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Kennedy Road Right-of-Way Acquisition (The Barony Inc.) Copyright 2014 City of Dubuque Consent Items # 7. ITEM TITLE: Kennedy Road Right-of-Way Acquisition (The Barony Inc.) SUMMARY: City Manager recommending approval of the acquisition of real estate owned by The Barony, Inc. along the Kennedy Road right-of-way to clean up the City boundary and facilitate economic development projects in the area. RESOLUTION Approving the acquisition of real estate owned by the Barony, Inc. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt Resolution(s) ATTACHMENTS: Description Type Kennedy Road Right-of-Way Acquisition (Barony, City Manager Memo Inc.)-MVM Memo Staff Memo Staff Memo Resolution Resolutions Offer to Buy Supporting Documentation THE CITY OF Dubuque DUB E i" Masterpiece on the Mississippi 2007.2012.2013 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Kennedy Road Right-of-Way Property Acquisition DATE: December 12, 2016 City Attorney Crenna Brumwell recommends City Council approval of the acquisition of real estate owned by The Barony, Inc. along the Kennedy Road right-of-way to clean up the City boundary and facilitate economic development projects in the area, including the anticipated development of the Rustic Point residential subdivision at the northwest corner of the intersection of Kennedy Road and Derby Grange Road. The purchase price for the property is $44,500. 1 concur with the recommendation and respectfully request Mayor and City Council approval. ZV4-14�1 Mic ael C. Van Milligen MCVM:jh Attachment cc: Crenna Brumwell, City Attorney Cindy Steinhauser, Assistant City Manager Teri Goodmann, Assistant City Manager THE CITY OF DUB ObE MEMORANDUM Masterpiece on the Mississippi CRENNA M . BRUMWELL , SQ1 CITY ATTORNEY To: Michael C. Van Milligen City Manager DATE: December 13, 2016 RE: Kennedy Road Right-of-Way Property Acquisition The City of Dubuque is acquiring right-of-way on Kennedy Road to clean up the City boundary and to facilitate an economic development projects in the area, including the anticipated development at the Rustic Point residential subdivision at the Northwest corner of the intersection of Kennedy Road and Derby Grange Road. Attached please find a resolution approving the acquisition of real estate owned by The Barony, Inc., a defunct Iowa corporation. The heirs of the shareholders of The Barony, Inc. were identified and located. All heirs have agreed to the purchase. This real estate is located on Kennedy Road. I request that the resolution is reviewed and forwarded to the City Council for consideration and approval. Please let me know if you have any questions. 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 RESOLUTION NO. 414-16 RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY THE BARONY INC. Whereas, the City of Dubuque intends to acquire certain real estate as necessary along the Kennedy Road right-of-way to clean up the City boundary and facilitate an economic development project in the area; and Whereas, The Barony Inc., a defunct Iowa corporation, is the Owner of this certain real estate. As the shareholders for The Barony, Inc. are deceased the heirs were identified, located, and they have voluntarily agreed to sell to the City of Dubuque the certain real estate legally described as follows (the Property): Lot A of Goldthorp Place in the County of Dubuque, Iowa; Lot B of Goldthorp Place in the County of Dubuque, Iowa; Lot C of Goldthorp Place in the County of Dubuque, Iowa; Lot D of Goldthorp Place in the County of Dubuque, Iowa; ; 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 heirs of The Barony, Inc's. shareholders have agreed on behalf of The Barony, Inc. to sell the property for a total cost of $44,500.00; and Whereas, the $44,500.00 cost for the City to acquire the property corresponds to the costs the City would incur if the property was acquired through the eminent domain process; and Whereas, a purchase agreement has been finalized with the heirs of The Barony, Inc's. shareholders on behalf of The Barony, Inc. as owner of the real estate scheduled for acquisition; and Whereas, it is in the best interest of the City to acquire the Property. 