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256658 03/18/16
VOUCHER NO. WARRANT NO. ALLOWED 20 RANDOLF &GRETCHEN MARTIN 5700 E 116TH STREET IN SUM OF$ CARMEL, IN 46033 $325.00 ON ACCOUNT OF APPROPRIATION FOR Engineering PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members 0 I 44-605.00 I $325.00 1 hereby certify that the attached invoice(s), or 2200 201 bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Friday, March 04, 2016 Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc. Payee Purchase Order No. Terms Date Due Invoice Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 03/09/16 I 0 I __---1-16th-and�Hazel-Dell�Parcel-5- - I $325.00 2200 201 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL,INDIANA An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Randolph D. Martin and Gretchen R. Martin Purchase Order No. 5700 E. 116th Street Terms Carmel, IN 46033 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount DES. NO.: 1297561 PROJECT: 116th St. & Hazel Dell Pkwv. PARCEL: 5 COUNTY: Hamilton Compensation for Permanent Fee Simple) and Temporary Right-of-Way Total:F$19,060.00 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered an-&received excep J 1A a AA lag 2016. ignature: Ra olph in, husband Signature: re ch n R. Martin, wife I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6. , 2016. Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED , 2016 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION Board/Council Members FOR COST DISTRIBUTION LEDGER CLASSIFICATION IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND Acct. Account Title Amount No. Page 4 Project: 1297561; 116th St. &Hazel Dell Pkwy. Parcel: 5 If you decide to accept the offer of $19,060.00 made by the City of Carmel, Indiana, sign your names below and mail this form to the address indicated above. An additional copy of this offer has been provided for your file. ACCEPTANCE OF OFFER We, Randolph D. Martin and Gretchen R. Martin, husband and wife, owners of the above described property or interest in property, hereby accept the offer of$19,060.00 made by the City of Carmel, Indiana, on this '`O' day of 52016. Original Offer $19,060.00 6 Rando h D. M in,husband Total Amount $19,060.00 Gretc en R. Martin, wife NOTARY'S CERTIFICATE STATE OF: SS: COUNTY OF A�41�.� Subscribed and sworn to before me this ZqA day of�_�..�m.Aj _ , 2016. Signature �a , aQ AMY J.LARMOAE Printed Name µv La t;M'o t-e Notary Public-S„i State of-Indiana My Commission expires f .0 y.22 Johnson Coungr Emy mission EKpiret May 4,2022 I am a resident ofCounty. COPY Uniform Offer REVISED 04/2015 10,108 STATEMENT OF THE BASIS FOR JUST COMPENSATION Code NIA 1. This is a written statement of, and summary of the basis for, the establishment of the amount believed to be, through a valuation process,just compensation for the purchase of this right-of-way for highway purposes. The amount set forth in Item 5 below isnot less than the approved estimate of value.In accordance with Public Law 91-646 as amended,the"Uniform Act",and as codified in Indiana at IC 8-23-17-1 through 8-23-17-35,this value disregards any decrease or increase in fair market value of the property prior to the date of valuation caused by the public improvement for which the property is acquired other than physical deterioration within reasonable control of the owner. 2.The legal description of this acquisition is set forth in the instrument of conveyance in the following identified parcel and this acquisition is identified in the Acquiring Agency's records as: Des.# 1297561 Parcel 5 Road 116th Street County Hamilton Owner(s) Randolph D. Martin and Gretchen.R. Martin 3.The area and type of interest being acquired: 0.078 Acres New F.S.RMI and 0.003 Acres Temporary RNV The amount in Item 5 below includes payment for the purchase of all interests in the real property and no separately held interest is being acquired separately in whole or part,except as may be explained in Item 8 below. 4.This acquisition is(Check one): a. ❑ A total acquisition of the real property. b. ® A partial acquisition of the real property. 5.The Agency's Offer: Just compensation has been determined to be and the Acquiring Agency's offer for the purchase of this real property is as follows: a.Total Land,Land Improvements and Buildings $11,600.00 b.Perpetual Easement $0.00 c.Severance Damages(i.e.:Setback,Loss if Value to the Residues,etc) $7,400.00 d.Other Damages(Itemize)Cost To Cure Estimates: $0.00 $0.00 Total Damages $7,400.00 Temporary RNV $60.00 Total amount believed to be Just Compensation offered for this Acquisition Is: $19;060.00 6.The amount in Item 5 above may Include payment for the purchase of certain buildings and improvements and their ownership shall pass to the Acquiring Agency. These buildings and Improvements are identified as follows: None 7.The amount in Item 5 above may include payment for the purchase of certain Land Improvements,Fixtures,Equipment,Machinery, Signs,Etc.,and their ownership shall pass to the Acquiring Agency. These items are identified as follows: Asphalt,lawn,trees 8.Items owned by others(i.e.:lessee,tenants,etc.) included in Item 5 above are identified as follows: None 9.Rerriarks: None Copy City of Carmel,Indiana Reviewer: Signature: Signature: �r Name Printed: 4'�,y 4&;- Name Printed: -Shawn M.Patterson,MAI,,AI-GRS Indiana CertifiedGeneral Appraiser,CG49600166 Title: Company: Monroe/Owen Appraisal,Inc. Date: �C�! 'GCS/',�— Date: 12/8/2015 j f i 1 � WARRANTY DEED Form WD-1 Des.No.: 1297561 Revised 07/2014 Project: 116 St. &Hazel Dell Pkwy. Parcel: 5 Page: 1 of 2 THIS INDENTURE WITNESSETH, That Randolph D. Martin and Gretchen R. Martin, husband and wife, the Grantors, of Hamilton County, State of Indiana Convey and Warrant to the CITY OF CARMEL,INDIANA,the Grantee,for and in consideration of the sum of Nineteen Thousand and No/100 Dollars ($19,000.00) (of which said sum $11,600.00 represents land and improvements acquired and $7,400.00 represents damages) and other valuable consideration,the receipt of which is hereby acknowledged, certain Real Estate situated in the County of Hamilton, State of Indiana, and being more particularly described in the legal description(s)attached hereto as Exhibit"A"and depicted upon the Right of Way Parcel Plat attached hereto as Exhibit`B",both of which exhibits are incorporated herein by reference. This conveyance is subject to any and all easements,conditions and restrictions of record. The Grantors hereby specifically acknowledge and agree that the Real Estate conveyed herein is conveyed in fee simple and that no reversionary rights whatsoever shall remain with the Grantors,or any successors in title to the abutting lands of the Grantors, notwithstanding any subsequent abandonment, vacation, disuse, nonuse, change of use, conveyance, lease and/or transfer by the Grantee or its successors in title,of a portion or all of the said Real Estate or any right of way,roadway or roadway appurtenances established thereupon. This acknowledgement and agreement is a covenant running with the land and shall be binding upon the Grantors and all successors and assigns. The Grantors assume and agree to pay the 2015 payable 2016 and 2016 payable 2017 (through the date of conveyance) real estate taxes and assessments on the Real Estate. This obligation to pay real estate taxes and assessments shall survive the conveyance of the Real Estate and shall be enforceable by the Grantee in the event of any non-payment of such real estate taxes and assessments. Interests in