid, and as such Clerk I have in my possession or have access to the records of the proceedings of the City Council. I do further state that the hereto attached Resolution No 55-00 is a correct copy of the original Resolution No 55-00 approved and adopted by the City Council of the City of Dubuque, Iowa, at a session held by said Council on the 7th day of February, 2000, In Testimony Whereof, I hereunto set my hand and official seal of the City of Dubuque, Iowa, Dated at Dubuque, Iowa this 21st day of February, 2000. Jeanne F, Schneider City Clerk City of Dubuque, Iowa - (SEAL) : :::: Ç. i,';'.~,:~~:,::'T~~E,~:R ASSOCIATION Da,'d L. Cleme" ISBA' 08BO . 1868-00 2JUOFEB23 PH I: 19 "'iBJNT~~~C~¡:gW,1 ð CJSUQUE co., IOWA FEES ¿ 0 rn'.:r~:¡'on Dov;d L. Clemens, 222 Fischer Bldg., Dubuque, Iowa 52004-0239, (319) 556-8000 Lodi,id"L', Nama St"" Add"" City Ph,", City of Dubuque, CityHall, 50 West 13th St., Dubuque, IA SPA~õ~~~~õJ~~RLlNE WARRANTY DEED (CORPORATE GRANTOR) For Ihe consideration of Ten and 00/100----------- Dollar(s) and other valuable consideration, Dubuque Initiat;,", tiKIa Dubuoue In-Futuro, Inc. a corporation organized and existing under the laws of Iowa dDBS hereby Convey to City ofDubuque, the following described real estate in Dubuque County, Iowa: The South 25-5/12 feet of Lot 72: and Lot 72A: In the City of Dubuque, Iowa, accotding to the United States Commi"ionm' Map of Ihe Town ofDubuque, Iowa, _...-AT.TRANS.... TAXPAtQ ..:IL -.111,9.0 STAMP' F""," Thu"~1 4w1 ;g;RDER ~aD ".c,,',~ DATE cou¡m . The Corporation hereby covenants with grantees, and successors in interest, that it holds the real estate by title in fee simple; that it has good and lawful authority to sell and convey the real estate; that the real estate is free and clear of all liens and encumbrances, excBpt as may be above stated; and it covenants to Warrant and Defend the real estatB against the lawful claims of all persons, except as may be above stated, Words and phrases herein, including acknowledgment hereof, shall be construed as in the singular or plural number, according to the context Dubuque Initiati"" fiKIa Dubuque In-Fuow-o, Iuc. a(n) Iowa corporation Dated: k.f / Y,.J'~¡J</ BY~""~ 'L. -->:Y:.. .~',,;,"---' Kit: E, , P",ident Title By ~ I )r¡, rÆt',¡.,h"~ Ann E, Mkhal,lci, Secætary Title . STATE OF IOWA DUBUOUE COUNTY,55: On this /V day of JJfL.- .lð~ before me, the undersigned, a Notary Public in and for said StatB, personally appeared Kathryn E, lúieg and Ann E, Michalski to me personally known, who being by me duly sworn, did say that they are the P",ident and Smeta", , respectively, of said corporation; that (no seal has been procurBd by the said) (tlge oeol offi..d thereto io tho seal ef OBid) corporation that said instrument was signed (."~ .a.la~1 on behalf of said corporation by authority of its Board of Directors: and that the said Kathryn E, Krieg and Ann E, Michal,ki as such officers, acknowledged the execution of said instrument to be the voluntary act and deed of said cor tl n, by it and by them vDlunlarily executed, Notary Public .:3~~:~";";"""'."M '" WARRANTY OEEO (CORPORATE ORANTORI ......,~""'"w" . REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT Plaasa read tha filing Instructions on the ravarse slda BEFORE compiatlng this form- PART I - TO BE COMPLETED BY TRANSFEROR (Please Type or Print Legibly) Social Security No. (or FederalLD, No,) "fJ--//{.r7fc- TRANSFEROR Name Dubuque InÜialives, fIIea Dubuque In-Futuro, Inc, Address CitY Hall, 50 West 13th Scree! Dubuque, Iowa 52001 Numbor oed Slreel or RR City, Town or P.O TRANSFEREE Name CitY of Dubuque Stato Zip fD~c~~d~~~~ri~ ~~) '?':?-C:-cV7"~-7¿;?L Address Ci ty Hall, 50 West 13th Street, Dubuque, Iowa 52001 Numbor a,d S""I or RR c,~, Town or PO Stato Zip Address of Property Transfered 301 Main Sueet, Dubuque, Iowa 52001 Numbor oed S""I or RR Ci~, Town or PO Stal, Zip Legal Description of Property The Soulh25-5/I2 feel ofL" 72: and Lot 72A: in the CitYo/Dubuque, Iowa, according tolhe United States Comis;mnm' Map of the Town o/Dubuque, Iowa, " Walls (check ona) g--There are no known wells situated on this property, 0 There is a well or wells situatBd on this property, The type(s), IDcation(s) and legai status are stated below. . 2, Solid Waste DIsposal (check one) G-There is no known solid waste disposal site on this property. 0 TherB is a solid waste disposal site on this property, but no notice has been received from the Department of Natural Resources that the site is deemed to be potentially ha2ardous. 0 There is a solid waste disposal site on this property which has been deemed to be potentially hazardous by the Department of Natural Resources, The 10catiDn(s) of the site(s) is stated below, 3, ttlØ1'dous WastBs (check onB) t:! There is no known hazardous waste on this property, 0 There is hazardous waste on this property and it is being managed in accordance with Department of Natural Resources rules, 4, Undarground StoragB Tanks (chack one) ŒYfhere are no known underground storage tanks on this property, (Note exclusions such as small farm and residential motor fuei tanks, most heating oil tanks, cisterns and septic tanks, in instructions,) 0 There is an underground storage tank or tanks on this property, The type(s), size(s) and any known substance(s) contained are described below, Information, if any, requirBd by statements checked above: 5, Private Burial Site (cheek one) _L-fhere are no known private burial sites on thi, pwperty, - There is a private burial sÜe on this property, The localion(s) of the site(') i, "ate below, The known identifying infortrnllion oflhe decedent is "ated below, Attachment for Additional Information? Y I@ If so, number of pages - I HEREBY DECLAR AND CORRECT, Signature: Telephone Number: -5/f-r---r7 f-~ - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- PART /I - TO BE COMPLETED BY RECORDER . Date of Instrument j - /I.f- :<OtPO BooklLD, ø 0 PagelLD, I ¡r; f ~::dofR"iing 2-;]<3-2.000 @TownshiP ~--'-< -6~n~~;~~¡ËPT 96) - - - -- - - - - - - - - -- - - - -F-,i:É WITH RË~:~%ÊR- - - - - - - - ~ - - --';,:';';- (See Instructions, #5)