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. Section 2. That the City of Dubuque be and is hereby authorized to accept a Quit Claim. Deed from the heirs of The Barony, Inc.'s shareholders, 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 Quit Claim 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 19th day of December, 2016. Roy D. B%6I, Mayor Attest: OFFER TO BUY REAL ESTATE AND ACCEPTANCE TO: The Barony Inc., an administratively dissolved Iowa Corporation (Seller) SECTION 1. REAL ESTATE DESCRIPTION. The undersigned BUYER hereby offers to buy and the undersigned SELLERS by their acceptance agree to sell the real estate (Real Estate) situated in Dubuque, Iowa, legally described as: Lots A, B, C, and D of Goldthorp Place 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 $44,500.00, payable in cash at the Closing. SECTION 3. REAL ESTATE TAXES. Buyer shall pay any unpaid real estate taxes payable for fiscal year 2015-2016 and prior years. Buyer shall also pay real estate taxes for fiscal year 2016-2017 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. Buyer 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 also 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 Agreement 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 replace same. 1 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 January 15, 2017, 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 Seller agrees to permit Buyer to inspect the Real Estate within 72 hours prior to closing to assure that the premises are in the condition required by this Agreement. 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 Agreement. SECTION 8. FIXTURES. 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, whether attached or detached. Also included shall be the following: N/A. The following items shall not be included: N/A SECTION 9. DEED. Upon payment of the Purchase Price, Seller shall convey the Real Estate to Buyer by Quitclaim Deed. SECTION 10. CONTRACT BINDING ON SUCCESSORS IN INTEREST. This Contract shall apply to and bind the successors in interest of the parties. This Agreement shall survive the closing. SECTION 11. RIGHTS OF INSPECTION, ENVIRONMENTAL TESTING AND REVIEW. NONE, property deeded herein is taken in "as is" condition with no guarantees or warranties express or implied. SECTION 12. 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 13. 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 my breach of 2 the foregoing certification. SECTION 14. REMEDIES OF THE PARTIES. 14.1 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. 14.2 If Seller fails to timely perform this Contract, Buyer has the right to have all payments made returned to it. 14.3 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 15. 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 16. NOTICE. Any notice under this Agreement 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. Nels Turnquist Eric Turnquist, Power -Of -Attorney 3405 Erin Oaks Court Fort Smith, AR 72908. Dana Kisting 702 Wilson Avenue Dubuque, IA 52001 The Fuerste Law Firm Attn: Steve Juergens 200 Security Building 151 W. 8th Street Dubuque, IA 52001 Attorney for Conlon, Smith, & Rafoth City of Dubuque Attn: Crenna Brumwell 300 Main Street, Suite 330 Dubuque, IA 52001 SECTION 17. TIME IS OF THE ESSENCE. In the performance of each part of this Agreement, time shall be of the essence. SECTION 18. TIME FOR ACCEPTANCE. When accepted, this Agreement shall become a binding contract. If this offer is not accepted and delivered to BUYER on or before 5:00 p.m. CDT on November 30, 2016, this Agreement shall be null and void and all payments shall be returned immediately to the Buyer. 3 SECTION 19. ENTIRE AGREEMENT. This Agreement contains the entire agreement of the parties and shall not be amended except by a written instrument duly signed by Seller and Buyer. SECTION 20. PARAGRAPH HEADINGS AND CONSTRUCTION.. Paragraph headings are for convenience of reference and shall not limit or affect the meaning of this Agreement. 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 21. OTHER PROVISIONS. 21.1 Seller will provide Buyer with a signed Acknowledgment of Voluntary Negotiation and Purchase of Property at the time of closing. 21.2 Buyer will pay Seller's closing costs (transfer tax and deed preparation), excluding attorneys' fees. 21.3 A designated representative of the Sellers shall sign the Acquisition Plat at the time of closing. Dated: BUYER CITY OF D BUQUE, IOWA By: Roy D.: uol, Mayor 50 West 1 Street Dubuque, IA 52001 , 2016 4 Accepted: i3 2016. SELLER THE BARONY, INC. �i7NLn By: Eric Turnquist, Power -of -Attorney for Nels Turnquist 3405 Erin Oaks Court Fort Smith, AR 72908 5 Accepted: , 2016. SELLER THE BARONY, INC. ti By: Dana Kisting 702 Wilson Avenue Dubuque, IA 52001 6 Accepted: October 14 , 2016. SELLER THE BARONY, INC. 