land acquired by the City of Carmel,Indiana Grantee mailing address: Department of Engineering One Civic Square,Carmel,IN 46032 t } Form WD-1 Des.No.: 1297561 Revised 07/2014 Project: 116th St. &Hazel De 11 Pkwy. Parcel: 5 Page: 2 of 2 IN WITNESS WHEREOF,the said Grantors have executed this instrument this Z t�day of 2016. (Seal) J (Seal) afore Signature Randolph D.Martin,husband Gretchen R.Martin,wife Printed Name Printed Name STATE OF: SS: COUNTY OF: Before me,a Notary Public in and for said State and County,personally appeared Randolph D.Martin and Gretchen R. Martin, husband and wife, the Grantors, in the above conveyance, and acknowledged the execution of the same on the date aforesaid to be their voluntary act and deed and whom,being duly sworn, stated that any representations contained therein are true. Witness my hand and Notarial Seal this day of 52016. Signature AMY J.LARMORE Printed Name Pr L 0.rVMTE Notary Public-Seel State of Incliana My Commission expires O,S.Eq. Z Z Johnson County My Commission Expires May 4,2022 I am a resident of County. This instrument was prepared by Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 46032 After recording,return deed to:Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 46032 I affirm,under the penalties for perjury,that I have taken reasonable care to redact each and every Social Security number from this document,unless it is required by law.Douglas C.Haney EXHIBIT "A" Project: 1297561 Parcel 5 (Fee Simple) Encumbers Key No.: 29-10-33-000-014.000-018 A part of the East Half of the Southeast Quarter of the Section 33, Township 18 North, Range 4 East, of the Second Principal Meridian, in Clay Township, Hamilton County, Indiana and being all that part of the grantors land, lying within the right of way lines depicted on the Right of Way Parcel Plat marked EXHIBIT `B, attached herewith and made a part of this description by reference, described as follows: Commencing at the Southwest Corner of said Half Quarter Section designated point "441" on said Right of Way Parcel Plat; thence along the East line thereof North 00 degrees 10 minutes 07 seconds East (basis of bearings is the North line of said Northeast Quarter as shown on a certain Location Control Route Survey Plat recorded in Instrument number 2014033040 in the Office of the Recorder of the County and State aforesaid) 40.00 feet to the Northwest corner of land described in Instrument Number 9544577 and recorded in the Office of the Recorder of the County and State aforesaid and the POINT OF BEGINNING; thence continuing along said East line thence North 00 degrees 10 minutes 07 seconds East 20.00 feet to point "518" as shown on said Right of Way Parcel Plat; thence North 89 degrees 48 minutes.44 seconds East 44.53 feet to point "314" as shown on said Right of Way Parcel Plat; thence North 89 degrees 47 minutes 26 seconds East 23.99 feet to point "311" as shown on said Right of Way Parcel Plat; thence North 89 degrees 49 minutes 00 seconds East 94.02 feet to the East line of said .grantor designated point "309" on said Right of Way Parcel Plat; thence along said East line South 00 degrees 10 minutes 07 seconds West 21.79 feet the Southeast corner thereof; thence along the South line of said grantor North 89 degrees 33 minutes 32 seconds West 162.54 feet to the POINT OF BEGINNING, and containing 0.078 acres,more or less. This description was prepared by DLZ Indiana, LLC for the City of Carmel, Indiana, as part of Project N . 1297 61 on June 22, 2015. �xN 1T Q,�, 51 Alan Brent Cleveland ;Z Registered Land Surveyor,Number LS80880007 — Q -- 880��7 = _— STATE OF Within the State of Indiana SURN`;� ��lll I 1111\�� Page 1 of 1 EXHIBIT " B„ SHEET IOF2 RIGHT OF WAY PARCEL PLAT Prepared for the City of Carmel,Indiana By DLZ Indiana,LLC(Job No.1463-0982-90) 519 33 33 33 33 33 34 33 34 507 �I I J � 01 �I C a JI � C �1 0 50 100 200 i1 Scale: V= 100' 162.54' H i 338 N (Res.A) CO 341+00 518 i 368 314 311336 336 505 .ol 503 0 '00 709 `I i 34 I ---1--- AppExrsfirlg�j;7-- 710------- -- - 162.54' -- - �96fh Sl�eel 33 34 33 330, (Exception) 40.00' 162.54' 33 34 Section Line ine PRC" 441 347 349 339,00 335 711 0 0350 0 352 0 0 703 0 0 + + + + + s a 3 a S 3 PARCEL: 5 Owners: Randolph D.&Gretchen R.Malin DRAWN BY: CAD v PROJECT: 1297561 Instrument Number 2008000557 Dated:12 20-2007 CHECKED BY: NMG 06-06-2015 1 ROAD: Hazel Dell Pkwy COUNTY: Hamilton ` SECTION: 33 DLZ TOWNSHIP: 18N ENCUMBERS KEY N0. 29-10-33-000-014.000-018 INDIANA LLC RANGE: 4E ® HATCHED AREA IS THE 157 EAST MARYLAND STREET INDIANAPOLIS,INDIANA 46204 APPROXIMATE PERMANENT RIGHT OF WAY 317 633 4120 Dimensions shown are from the above listed record documents. EXHIBIT 55B77 SHEET 2OF2 RIGHT OF WAY PARCEL PLAT Prepared for the City of Carmel;Indiana By DLZ Indiana,LLC(Job No.1463-0982-90) Station I- Point�_ . - �=Offset + Northing Ia Easting . ( I Line"PRB" _ 335 338+93.04 0 0 R 1715153.2690 i 213877.5774 + Curve Datal urve Data 336 +_ _3_39_+89.49_i 0.00 R + 1715249.6888 j_2138_75.3374 j PI=47+74.18 PRC PI=341+91.54 PRB i 338 341+00.43 { 0.00 R- 1 1715356.4318213848.6371 f { Delta=3°34'35"Lt I Delta=12°57'01"Rt j - r _--- ___ 70_3 See Location Control Route Survey Plat l 11=1500.00'I R=802.75' - -__--_� _ _ w_.. _ �_._._.__„...a......_!_. 02..75' See Location Control Route Survey Plat - _{ T=46.83 ! I I T=91.11' i 710 ^- See Location Control Route SurveyPlat a I i ' �`- - - --`--____-{ -__._._ _-____...__..._.._,.._. �._._.� L=93.63_I L=181.44'_ I 711 See Location Control Route Se Plat IE=0.73'� _ury Y !._ 503 See Location Control Route Survey Plat � 507 I See Location Control Route Survey Plat -` I Curve Data x _ _j Curve Data 505 { See Location Control Route Survey Plat { PI=48+62.48"PRC" SPI-344+68.17"PRB" I Line PRC -_ Delta=l3°50' " " '39"Rt _-- - .- - . y tI39Rt Delta=l343_ _ + 309 µ+PQ339+82.0_1) 15_9.9_2 L ' 1715238.49991 213715 6301 - R=300.00' ' R-1547.71' { _I -, 311 47+60.00 60.42 L :1715238.19891 213621.6119 _T=36_.42' 1314 47+35.00 L 60.47 L1715238.1112 0 213597.6197 ( I L=72.49' L=370.81' ; + ! i J I� 335 r 50+17.57 I 0.00 R 1715153.26901 213877.5774 ' j i E=2.20' 1 E=11.17' 347 { 47+27.35 0.00 R 1715177.6808L213589.8091 J { r-- ---___ _ 48+20.98_- E_0.00 R M 1715179.88181.213683.3987 ! + I Curve Dataj___.._ ( _350 `i _ 48+26:06 # 0.00 R1l 715180.1600 213688L4772 4589"PRB PI=340+ 352 48+98.55 0_00 R 171517 .38451 _ 213760.6304 - Delta=25"25'32"Lt I � { _46+8 L 11715237.9741 21355 + R=250.00 368 9.00 60.00 1.9258_. ._ ._ _ �_ a 441 # 46+90.45 + 0.00 R 1715177.9648 213552.9129 { T=56.40' 518 +PL 46+90.16_L6000 L 1715237.9652 213553.0896 - T_{ L=110.94'�_ __-- ! NOTE: Stations and Offsets Control Over both North &East Coordinates and Bearings & Distances. SURVEYOR STATEMENT To the best of my knowledge and belief, this plat, together with the 'Location Control Route Survey Plat \���\\�) ///��/ recorded as Instrument No. 2014033040 in the Office of �g I� \ ► T C4, the Recorder of Hamilton County, Indiana (Incorporated "" L and made a part hereof by reference) comprise a Route Survey executed in accordance with- Indiana _- =Q�Q'' No �yZ Administrative Code 865 IAC 1-12, (Rule 12) -_Q= 0007 =O- * "s 88STATE OF AAE Mp IN Ao%lb. / June 22, 20/5 %tiP�i N, SUR \X yJ S PARCEL: 5 Owners: Randolph D.&Gretchen R.Martin DRAWN BY: CAD i PROJECT: 1297561 CHECKED BY: NMG 06-06-2015 ROAD: Hazel Dell Pkwy COUNTY: Hamilton ` SECTION: 33 DLZ TOWNSHIP: 4E ENCUMBERS KEY N0. 