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HomeMy WebLinkAbout207018 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 366074 Page 1 of 1 ONE CIVIC SQUARE EMMA LOU CUNNINGHAM CARMEL, INDIANA 46032 510 W 116TH ST CHECK AMOUNT: $15,000.00 CARMEL IN 46032 CHECK NUMBER: 207018 CHECK DATE: 3/13/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462865 15,000.00 ILLINOIS STREET 0 AMERICAN ❑E STRUCTUREPOINT r --1 INC. LJ March 5, 2012 Katie Neville �7 City of Carmel L One Civic Square''u Carmel IN 46032 Re: Illinois Street IV Project 11-09 Parcel 10 Secured Request for Check Processing Dear Katie: After Mike McBride's review, please forward the enclosed check request and backup to Clerk Treasurer's office for check processing. Attachments include: Accounts Payable Voucher Signed W -9 Copy Signed Acceptance Offer Statement of Basis for Just Compensation Signed Right -of -Entry Form Copy of Unrecorded Conveyance Documents Copy of Sales Disclosure Form Please forward the check to Sam Balog, American Structu repo] nt, Inc., 7260 Shadeland Station, Indianapolis IN 46256 for distribution to the owner. Structurepoint will record the appropriate transfer documents on behalf of the City after delivery of the check to the property owner. If you have any questions or need additional information, please let me know. Best regards, Sylvia "Skip" Tennancour Land Acquisition Coordinator cc: Sam Balog, American Structurepoint, Inc. �w r� r s ofl kD*.`+ 6 9 00 0 Qo emu' 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 Emma Lou Cunninaham Purchase Order No. 510 W. 116 St, Terms Carmel, IN 46032 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount PROJECT: Illinois St. Prolect #11 -09 PARCEL: 10 COUNTY: Hamilton Compensation for Fee-Simple acquisition over 0.132 acres of land Total: 54 G0Q c I 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 received except 20 Emma Lou Cunningham 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 Form W R equest for Taxpayer Give Form to the (Rev. De cembe r 2 e T send to the Identification Number and Certification requester. I not Departme of th e IRS. Internal Revenue Service Name (as shown on your income tax return) Cunningham, Emma Lou Business name disregarded entity name, if different from above N m O� 10 Q Check appropriate box for federal tax classification: C IndividuaNsole proprietor C Corporation 5 Corporation Partnership Trust/estate m c CL o u Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) Exempt payee 0 2 C CL Other (see instructions) !S Address (number, street, and apt. or suite no.) Requester's name and address optiona) L1 CL 510 W. 116th St. City, state, and ZIP code Carmel, IN 46032 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 the "Name" line Social security number to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other 77N on page 3. Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose Employer Identification number number to enter. LM 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). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Signature of Here U.S. person L Date Z 1 2 G eneral Instructions If a requester gives you a form other than Form W -9 to request your TIN, you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W -9. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: A person who is required to file an information return with the IRS must An individual who is a U.S. citizen or U.S. resident alien, obtain your correct taxpayer identification number (TIN) to report, for A partnership, corporation, company, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation An estate (other than a foreign estate), or of debt, or contributions you made to an IRA. Use Form W -9 only if you are a U.S. person (including a resident A domestic trust (as defined in Regulations section 301.7701 -7). alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to: business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. 1. Certify that the TIN you are giving is correct (or you are waiting for a Further, in certain cases where a Form W -9 has not been received, a number to be issued), partnership is required to presume that a partner is a foreign person, 2. Certify that you are not subject to backup withholding, or and pay the withholding tax. Therefore, if you are a U.S. person that is a 3. Claim exemption from backup withholding if you are a U.S. exempt partner in a partnership conducting a trade or business in the United payee. If applicable, you are also certifying that as a U.S. person, your States, provide Form W -9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Form W -9 (Rev. 12 -2011) Page 4 Project: 11 -09 Parcel: 10 If you decide to accept the offer of $15,000.00 made by the City of Carmel, sign your name 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 I (We), Loo Cc n t �q land owner(s) of the above described property or inter se in property, hereby accept the offer of made by the City of Carmel on this 1 day of`�6 20 l L~r-c Emma Lou Cunningham NOTARY'S CERTIFICATE STATE OF SS: COUNTY OF Subscribed and sworn to before me this day of 20 J My commission expires: My county of residence is: (Signature) EMAN X016 (Printed) Notary Public Pj'•- z o•" STEPHEN J.KLVEMAN "o`A,Y•. Hainiffon County MY Cut expires April 16, 2016 COPY ilC 03/08 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. 