'y: Sharon Conlon 1975 South Grandview Avenue Dubuque, IA 52003 Accepted: /U V / , 2016. SELLER THE B - ONY, INC. By: Rebecca Smith 9 Clear Court Palm Coast, FL 32137 Accepted: A, 77 /7/ , 2016. SELLER THE BARONY, INC. By: David Rafoth 45 McIntyre Drive Asheville, NC 28803 11 11 11 11 11 u 11 11 111111 Doc ID 008592270009 Type GEN Kind: DEED WITH RESOLUTION Recorded: 02/10/2017 at 10:45:31 AM Fee Amt: $122.40 Page 1 of 9 Revenue Tax: $70.40 Dubuque County Iowa John Murphy Recorder F11e2017-00001743 QUIT CLAIM DEED Recorder's Cover Sheet Preparer Information: (name, address and phone number) Crenna Brumwell, 300 Main Street, Suite 330, Dubuque, IA 52001, Phone: (563) 589-4381 Taxpayer Information: (name and complete address) City of Dubuque, 50 West 13th Street, Dubuque, IA 52001 Return Document To: (name and complete address) City of Dubuque, 50 West 13th Street, Dubuque, IA 52001 Grantors: The Barony Inc., an administratively dissolved Iowa Corporation Heirs of the Barony Inc. Shareholders Sharon L. Conlon David R. Rafoth Rebecca R. Smith Nels Turnquist Dana Kisting Grantees: City of Dubuque, Iowa Legal Description: See Page 2 CI 07196 r °I) 'f2f"eir/i4 QUIT CLAIM DEED For the consideration of Forty Four Thousand Five Hundred Dollar(s) and other valuable consideration, The Barony Inc., an administratively dissolved Iowa Corporation, through the Heirs of Barony Inc. Shareholders (Sharon Conlon, David Rafoth, Rebecca Smith, Nels Turnquist, and Dana Kisting) do hereby Quit Claim to the City of Dubuque, Iowa all our right, title, interest, estate, claim and demand in the following described real estate in Dubuque County, Iowa: Lots A, B, C, and D of Goldthrop Place in the County of Dubuque, Iowa 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, and as masculine or feminine gender, according to the context. Dated: c.)71-(„ HEIR OF THE BARONY INC. SHAREHOLDERS SHARON L. CONLON By: M"1"-ir`,/ NOTARY PUBLIC STATE OF IOWA, COUNTY OF DUBUQUE, SS: On this 6th day of February , A.D., 2017 before me, the undersigned, a Notary Public in and for said County, in said State, personally appeared Sharon L. Conlon, to me known to be the identical person(s) named in and who executed the within and foregoing instrument, to which this is attached, and acknowledged that they executed the same as their voluntary act and deed. p1F.l No ice'LARSON tiP C- : i. ?. 137222 ,J EXPIRES il71t6e4( Notary Public In and For Said State Dated: /21 HEIR OF THE BARONY INC. SHAREHOLDERS DAVID R. RAFOTH By: NOTARY PUBLIC STATE OF NORTH CAROLINA, COUNTY OF BUNCOMBE, SS: On this 1 e day of T8nu5 al, A.D., 2017 before me, the undersigned, a Notary Public in and for said County, in said State, personally appeared David R. Rafoth, to me known to be the identical person(s) named in and who executed the within and foregoing instrument, to which this is attached, and acknowledged that they executed the same as their voluntary act and deed. 0011111N ?. NOTE. ee fC) CD1"ARk My COMM, Expires s October 20, 2018 0 U iiiP,44/3E GO 11101 kiaPNod Notary Public In and For Said State rft cornmicion Qxpi OGOba 90, RN) Dated: HEIR OF THE BARONY INC. SHAREHOLDERS REBECCA R. SMITH NOTARY PUBLIC STATE OF FLORIDA, COUNTY OF FLAGLER, SS: On this 1th day ofja n JAAA, , A.D., 2017 before me, the undersigned, a Notary Public in and for said County, in said State, rsonally appeared Rebecca R. Smith, to me known to be the identical person(s) named in and who executed the within and foregoing instrument, to which this is attached, and acknowledged that they executed the same as their voluntary act and deed. Ru &ec r=1._ 1)1 -- JACQUELINE WILLIAMS OO Commission # FF 109451 Expires August 3, 2018 Banded Thru Troy Fain Inauranae NO -3854019 otary Public In and For Said State Dated: Ol - 11 - t7 HEIR OF THE BARONY INC. SHAREHOLDERS NELS TURNQUIST C/O ERIC TURNQUIST, POA NOTARY PUBLIC STATE OF ARKANSAS, C [Sfi — K br Allawti� COUNTY OF SEBASTIAN, SS: On this % 61 day o GGgwer'e , A.D., 2017 before me, the undersigned, a Notary Public in and for said County, in said Staetl , personally appeared Eric Turnquist, to me known to be the identical person(s) named in and who executed the within and foregoing instrument, to which this is attached, and acknowledged that they executed the same as their voluntary act and deed. OFFICIAL SEAL DANIEL SCAMARCO NOTARY PUBLIC, ARKANSAS ul— f SEBASTIAN COUNTY = �- COMMISSION #12697418 "" Notary Public In and For Said State COMMISSION EXP. 03/31/2026 Dated: ( Cite Cwt,,/_ % f % 0 STATE OF IOWA, HEIR OF THE BARONY