29-10-33-000-014.000-018 INDIANA LLC a RANGE: 4E ANA, LLC EAST MARYLAND STREET INDIANAPOLIS,INDIANA 46204 317 633-4120 TEMPORARY EASEMENT GRANT (FOR CONSTRUCTION OF A DRIVEWAY) Form T-1 Des.No.: 1297561 Revised 07/2014 Project: 11 6th St. &Hazel Dell Pkwy. Parcel: 5A Reference: Instrument#2008000557,200400073409,&8819464 Page: 1 of 2 THIS INDENTURE WITNESSETH, That Randolph D. Martin and Gretchen R. Martin, husband and wife, the Grantors, of Hamilton County, State of Indiana Grant to the CITY OF CARMEL, INDIANA, the Grantee, for and in consideration of Sixty and No/100 Dollars 60.00 (of which said sum $0.00 represents land improvements acquired and $60.00 represents land temporarily encumbered and damages) and other valuable consideration, the receipt of which is hereby acknowledged, a temporary easement to enter upon and have possession of the Real Estate owned by Grantors and situated in the County of Hamilton, State of Indiana, and which is more particularly described in the legal description(s)attached hereto as Exhibit "A" which is incorporated herein by reference, for the purpose of constructing thereupon a drive and/or other road related improvements in connection with that public improvement project known as 116'h Street and Hazel Dell Parkway, Project 1297561 (the "Project"). This temporary easement grant shall be extinguished,become void and revert to the Grantors and/or the Grantors' successor(s)in title upon completion of the Project. Any and all timber, shrubbery, fences,buildings and any other improvements situated within the area of the temporary easement granted herein shall become the property of the City of Carmel, Indiana, and shall not be restored or replaced in connection with the Project except: NIA The Grantors acknowledge that all provisions of this Temporary Easement Grant are as stated and set forth herein and that no verbal agreements or promises exist with respect thereto. This Temporary Easement Grant is subject to any and all easements, conditions and restrictions of record. However, the Grantors,for the purpose of inducing the City of Carmel,Indiana,to accept this grant and to pay the hereinbefore referenced consideration,represent that the Grantors are the owners in fee simple of the Real Estate and that there exist no encumbrances, conditions,restrictions, leases,liens (except current real estate taxes and assessments) of any kind or character which would be inconsistent with the temporary rights granted herein. f , 7 Form T-1 Des.No.: 1297561 Revised 07/2014 Project: 116th St. &Hazel Dell Pkwy. Parcel: 5A Page: 2 of 2 IN WITNESS WHEREOF,the said Grantors have executed this instrument this Z y-L day of ,2016. ZfP,4—� (Seal) (Seal) 6-1Kgnatur4 Si e 14 Randolph D.Martin,husband Gretchen R.Martin,wife Printed Name Printed Name STATE OF: SS: COUNTY OF Before me,a Notary Public in and for said State and County,personally appeared Randolph D.Martin and Gretchen R. Martin, husband and wife, the Grantors in the above conveyance, and acknowledged the execution of the same on the date aforesaid to be their voluntary act and deed and who, being duly sworn, stated that any representations contained therein are true. Witness my hand and Notarial Seal this Z..LA414�- day of _ ,2016. Signature Printed Name 3, Lar&Lm m AMY J.LARMORE Notary Public-Seal State of Indiana My Commission expires 10, .2Z, Johnson County MEy Commission Expires.May 4,2022 I am a resident of County. This instrument was prepared by Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 46032 After recording,return deed to:Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 4032 I affirm,under the penalties for perjury,that I have taken reasonable care to redact each and every Social Security number from this document,unless it is required by law. Douglas C.Haney I - I L . EXHIBIT "A" Project: 1297561 Parcel 5A (Temporary Right of Way for Driveway Construction) A part of the East Half of the Southeast Quarter of the Section 33, Township 18 North, Range 4 East, of the Second Principal Meridian, in Clay Township, Hamilton County, Indiana, described as follows: Commencing at the Southwest Corner of said Half Quarter Section; thence along the East line thereof North 00 degrees 10 minutes 07 seconds East (basis of bearings is the South line of said Southeast Quarter as shown on a certain Location Control Route Survey Plat recorded in Instrument number 2014033040 in the Office of the Recorder of the County and State,aforesaid)40.00 feet to the Southwest corner of land described in Instrument Number 9544577 and recorded in the Office of the Recorder of the County and State aforesaid; thence continuing along said East line thence North 00 degrees 10 minutes 07 seconds East 20.00 feet; thence North 89 degrees 48 minutes 44 seconds East 44.53 feet to the POINT OF BEGINNING; thence North 00 degrees 08 minutes 55 seconds East 4.53 feet; thence North 89 degrees 40 minutes 16 seconds East 23.92 feet; thence South 00 degrees 48 minutes 23 seconds East 4.58 feet; thence South 89 degrees 47 minutes 26 seconds West 23.99 feet to the POINT OF BEGINNING, and containing 0.003 acres, more or less. This description was prepared by DLZ Indiana, LLC for the City of Carmel, Indiana, as part of Project Ng. 1297 61 on June 7, 2015. \I I I I// /vim wL \���\ l//// �' NT C4 /// 'w�No. ���� Alan Brent Cleveland __ _ , Registered Land Surveyor,Number LS80880007 —_Q = 880007 =0_— STATE OF Within the State of Indiana < ; iP; ZVDIAN , : Q --„ y � SURv ����` /111M\ Page 1 of 1 S,,,, SALES DISCLOSURE FORM State Form.46021(1131/12-11) - • SDF ID •� ''-"L jii Prescribed by Department of Local Government Finance. 'd J. Pursuant to It 6-1.1-5.5 County. Year Unique ID �►. '� SDF Date: tare PRIVACY NOTICE:The telephone numbers and Social Security numbers of the parties on this form are confidential - - accordine to 1C 6.1:1=5.5-3fd1. INDIANA SALES DISCLOSURE FORM SDF ED - SDO ID .. 1819106 Page i PART-1-Tobe completed by BUYER/GRANTEE and SELLER/GRANTOR- A.PROPERTY TRANSFERRED-MUST,BE CONVEYED ONASINGLE.CONVEYANCE DOCUMENT; 1:Property Number Check box lfapplicableto S.Complete Address of Property 6.Compiete:T-Billing Address(Ifdiferentf-in parcel.: property address) .- © 2.Split 5700E 11.6th Street One Civic Square.. 29-10=33-000-014:000-01.8 3.Land. Carmel, IN 46032 Carrrlel,-IN 46032 0 4.Improvement .. Z Legal Description of Parcel A part of the East Half.of the Southeast Quarter of S33,T1 8N,R4E;Hamilton County;Indiana. - - ❑ .2..Spit 3:.Land- 4.Improvement . .7.Legal Description of P.arrei B.CONDITIONS-IDENTIFY ALL.THAT APPLY' C.SALES DATA : DISCLOSE VALUE OF ITEMS LISTED IN TABLE B,: ITEMS-145 . . . If condition i applies,filer.is subject-to'disclosure and a disclosure filing fee. 1;Conveyance date(nrMiDbjvrrn; 01/24/2016 YES NO CONDITION 0. . ❑- 1.A transfer of real property interest-for valuable 2..Total number of parcels: consideration. .. 3 .Describe any unusual or special circumstances related to this ❑ 2..Buyer is an adjacent.property owner._ sale,including the specification of any less=than-complete 0. ❑ -.3:Vacant land: .. ownership interest and terms of seller financing. . .❑ -4;Exchange for other Teal property("Trade"). Permanent right-of-Way acquired in conjunction with the-116th& 5.Seller aid Dmfs: Hazel Dell Roundabout project. p p (Provide the value Table C/tem 12) ❑X El6,'Change planned,in the primary use of the Damages:$7,400.00 property?(Describe In special circumstances in Table Cltern3.) - - - - 7.Existence:offamily_orbusiness relationship. between buyer and seller.(Complete Table Cltem4.). 8.Land contract:Contract term(M: and contract date.cmmpblYri : 0. .F 9.Personal property included.in fransfer..