11 -09 Parcel 10 Road Illinois St. County Hamilton Owner(s) William T. and Emma Lou Cunningham 3. The area and type of interest being acquired: 0.084 Acres (Fee) and 0.048 Acres (Fee -PER) 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 $11,385.00 b. Severance Damages (i.e.: Setback, Loss in Value to the Residues, etc) $3,615.00 c. Other Damages (Itemize) Cost -To -Cure estimates: N/A N/A N/A N/A Temporary R/W N/A Total Damages $3,615.00 Total amount believed to be Just Compensation offered for this Acquisition is: $15,000.00 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: N/A 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: Lawn area, fencing and gravel 8. Items owned by others (i.e.: lessee, tenants, etc.) included in Item 5 above are identified as follows: N/A 9.Remarks: N/A Approval: Reviewer: Signature: Signature: Name Printed: ���q� Name Printed: Title: 2 Company: Date: f J L Date: Project 11 -09 Parcel 10 RIGHT OF ENTRY This Right of Entry has been executed this 22nd day of February, 2012, by Emma Lou Cunningham "Grantor and the City of Carmel, Indiana, an Indiana municipal corporation "Grantee RECITALS WHEREAS, Grantor is the owner of certain real estate (the "Grantor Parcel located in the City of Carmel, Hamilton County, Indiana, which Grantor Parcel is more particularly described on Exhibit B attached hereto and incorporated herein; and WHEREAS, Grantee is involved in a project to extend Illinois Street in the City of Carmel, Hamilton County, Indiana (the "Project and WHEREAS, the Project affects a portion of the Grantor Parcel and Grantee needs to acquire fee simple title to a portion of the Grantor Parcel which portion (the "Fee Parcel) is more particularly described in Exhibit A attached hereto and incorporated herein by this reference; and WHEREAS, Grantor has executed a warranty deed (the "Deed for the Fee Parcel and desires to enter into this Grant of Right of Entry to allow Grantee to come onto the Grantor parcel, beyond the area of the Fee Parcel in order to allow Grantee to relocate the boulders that are currently located within the Fee Parcel. NOW THEREFORE, in consideration of the sum of Ten Dollars ($10.00), the foregoing Recitals, all of which are incorporated herein and the following mutual covenants and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the parties agree as follows: 1. Grant Grantor hereby grants and provides to Grantee, its agents, contractors, subcontractors and employees the right to use the Grantor Parcel for the sole purpose of moving the Grantor's boulders from the Fee Parcel onto an area of the Grantor Parcel that is located outside of the Fee Parcel. However, this right of entry shall preclude the Grantee, its agents, contractors, subcontractors, and employees from exerting control over or entering upon or into any permanent structure situated on the Grantor Parcel. 2. Warrant Grantor, by executing below, hereby warrants that Grantor is the lawful owner of the Grantor Parcel and that there is no encumbrance or other restriction upon Grantor providing this "Right of Entry" to Grantee. r 11 "il'l`J�` 3. Indemnification Grantee shall indemnify, defend and save Grantor harmless from any and all liability, loss, damage, cost, obligation and expense which arises out of or results from any negligent act, whether of commission or omission, of Grantee, its agents, employees, contractors, subcontractors, licensees or others claiming by, through or under Grantee, occurring in or about the Fee Parcel whether in the exercise of Grantee's rights hereunder or in breach or excess thereof. IN WITNESS WHEREOF, Grantor and Grantee herein have executed this Grant of Right of Entry as of the day first above written. GRANTOR: GRANTEE: The City of Carmel, Indiana By: Emma Lou Cunningham STATE OF INDIANA SS: COUNTY OF HAMILTON Before me, a Notary Public in and for said County and State; personally appeared Lo L CU-I rvx L- who acknowledged the execution of the foregoing Grant of Right of Entry and who having been duly sworn acknowledged that any representations set forth therein are true and correct. Witness my hand and Notary Seal this o day of f�e 2012. My Commission Expires: Notary Public County of Residence: 44"S AN Printed �V NGTAFlI' }�i9�'lIIIOfI County My Commission Expires STATE OF INDIANA i "'g;;F April 16,2016 