INC. SHAREHOLDERS DANA B. KISTING NOTARY PUBLIC COUNTY OF DUBUQUE, SS: On this day ofd iY 1€i , A.D., 2017 before me, the undersigned, a Notary Public in and for said County, in said Stae,j)ersonally appeared Dana B. Kisting, to me known to be the identical person(s) named in and who executed the within and foregoing instrument, to which this is attached, and acknowledged that they executed the same as their voluntary act and deed. .111,11111 �I '111.111 iJl 11,41 III dnllhn!III II Il ,7 `N,o.tary Public In and For Said 'Stat r RESOLUTION NO. 414-16 RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY THE BARONY INC. Whereas, the City of Dubuque intends to acquire certain real estate as necessary along the Kennedy Road right-of-way to clean up the City boundary and facilitate an economic development project in the area; and Whereas, The Barony Inc., a defunct Iowa corporation, is the Owner of this certain real estate. As the shareholders for The Barony, Inc. are deceased the heirs were identified, located, and they have voluntarily agreed to sell to the City of Dubuque the certain real estate legally described as follows (the Property): Lot A of Goldthorp Place in the County of Dubuque, Iowa; Lot B of Goldthorp Place in the County of Dubuque, Iowa; Lot C of Goldthorp Place in the County of Dubuque, Iowa; Lot D of Goldthorp Place in the County of Dubuque, Iowa; ; 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 heirs of The Barony, Inc's. shareholders have agreed on behalf of The Barony, Inc. to sell the property for a total cost of $44,500.00; and Whereas, the $44,500.00 cost for the City to acquire the property corresponds to the costs the City would incur if the property was acquired through the eminent domain process; and Whereas, a purchase agreement has been finalized with the heirs of The Barony, Inc's. shareholders on behalf of The Barony, Inc. as owner of the real estate scheduled for acquisition; and Whereas, it is in the best interest of the City to acquire the Property. 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. Section 2. That the City of Dubuque be and is hereby authorized to accept a Quit Claim_ Deed from the heirs of The Barony, Inc.'s shareholders, 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 Quit Claim 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 19th day of December, 2016. Roy D. BGbI, Mayor Attest: Kevin I irnstahl, City Jerk STATE OF IOWA CERTIFICATE of the CITY CLERK ) SS: COUNTY OF DUBUQUE ) I, Kevin S. Firnstahl, do hereby certify that I am the duly appointed, qualified, City Clerk of the City of Dubuque, Iowa, in the County aforesaid, and as such City 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. 414-16 is a true and correct copy of the original. In Testimony Whereof, I hereunto set my hand and official seal of the City of Dubuque, Iowa. Dated at Dubuque, Iowa, on this 20th day of December, 2016. Kevi S. Firnstahl, ITC; City Clerk 11 ONO 110 i 11 11 11 11 Doc ID 008592280002 Type: GWH Kind: GROUNDWATER HAZARD Recorded: 02/10/2017 at 10:45:57 AM Fee Amt: $0.00 Page 1 of 2 Dubuque County Iowa John Murphy Recorder F11e2017_00000178 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name The Barony Inc., an administratively dissolved Iowa Corporation Address 200 Security Building, 151 West 8th Street, Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name The City of Dubuque, Iowa Address 50 West 13th Street, Dubuque, IA 52001 Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: Kennedy Road Right -of -Way Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) Lots A, B, C, and D of Goldthorp Place in the County of Dubuque, Iowa 1. Wells (check one) g 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) x 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) X 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) 0/7"-)71/3 5. Private Burial Site (check one) X There are no known private burial sites on this property. _ There is a private burial site on this property. The location(s) of the site(s) and known identifying information of the decedent(s) is stated below or on an attached separate sheet, as necessary. 6. Private Sewage Disposal System (check one) All buildings on this property are served by a public or semi-public sewage disposal system. X 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. Sig naturevl-��._� Telephone No.: (563) 556-4011 1 (Transfer orAgent2/y1-).f Steve Ju rgens, Attorney for Sharon Conlon, Rebecca Smith, and David Rafoth FILE WITH RECORDER DNR form 542-0960 (July 18, 2012)