(Prrvidetbevalue YES. NO.: CONDITION - Table C Item 5.) 10 X .Phsica 4 Family or business relationship existing be .; ❑. ❑ yl changes to propertybetween March 1 [71 ❑. and date of sale.(Ues�raemspe�ioieo-eamsta��esr�TableClrema.) buyer and seller? Amount of discount: $ 0.00 ❑' _ 11.Partial Interest.(Describe in specialcirrumstan'cesinTable CItem 3.) - - - Disclose actual value in money,property,a service,an agreement,or other consideration. ❑ 12.Easements or right-of-way grants. If conditions 13-15 apply,filers are subject to disclosure,but no.disclosure filing fee: 5:Estimated value of. ersonal ro er. $ 0.00 YES NO CONDITION. .. . 6.Sales rice: $ ' .' 11-,600.00.. 0 : 13.Document for compulsory.transactions as a YES. NO CONDITION result of foreclosure or express threat of ❑ ® ale? 1f yes,answer 7:Is the.seller financings foreclosure,divorce,court order,judgment, questions($=13)'. condemnation,or probate, . Q ❑ 14.Documents involving the partition of land ❑ ©. 8•Is buyer/borrower personally liable for loan?- between tenants in common,joint tenants,or ❑ 9.Is this a.mortgage loan? tenants by the entirety. 10..Amount of loan: $ 0.00 ❑X Q 15.;Transfer to,a charity,not-for-profit organization; 00 or government. 11.Interest rate 0. '12.Amount in oints: $. . 0:00 ' 13:Amortization period: . 0.00 INDIANA SALES DISCLOSURE FORM SDF ID: �t/ ` y Page 2 D.PREPARER Gina M. Hansen Land Agent Preparer of the Sales Disclosure Form Title 5214 S. East Street,Suite D-2 RWS South, Inc. Address(Number and Street) Company Indianapolis, IN 46227 317.781.9723 gina(cDnNssouth.com City,State,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) Randolph D. Martin Gretchen R.Martin Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 5700 E. 116th Street 5700 E. 116th Street Address(Number and Street) Address(Number and Street) Carmel IN 46033 Carmel, IN 46033 City,State,and ZIP Code City,State,and ZIP Code 317.414.8547 317.414.8547 Telephone Number E-mail Telephone Number E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of y knowledge and belief,is true,correct t anti comple a law,and is prepared in accordance with IC - .5," eal Prop Sales Disclosure Act". ,g a of Iter Sig eller // / Randolph D. Martin 1--L.� Gretchen R.Martin b �`Q—l Printed Name o Seller &n Date(MMIDDIffM Printed Name o Seller Sinn Date(MMIDDIYYM F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY City of Carmel, Indiana Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document One Civic Square Addreu(Number and Street) Address(Number and Street) Gow-M6, m L\ 03a City,State,and ZIP Code City,State,and ZIP Code 317.571.2400 Telephone Number E-mail Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION ❑ 0 1.Will this property be the buyer's primary ❑ [Z 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ ❑✓ 5.Wind Power Device One Civic Square 4ddress(Numhnrand.Ctraet) ❑ [Z 6.Hydroelectric Power Device r,ay,n) 4, KI 4UO3-2_ Hamilton ❑ 7.Geothermal Energy Heating/Cooling Device nary,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ [Z 8•Is this property a residential rental property? vacated for this residence? If yes,provide ❑ Q 9.Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail?(Provide contact information including county: below.Please see instructions for more information. Not available in all counties.) Address(Number and Street) City,State ZIP Code Coun ty Primary property owner contact name E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed. Signature of Buyerl Signature of Buyer2/Spouse 0-j nA AA �kc,�n�-eA 62- t-7 1-2-V/6 Printed Legal Name of Buyer 1 Sign Date(MM/DDAWY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/Y" Last 5 digits of Buyer 1 Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security License/ID10therNumber Number License/ID/0therNumber INDIANA SALES DISCLOSURE FORM SDF ED SDO ED 1819106 Page 3 PART 2-COUNTY ASSESSOR. The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending to the auditor: 1.Property Z AV Land 3.AV Improvement 4.Value of Personal 5.AV Total 6.Property 7.Neighborhood B.Tax District 9.Acreage Property Class Code Code A.) B.) Assessor Stamp 10.Identify physical changes to property between March 1 and YES I NO I CONDITION date of sale. ❑ ❑ 11.Is form completed? ❑ ❑ 12.State sales fee required? 13.Date of sale(MM/DD/rrrtl: 14.Date form received(mi/DD/mom: Items15:throu h,18'are to be corn leted ti the assessor:when validathig this-sale: 1511"applicab1e,identify;ariy additional special'circumstances relating to,validation of'sale: YES ..NO ,�CONDITION.- ❑ ❑ 16:;Sale valid for e•ending? ❑ ❑ 1Y,Yalidati6n of sale complete?' 18.Validated-'by: -PART 3-COUNTY.AUDITOR Auditor Stamp 1.Disclosure fee amount collected:$ YES NO CONDITION 2.Other Local Fee: $ ❑ ❑ 6.Is form completed? 3.Total Fee Collected:$ ❑ ❑ 7.Is state fee collected? 4.Auditor receipt book number: ❑ ❑ 8.Attachments complete? 5.Date of transfer(MM/DD/rm): PART 4—RECEIPT FOR STATEMENT OF.DEDUCTION OF ASSESSED VALUATION SDFID SDFDate(MM/DD/Yri7) Buyerl-Nameasappearsonconveyancedocument Parcel Number Address of Property(Number and Street) Check all that apply: City,Stale,and ZIP Code of Property ❑ Homestead ❑Solar Energy ❑ Wind Power ❑ Hydroelectric ❑Geothermal ❑ Rental Property Auditor Signature Date(MMIDD/Y" Electronic Statement(e-mail) A person who knowingly and intentionally falsifies value of transferred real property,or omits or falsifies any information required to be provided in the sales disclosure form commits a Class C felony. INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1819106 Page 1 Parcel Addendum Sheet 1.Property Number Check box if applicable to 5.Complete Address of Property 6.Complete Tax Billing Address(if different from parcel property address) 1) X❑ 2.split 5700 E.116th Street One Civic Square 29-10-33-000-014.000-018 ® 3.Land Carmel,IN 46032 Carmel,IN 46032 4.Improvement 7.Subdivision Name&Lot Number 8.Deductions ❑Homestead ❑Solar Enerov ❑Wind Power ❑Hvdroelectric ❑ Geothermal 9.Rental Property ❑ 10.Parcel Acreage 0.00 10.Legal Description A part of the East Half of the Southeast Quarter of S33,T18N,R4E,Hamilton County,Indiana. Signature Date INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1819106 Page 2 Seller Addendum Sheet Randolph D.Martin Seller-Name as appears on conveyance document 5700 E.116th Street Address(Number and Street) Cartmel,IN 46033- City,State,and ZIP Code 317414-8547 Telephone Number E-mail IN Last 5 digits of Seller Driver's State Last 5 Digits of Social Security Number License/1D/0ther Number Gretchen R.Martin Seller-Name as appears on conveyance document 5700 E.116th Street Address(Number and Street) Carmel,IN 46033- City,State,and ZIP Code 317-414-8547 Telephone Number E-mail IN Last 5 digits of seller Driver's State Last 5 Digits of Social Security Number License/1D/0ther Number Signature Date INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1819106 Page 3 Buyer Addendum Sheet City of Carmel,Indiana Buyer-Name as appears on conveyance document One Civic Square Address(Number and Street) Carmel,IN 46032- City,State,and ZIP Code 317-571-2400 Telephone Number E-mail IN Last 5 digits of Buyer Driver's State Last 5 Digits of Social Security Number License/ID/Other Number Signature Date Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL, INDIANA An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Randolph D. Martin and Gretchen R. Martin Purchase Order No. 5700 E. 116`h Street Terms Carmel, IN 46033 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount DES. NO.: 1297561 PROJECT: 