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.
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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
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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.
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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
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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
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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
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fC) CD1"ARk
My COMM, Expires s
October 20, 2018 0
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Notary Public In and For Said State
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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
=
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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
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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)