116th St. &Hazel Dell Pkwy. PARCEL: 5 COUNTY: Hamilton Compensation for Permanent Fee Simple) and Temporary Right-of-Way Total: $19,060.00 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and'r`-eb ived excep a , 2016. ignature: Ra olph in, husband Signature: re ch n R. Martin,wife I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accordance with IC 5-11-10-1.6. , 2016. Clerk-Treasurer REAL ESTATE CODE n/a PCL 5 Form W-9 Request for Taxpayer Give Form to the Depart ec Department real Identification Number and Certification requester.Do not DepartmentoftheTreasury send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. Randolph D.Martin N 2 Business name/disregarded entity name,if different from above tU OI ca tz 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to C certain entities,not individuals;see ❑singl -mem le proprietor or ❑C Corporation ❑S Corporation ❑Partnership ❑Trustlestate H instructions on page 3): m c single-member LLC ❑ ❑ ❑ ❑ 0 o Exempt payee code(ifany) �,� Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership) `o 2 Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting y the tax classification of the single-member owner. code(if any) — c ICL ❑Other(see instructions) (Applies to amounts maintained outside the U.S.) w 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) CD 5700 E. 116th Street U) 6 City,state,and ZIP code n Carmel, IN 46033 7 List account number(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a ^ n 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. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. T_ JIM 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. 1 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. 1 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 thpiate nd dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign Signature of Here U.S.person► Date 2 General Instructions -Form 1098(home mortgage interest),1098-E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. -Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such -Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at wwwirs.gov/f v9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or -Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also cerfifying 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 -Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and -Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(Ifany)indicating that you are brokers) exempt from the FATCA reporting,is cored See What is FATCA reporting?on -Form 1099-S(proceeds from real estate transactions) page 2 for further information. -Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014 Page 4 Project: 1297561; 116th St. &Hazel Dell Pkwy. Parcel: 5 If you decide to accept the offer of $19,060.00 made by the City of Carmel, Indiana, sign your names below and mail this form to the address indicated above. An additional copy of this offer has been provided for your file. ACCEPTANCE OF OFFER We, Randolph D. Martin and Gretchen R. Martin, husband and wife, owners of the above described property or interest in property, hereby accept the offer of$19,060.00 made by the City of Carmel, Indiana, on this day of 2016. Original Offer $19,060.00 4Rando 4Min, usband Total Amount $19,060.00 Gretc en R. Martin,wife NOTARY'S CERTIFICATE STATE OF: .te„a. SS: COUNTY OF Subscribed and sworn to before me this day of� ,,.� —52016. Signature Printed Name .n ��re AMY J.tkRoi3E � _Notacy�uDtie-SQaI State of tnl i My Commission expires y.22 Johnson Coutny My Commission Eupiee�May 4.2022 I am a resident of County. COPY Uniform Offer REVISED 04/2015 1W08 STATEMENT OF THE BASIS FOR JUST COMPENSATION Code N/A 1. This is a written statement of, and summary of the basis for, the establishment of the amount believed to be, through a valuation process,just compensation for the purchase of this right-of-way for highway purposes. The amount set forth in Item 5 below is not less than the approved estimate of value. In accordance with Public Law 91-646 as amended,the"Uniform Act",and as codified in Indiana at IC 8-23-17-1 through 8-23-17-35,this value disregards any decrease or increase in fair market value of the property prior to the date of valuation caused by the public improvement for which the property is acquired other than physical deterioration within reasonable control of the owner. 2.The legal description of this acquisition is set forth in the instrument of conveyance in the following identified parcel and this acquisition is identified in the Acquiring Agency's records as: Des.# 1297561 Parcel 5 Road 116'^Street County Hamilton Owner(s) Randolph D. Martin and Gretchen.R. Martin 3.The area and type of interest being acquired: 0.078 Acres New F.S.R/W and 0.003 Acres Temporary RMI The amount in Item 5 below includes payment for the purchase of all interests in the real property and no separately held interest is being acquired separately in whole or part,except as may be explained in Item 8 below. 4.This acquisition is(Check one): a. ❑ A total acquisition of the real property. b. ® A partial acquisition of the real property. 5.The Agency's Offer: Just compensation has been determined to be and the Acquiring Agency's offer for the purchase of this real property is as follows: a.Total Land,Land Improvements and Buildings $11,600.00 b. Perpetual Easement $0.00 c.Severance Damages(i.e.:Setback,Loss if Value to the Residues,etc) $7,400.00 d.Other Damages(Itemize)Cost To Cure Estimates: $0.00 $0.00 Total Damages $7,400.00 Temporary RNV $60.00 Total amount believed to be Just Compensation offered for this Acquisition Is: $19,060.00 6.The amount in Item 5 above may include payment for the purchase of certain buildings and improvements and their ownership shall pass to the Acquiring Agency. These buildings and improvements are identified as follows: None 7.The amount in Item 5 above may include payment for the purchase of certain Land Improvements, Fixtures,Equipment,Machinery, Signs, Etc.,and their ownership shall pass to the Acquiring Agency. These items are identified as follows: Asphalt,lawn,trees 8.Items owned by others(i.e.:lessee,tenants,etc.) included in Item 5 above are identified as follows: None 9.Rerriarks: None Cno Rr City of Carmel,Indiana Reviewer: Signature: _ Signature: . Name Printed: .S� a � �� ,��- Name Printed: -Shawn M.Patterson,MAI;AI-GRS Indiana Certified General Appraiser,CG49600166 Title' Company: Monroe/Owen Appraisal,Inc. Date: Date: 12/8/2015 WARRANTY DEED Form WD-1 Des.No.: 1297561 Revised 07/2014 Project: 116`h St.&Hazel Dell Pkwy. Parcel: 5 Page: 1 of 2 THIS INDENTURE WITNESSETH, That Randolph D. Martin and Gretchen R. Martin, husband and wife, the Grantors, of Hamilton County, State of Indiana Convey and Warrant to the CITY OF CARMEL,INDIANA,the Grantee,for and in consideration of the sum of Nineteen Thousand and No/100 Dollars ($19,000.00) (of which said sum $11,600.00 represents land and improvements acquired and $7,400.00 represents damages) and other valuable consideration, the receipt of which is hereby acknowledged, certain Real Estate situated in the County of Hamilton, State of Indiana, and being more particularly described in the legal description(s)attached hereto as Exhibit"A"and depicted upon the Right of Way Parcel Plat attached hereto as Exhibit`B",both of which exhibits are incorporated herein by reference. This conveyance is subject to any and all easements,conditions and restrictions of record. The Grantors hereby specifically acknowledge and agree that the Real Estate conveyed herein is conveyed in fee simple and that no reversionary rights whatsoever shall remain with the Grantors,or any successors in title to the abutting lands of the Grantors, notwithstanding any subsequent abandonment, vacation, disuse, nonuse, change of use, conveyance, lease and/or transfer by the Grantee or its successors in title,of a portion or all of the said Real Estate or any right of way,roadway or roadway appurtenances established thereupon. This acknowledgement and agreement is a covenant running with the land and shall be binding upon the Grantors and all successors and assigns. The Grantors assume and agree to pay the 2015 payable 2016 and 2016 payable 2017 (through the date of conveyance) real estate taxes and assessments on the Real Estate. This obligation to pay real estate taxes and assessments shall survive the conveyance of the Real Estate and shall be enforceable by the Grantee in the event of any non-payment of such real estate taxes and assessments. Interests in land acquired by the City of Carmel,Indiana Grantee mailing address: Department of Engineering One Civic Square,Carmel,IN 46032 Form WD-1 Des.No.: 1297561 Revised 07/2014 Project: 116th St.&Hazel Dell Pkwy. Parcel: 5 - Page: 2 of 2 IN WITNESS WHEREOF,the said Grantors have executed this instrument this 2.qiL day of 2016. (Seal) (Seal) 16L4 J I ature , Signature Randolph D.Martin,husband Gretchen R.Martin,wife Printed Name Printed Name STATE OF: 4nti SS: COUNTY OF: Before me, a Notary Public in and for said State and County,personally appeared Randolph D.Martin and Gretchen R. Martin, husband and wife, the Grantors, in the above conveyance, and acknowledged the execution of the same on the date aforesaid to be their voluntary act and deed and whom,being duly sworn, stated that any representations contained therein are true. Witness my hand and Notarial Seal this Z-Lt&day of 32016. Signature U AMY J.LARMORE Printed Name 7_ L 0.r Notary Pu01ic-Seal State of Indiana My Commission expires 0.5.cy. Z Z Johnson County My Commission Expires,May 4,2022 I am a resident of County. This instrument was prepared by Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 46032 After recording,return deed to:Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 46032 I affirm,under the penalties for perjury,that I have taken reasonable care to redact each and every Social Security number from this document,unless it is required by law.Douglas C.Haney EXHIBIT "A" Project: 1297561 Parcel 5 (Fee Simple) Encumbers Key No.: 29-10-33-000-014.000-018 A part of the East Half of the Southeast Quarter of the Section 33, Township 18 North, Range 4 East, of the Second Principal Meridian, in Clay Township, Hamilton County, Indiana and being all that part of the grantors land, lying within the right of way lines depicted on the Right of Way.Parcel Plat marked EXHIBIT `B, attached herewith and made a part of this description by reference, described as follows: Commencing at the Southwest Comer of said Half Quarter Section designated point "441" on said Right of Way Parcel Plat; thence along the East line thereof North 00 degrees 10 minutes 07 seconds East (basis of bearings is the North line of said Northeast Quarter as shown on a certain Location Control Route Survey Plat recorded in Instrument number 2014033040 in the Office of the Recorder of the County and State aforesaid) 40.00 feet to the Northwest corner of land described in Instrument Number 9544577 and recorded in the Office of the Recorder of the County and State aforesaid and the POINT OF BEGINNING; thence continuing along said East line thence North 00 degrees 10 minutes 07 seconds East 20.00 feet to point "518" as shown on said Right of Way Parcel Plat; thence North 89 degrees 48 minutes 44 seconds East 44.53 feet to point "314" as shown on said Right of Way Parcel Plat; thence North 89 degrees 47 minutes 26 seconds East 23.99 feet to point "311" as shown on said Right of Way Parcel Plat; thence North 89 degrees 49 minutes 00 seconds East 94.02 feet to the East line of said grantor designated point "309" on said Right of Way Parcel Plat; thence along said East line South 00 degrees 10 minutes 07 seconds West 21.79 feet the Southeast corner thereof, thence along the South line of said grantor North 89 degrees 33 minutes 32 seconds West 162.54 feet to the POINT OF BEGINNING, and containing 0.078 acres, more or less. This description was prepared by DLZ Indiana, LLC for the City of Carmel, Indiana, as part of Project N . 1297 61 on June 22, 2015. \\� �r1T C4 STEI Alan Brent Cleveland Q: No. :y __J Registered Land Surveyor,Number LS80880007 — Q= �8000T _b — Within the State of Indiana * STATE OF -Y, IND IANP, C) / SUR Page 1 of 1 EXHIBIT "B" SHEET 1OF2 RIGHT OF WAY PARCEL PLAT Prepared for the City of Carmel,Indiana By DLZ Indiana,LLC(Job No.1463-0982-90) 519 33 33 33 33 33 34 33 34 507 c 0 50 M 100 200 Scale: 1"= 100' 162.54' H a 338 o � N (Res.A) N 341+00 r V 518 368 314 311 Q 309 336 505 °� 503 --- ' -- �v 340+00 709 710 162.54' �96fh Sfieef 33 39 33 3 0' (Exception) 40.00' 162.54 Section Line 33 34 ine PRC 441 347 349 339+p0 335 711 0 0 350 0 352 0 0 703 0 E 7 3 3 d ' t R 3 PARCEL: 5 Owners: Randolph D.&Gretchen R.Martin DRAWN BY: CAD PROJECT: 1297561 Instrument Number 2008000557 Dated:12-20-2007 CHECKED BY: NMG 06-06-2015 i ROAD: Hazel Dell Pkwy COUNTY: Hamilton ° SECTION: 33 DLZ TOWNSHIP: 18N RANGE: 4E ENCUMBERS KEY N0. 29-10-33-000-014.000-018 INDIANA, LLC ® HATCHED AREA IS THE 157 EAST MARYLAND STREET APPROXIMATE PERMANENT RIGHT OF WAY INDIANAPOLIS,INDIANA 46204 317 633-4120 Dimensions shown are from the above listed record documents. EXHIBIT „B„ SHEET 2OF2 RIGHT OF WAY PARCEL PLAT Prepared for the City of Carmel,Indiana By DLZ Indiana,LLC(Job No.1463-0982-90) _..__--------- Point ..-Point Station Offset 1 Northing i Eastin T i Line"PRB" 335 338+93.04 0.00 R ; 1715153.2690; 213877.5774 Curve Data !.Curve Data 336 339+89.49 ' 0.00 R ( 1715249.68881 213875.3374 ' P1=47+74.18"PRC" P1=341+9154"PRB" i 338 1 341+00._43 wj 4 0.00 R 1 1715356.43181 213848.6371 ti Delta=3"34'35°Lt Delta=12°57'01°Rt i 703 See Location Control Route Survey Plat .__ . !_R_1500 00 ,__._.. R=802.75 I 709See Location Control Route Survey_Plat T=46.83' T=91.11' _ -__,_-----____-_-_____�_.___ ' 1 710_ oca L i See tion Control Route Survey Plat L=93.63' ; L=181.44' ` .._ w..,.__._. oca _ 711 See Location Control Route Survey FlatE 0 73' 503 1 See Location Control Route Survey Plat + 507 See Location Control Route Survey Plat Curve Data; j Curve Data; 505See Location Control Route Survey Plat P1=48+62.448"PRC" P1=344+68.17"PRB" Line"PRC" # - ^- - i Delta 13°50'39"Rt Delta=13"43'39"Rt 309 +PL(339+82.01) -159.92L ?1715238.49991 213715.6301 _R=300_00'_ _4_V_4i R=1547.71'; i 311 i 47+60.00 i 60.42 L_..i 1715238.19891 2136216119 T=36.42' i i ; T=186.30' 314 1 47+35.00 60_47 L ' 1715238.1112 i 213597.6197L=72_49' _.__ __;__ L_370 81' 3_______ 335 50+17.57 000 R ; 1715153.26901 213877.5774 i E=2.20' E=11.17' j ------._._- ___.�.___.__.____ .,_.._-_._...._..___.__ i 347 47+27.35 000 R i 1715177.68081 213589.8091 { 349 1 48+20.98 1 0.00 R 1 1715179.8818 i 213683.3987 ,Curve Data. __._.._w.._.1._.._._....-._ _�..___. .,.....___... ._.,.. .._..._. _.._, __.. _..._ _ _ .. _.._..-... 350 48+26.06 0.00 R i 1715180.1600; 213688 4772 ; P1=340+4589 11PRB" 48+9855 ;._. 0.00 R_ 1715175.3845 i 213760.6304 1 i Delta=25"25'32"Lt F 3681 46+89.00 ! 60.00 L ' 1715237.9741` 213551.9258 1 R=250.00' _._. ........ ,_.._ ----------------__. .........,._ -.___..__.____ _ _ 441 46+90.45 0.00 R ? 1715177.96481 213552.9129 T=56.40' .._.. ;. _. ._ _ --__-.. 1-. 518 +PL(46+90.16) 60.00L1715237.9652; 213553A896L_110_94 NOTE: Stations and Offsets Control Over both North &East Coordinates and Bearings & Distances. SURVEYOR STATEMENT To the best of my knowledge and belief, this plat, together with the 'Location Control Route Survey Plat recorded as Instrument No. 2014033040 in the Office of X\\\��NT C4 the Recorder of Hamilton County, Indiana (Incorporated �N �,.��"""'R !%11 and made a part hereof by reference) comprise a Route " : �ZZ7 ITS NoRFO Survey executed in accordance with Indiana _--_ p Administrative Code 865 IAC 1-12, (Rule 12) __Q= 880007 = - STATE OF �o-* E ` June 22, 20/5 %�9tiQ�^;or'ANP,�yo��� I Owners: Randolph D.&Gretchen R.Martin PARCEL: 5 DRAWN BY: CAD F PROJECT: 1297561 CHECKED BY: NMG 06-06-2015 i ROAD: Hazel Dell Pkwy COUNTY: Hamilton s SECTION: 33 �bDLZ TOWNSHIP: 4E RANGE: 4E ENCUMBERS KEY N0. 29-10-33-000-014.000-018 - r INDIANA,LLC 157 EAST MARYLAND STREET INDIANAPOLIS,INDIANA 46204 317 633-4120 TEMPORARY EASEMENT GRANT (FOR CONSTRUCTION OF A DRIVEWAY) Form T-1 Des.No.: 1297561 Revised 07/2014 Project: 116`x'St. &Hazel Dell Pkwy. Parcel: 5A Reference: Instrument#2008000557,200400073409,& 8819464 Page: 1 of 2 THIS INDENTURE WITNESSETH, That Randolph D. Martin and Gretchen R. Martin, husband and wife the Grantors, of Hamilton County, State of Indiana Grant to the CITY OF CARMEL, INDIANA, the Grantee, for and in consideration of Sixty and No/100 Dollars $60.00 (of which said sum $0.00 represents land improvements acquired and $60.00 represents land temporarily encumbered and damages) and other valuable consideration, the receipt of which is hereby acknowledged, a temporary easement to enter upon and have possession of the Real Estate owned by Grantors and situated in the County of Hamilton, State of Indiana, and which is more particularly described in the legal description(s)attached hereto as Exhibit "A" which is incorporated herein by reference, for the purpose of constructing thereupon a drive and/or other road related improvements in connection with that public improvement project known as 116a` Street and Hazel Dell Parkway, Project 1297561 (the "Project"). This temporary easement grant shall be extinguished, become void and revert to the Grantors and/or the Grantors' successor(s)in title upon completion of the Project. Any and all timber, shrubbery, fences,buildings and any other improvements situated within the area of the temporary easement granted herein shall become the property of the City of Carmel, Indiana, and shall not be restored or replaced in connection with the Project except: N/A The Grantors acknowledge that all provisions of this Temporary Easement Grant are as stated and set forth herein and that no verbal agreements or promises exist with respect thereto. This Temporary Easement Grant is subject to any and all easements, conditions and restrictions of record. However, the Grantors, for the purpose of inducing the City of Carmel,Indiana,to accept this grant and to pay the hereinbefore referenced consideration, represent that the Grantors are the owners in fee simple of the Real Estate and that there exist no encumbrances, conditions,restrictions,leases, liens (except current real estate taxes and assessments) of any kind or character which would be inconsistent with the temporary rights granted herein. r , Form T-1 Des.No.: 1297561 Revised 07/2014 Project: 116th St. &Hazel Dell Pkwy. Parcel: 5A Page: 2 of 2 IN WITNESS WHEREOF,the said Grantors have executed this instrument this 2 yAL day of ,2016. (Seal) (Seal) -S'ignatur Si re Randolph D.Martin,husband Gretchen R.Martin,wife Printed Name Printed Name STATE OF: SS: COUNTY OF Before me,a Notary Public in and for said State and County,personally appeared Randolph D.Martin and Gretchen R. Martin, husband and wife, the Grantors in the above conveyance, and acknowledged the execution of the same on the date aforesaid to be their voluntary act and deed and who, being duly sworn, stated that any representations contained therein are true. Witness my hand and Notarial Seal this —L I`4414�- day oflycukg�Q- 22016. Signature ,`rf]Lhw etsL Printed Name 3, ` , AMY J.LA is-Se Notary Public-Se74,2022 State of Indiana My Commission expires .2Z Johnson County My Commission Expires:M I am a resident of ., County. This instrument was prepared by Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 46C 32 After recording,return deed to:Douglas C.Haney,Corporation Counsel,City Hall,One Civic Square,Carmel,Indiana 4CP032 I affirm,under the penalties for perjury,that I have taken reasonable care to redact each and every Social Security number from this document,unless it is required by law. Douglas C.Haney EXHIBIT "A" Project: 1297561 Parcel 5A(Temporary Right of Way for Driveway Construction) A part of the East Half of the Southeast Quarter of the Section 33, Township 18 North, Range 4 East, of the Second Principal Meridian, in Clay Township, Hamilton County, Indiana, described as follows: Commencing at the Southwest Comer of said Half Quarter Section; thence along the East line thereof North 00 degrees 10 minutes 07 seconds East (basis of bearings is the South line of said Southeast Quarter as shown on a certain Location Control Route Survey Plat recorded in Instrument number 2014033040 in the Office of the Recorder of the County and State aforesaid)40.00 feet to the Southwest comer of land described in Instrument Number 9544577 and recorded in the Office of the Recorder of the County and State aforesaid; thence continuing along said East line thence North 00 degrees 10 minutes 07 seconds East 20.00 feet; thence North 89 degrees 48 minutes 44 seconds East 44.53 feet to the POINT OF BEGINNING; thence North 00 degrees 08 minutes 55 seconds East 4.53 feet; thence North 89 degrees 40 minutes 16 seconds East 23.92 feet; thence South 00 degrees 48 minutes 23 seconds East 4.58 feet; thence South 89 degrees 47 minutes 26 seconds West 23.99 feet to the POINT OF BEGINNING, and containing 0.003 acres, more or less. This description was prepared by DLZ Indiana,LLC for the City of Carmel, Indiana, as part of Project N 1297 61 on June 7,2015. ........... No. Alan Brent Cleveland z Registered Land Surveyor,Number LS80880007 880007 : 0yE - STATE OF Within the State of IndianaZZ- NO I ANA U FN Page 1 of 1 R,rr SALES DISCLOSURE FORM _ State Form 46021(RI I/12-11) SDF ID Prescribed by Department of Local Government Finance County Year Unique ID Pursuant to IC 6-1.1-5.5 SDF Date: tare PRIVACY NOTICE:The telephone numbers and Social Security numbers of the parties on this form are confidential accordlne to IC 6-1.1-5.5-3(d). INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1819106 Page 1 PART 1 To be completed by BUYER/GRANTEE andrSELLER/GRANTOR , A PROPERTY TRANSFERRED,=MUSTBE CONVEYED,,ON A SINGLE.CONVEYANGE 1.Property Number Check box if applicable to S.Complete Address of Property 6.Complete Tax Billing Address(If different from parcel property address) 0 Z.split 5700 E.116th Street One Civic Square 29-10-33-000-014.000-018 ® 3.Land Carmel,IN 46032 Carmel,IN 46032 ❑ 4.Improvement 7.Legal Description of Parcel A part of the East Half of the Southeast Quarter of S33,T18N,R4E,Hamilton County,Indiana. ❑ 2,Split ❑ 3.Land ❑ 4.Improvement 7.Legal Description of Parcel ,B CONDITIONS IDENTIFY Alit THAT APPLY C SALES DATA DISCLOSE VALUE OF ITEMS LISTED IN TABLE B,-.I If condition 1 applies,filer Is subject to disclosure and a disclosure filing fee. 1.Conveyance date(mmlDolyy ): 01/24/2016 YES NO CONDITION ❑x ❑ 1.A transfer of real property interest for valuable 2.Total number of parcels: 1 consideration. 3.Describe any unusual or special circumstances related to this ❑ ❑ 2.Buyer is an adjacent property owner. sale,including the specification of any less-than-complete 0 ❑ 3.Vacant land, ownership interest and terms of seller financing. ❑ © 4.Exchange for other real property("Trade"). Permanent right-of-way acquired in conjunction with the 116th& ❑ © S.Seller paid points.(Provide the value Table C Item 12.) Hazel Dell Roundabout project. ❑X ❑ 6.Change planned in the primary use of the Damages:$7,400.00 property?(Describe In special circumstances In Table C Item 3.) ❑ © 7.Existence of family or business relationship between buyer and seller.(Complete Table Cltem4.) ❑ ® 8.Land contract. Contract term(yr): and contract date(mmlplyYYY): ❑ © 9.Personal property included in transfer.(pravidethevalue YES No CONDITION Table C Item 5) ❑ © 10.Physical changes to property between March 1 ❑ X❑ 4.Family or business relationship existing between and date of sale.(Describe In special circumstances in Table C Item 3.) buyer and seller? ❑ © Amount of discount: $ 0.00 11.Partial IritereSt.(DesrribelnspecialcircumstancesinTableCltem3.) Disclose actual value in money,property,a service,an agreement,or other consideration. ❑ © 12.Easements or right-of-way grants. If conditions 13-15 apply,filers are subject to disclosure,but no disclosure filing fee. 5.Estimated value Of personal property: $ 0.00 YES NO CONDITION 6.Sales rice: $ 11,600.00 ❑X ❑ 13.Document for compulsory transactions as a YES No CONDITION result of foreclosure or express threat of ❑ © 7.Is the seller financing sale? If yes,answer foreclosure,divorce,court order,judgment, questions(8-13). condemnation,or probate. ❑ © 14.Documents involving the partition of land E] © 8.Is buyer/borrower personally liable for loan? between tenants in common,joint tenants,or ❑ © 9.Is this a mortgage loan? tenants by the entirety. 10.Amount of loan: $ 0.00 ❑X ❑ 15.Transfer to a charity,not-for-profit organization, 11.Interest rate: 0.00% or government. 12.Amount inpoints: $ 0.00 13.Amortization period: 0.00 INDIANA SALES DISCLOSURE FORM SDF ID: fy 61 Page 2 D PREPARER 3 : iti Gina M. Hansen Land Agent Preparer of the Sales Disclosure Form Title 5214 S. East Street,Suite D-2 RWS South, Inc. Address(Number and Street) Company Indianapolis, IN 46227 317.781.9723 ginana rwssouth.com City,State,and ZIP Code Telephone Number E-mail -c - `nfi SELLERS Randolph D.Martin Gretchen R.Martin Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 5700 E. 116th Street 5700 E. 116th Street Address(Number and Street) Address(Number and Street) Carmel IN 46033 Carmel IN 46033 City,State,and ZIP Code City,State,and ZIP Code 317.414.8547 317.414.8547 Telephone Number E-mail Telephone Number E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best ofu; knowledge and belief,is true,correct t anll compl e>air law,and is prepared in accordance with ICUeller eal PropSales Disclosure Act". Sig Randolph D.Martin I 0 Gretchen R. Martin Printed Name o Seller Sign Date MM/DD Printed Name o Seller Sign Date MM DD/YYYY) '`F BUYER S� ;.GRANTE_E S APPLICATIONrFOR PROvPERTX_sTAX,DE�DUCTIQNS_�ID:ENTIFY�ALL ITEMSzTHAT.APPLY, �,<r�s���, , City of Carmel, Indiana Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document One Civic Square Addre_cc(Number and Street) Address(Number and Street) Carmel, IN %90301 City,State,and ZIP Code City,State,and ZIP Code 317.571.2400 Telephone Number E-mail Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION ❑ [71 1.Will this property be the buyer's primary ❑ 0 3.Homestead residence? Provide complete address of primary ❑ [0 4.Solar Energy Heating/Cooling System residence,including county: E] Z5.Wind Power Device One Civic Square 4ddre5clNumharnndStreat) ❑ [Z 6.Hydroelectric Power Device c,iyYY)6 i N1 4UD 32 Hamilton ❑ [Z 7.Geothermal Energy Heating/Cooling Device Wry,State ZIP Code County ❑ 7 2.Does the buyer have a homestead in Indiana to be E] Z 8•Is this property a residential rental property? vacated for this residence? If yes,provide ❑ [Z 9.Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail?(Provide contact information including county: below.Please see instructions for more information. Not available in all counties.) Address(Number and Street) City,State ZIP Code County Primary property owner contact name E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed. Signature ofBuyerl Signature ofBuyer2/Spouse C_ drl, s-2'� azul /�/6 Printed Legal Name of Buyer 1 Sign Date(MM/DD/YYYY) Printed Legal Name ofBuyer2/Spouse Sign Date(MM/DDM-M Last 5 digits ofBuyer 1 Driver's State Last 5 Digits ofSocial Security Number Last 5digits ofBuyer2/Spouse Driver's State Last 5Digits ofSocia/Security License/lD/Other Number Number License/ID10therNumber INDIANA SALES DISCLOSURE FmmIM mmn ID SDO ID 1819106 Page 3 The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending to the auditor: 1.Property ZAVLand 3.AVImprovement 4.Value of Personal S.AVTotal 6.Property 7.Neighborhood 8.Tax District 9.Acreage Prope Class Code Code Assessor Stamp 10.Identify physical changes to property between March I and YES NO CONDITION date of sale. E] [j 11.Is form completed? E] [j 12.State sales fee required? 13.Date of sale(mmlDply": 14.Date form received(Aw/p/n-M: Itern S 15 ihrbii�b 16 ire-io be-e6mp-leied by-the assessor ivhen validating this sale: fy.nY:;Wditibn' -xis mp 18.Validated by: Auditor Stamp 1.Disclosure fee amount collected:$ YES NO CONDITION 2.Other Local Fee: $ El El 6.Is form completed? 3.Total Fee Collected:$ E] E] 7.Is state fee collected? 4.Auditor receipt book number: E] 8.Attachments complete? 5.Date of transfer(AtAtIDDlyYyyy _____________________________________________ _____________________ INDIANA SALES DISCLOSURE FORMI SDF ID SDO ID 1819106 Page I Parcel Addendum Sheet 1.Property Number Check box if applicable to S.Complete Address of Property 6.Complete Tax Billing Address(if different from parcel property address) 1 ) 2.Split 5700 E.116th Street One Civic Square 29-1033-000-014.000-018 ® 3.Land Carmel,IN 46032 Carmel,IN 46032 ❑ 4.Improvement 7.Subdivision Name&Lot Number 8.Deductions ❑Homestead ❑Solar Enerqv ❑Wind Power ❑Hydroelectric ❑ Geothermal 9.Rental Property ❑ 10.Parcel Acreage 0.00 10.Legal Description A part of the East Half of the Southeast Quarter of S33,T18N,R4E,Hamilton County,Indiana. Signature Date INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1819106 Page 2 Seller Addendum Sheet Randolph D.Martin Seller-Name as appears on conveyance document 5700 E.116th Street Address(Number and Street) Cannel,IN 46033- City,State,and ZIP Code 317-414-8547 Telephone Number E-mail IN Last 5 digits of Seller Driver's State Last 5 Digits of Social Security Number License/ID/Other Number Gretchen R.Martin Seller-Name as appears on conveyance document 5700 E.116th Street Address(Number and Street) Carmel,IN 46033- City,State,and ZIP Code 317-414-8547 Telephone Number E-mail IN Last 5 digits of Seller Driver's State Last 5 Digits of Social Security Number License/ID/Other Number Signature Date INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1819106 Page 3 Buyer Addendum Sheet City of Carmel,Indiana Buyer-Name as appears on conveyance document One Civic Square Address(Number and Street) Cannel,IN 46032- City,State,and ZIP Code 317-571-2400 Teleahone Number E-mail IN Last 5 digits of Buyer Driver's State Last S Digits of Social Security Number License/lD/Other Number Signature Date