SS: COUNTY OF HAMILTON Before me, a Notary Public in and for said County and State; personally appeared SC— (k, the D;re 6 yf Ar tr of the City of Carmel, who acknowledged the execution of the foregoing Right of Entry and who having been duly sworn acknowledged that any representations set forth therein are true and correct. Witness my hand and Notary Seal this ;2-'/ day of 5 2012. My Commission Expires: Notary Public County of Residence: Printed ,Aa P� STEPHEN J. KLINEMAN n HImilton Ccunhf S�L My Commission Expires 4 '�OF Aprii 16.2016 71902 2.DOC/RAH EXHIBIT "A" Project: 11 -09 Sheet I of I Parcel: 10 Fee Simple Tax ID: 29- 09 -34- 000 020.000 -018 A part of Section 34, Township 18 North, Range 3 East, Hamilton County, Indiana and being that part of the grantors' land lying within the right-of-way lines depicted on the attached Right -of -Way Parcel Plat, marked Exhibit "B described as follows: Beginning at a point on the south line of said section South 89 degrees 17 minutes 57 seconds West 439.57 feet from the southeast corner of said section, said southeast corner being designated as point "9902" on said Plat, which point of beginning is the southeast corner of the grantors' land; thence South 89 degrees 17 minutes 57 seconds West 191.20 feet along said south line to the southwest corner of the grantors' land;. thence North 0 degrees 00 minutes 16 seconds East 25.00 feet along the west line of the grantors' land to point "63S" designated on said plat; thence North 86 degrees 17 minutes 24 seconds East 191.59 feet to the east line of the grantors' land; thence South 0 degrees 00 minutes 16 seconds West 35.07 feet along said east line to the point of beginning and containing 0.132 acres, more or less, inclusive of the presently existing right -of -way which contains 0.048 acres, more or less. This description was prepared for the City of Cannel, Indiana by Jessica L. Stapleton, -Indiana Registered Land Surveyor, License Number LS20600032, on the 2nd day of November, 2011. LS286000321 11 turf STATE c� :S fl 8 1. 1 11: i6IIGgitS�• EXHIBIT B fihixty� -nib and. Siftp� �gn, at a point Saar hu:adr� s feet (439..57). Walt of the Sou r tbAMA `0 ran tike e� 18 worth, of Range Tire (3) T tc� (3k) in. Yb�+�A th 2 to an ire eke i tom W"t one .hau red nin®ty-° and tao• tenths. feet (1 91.) to ffia Iran st Ikh four hundred Ake; w �et�i and thirty -five �unid='edths 4191 (43- ta tt ace Best a¢se hundred ninet me and. two tenths feet (191.0 an .iron to thaw* South four hurAr*d nineteen and thirty -five hundredths f®at (219.3 to the place of b®nning, emt4�g one and eighty` -tonx .hundredth$ acres, more or lase, g in Hanil County: DAiAMA e t Project: 11 -09• Illinois Street Parcel: 10 WARRANTY DEED THIS INDENTURE WITNESSETH THAT Emma Lou Cunningham (individually and collectively the "Grantor conveys and warrants to the City of Carmel, Indiana (the "Grantee for the sum of Fiieen Thousand and N01100 Dollars ($15,000.00) and other valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the following described real estate in Hamilton County, State of Indiana: See attached Exhibit A and Exhibit B, which are attached hereto and incorporated herein Subject to any and all easements, agreements, restrictions and other matters of record.. It is understood between the parties hereto, and their successors in title, and made a covenant herein which shall run with the land, that all real estate herein described (excepting any parcels or portions thereof that are specifically and expressly designated as easements or temporary rights of way) is conveyed in fee simple and not merely for right of way purposes, and that no reversionary rights whatsoever are intended to remain in the Grantor. Emma Lou Cunningham represents and warrants that she is the surviving spouse of William T. Cunningham, who died in the County of Hamilton, State of Indiana, on April 22, 1987 and that they lived together continuously as husband and wife until the date of decedent's death, that husband and wife held title to the subject real estate as tenants by the entireties, that all funeral expenses, expenses of last illness, and debts of every kind and character were fully paid, that state, federal, or any other taxes which might have been assessed against the decedent's estate have been paid in full. Emma -Lou Cunningham makes these representations for the purpose of inducing the Auditor of said County to remove decedent's name from the tax records, and to induce the State of Indiana to accept a deed from the Grantor conveying the subject real estate to the State of Indiana. f 1 A4 ,ITNESS WHEREOF, Grantor has caused this Warranty Deed to be executed this day of 2012- Emrna Lou Cunningham NOTARY CERTIFICATION STATE OF COUNTY OF SS: Before me the undersigned, a Notary Public in and for said County and State, personally appeared Emma Lou Cur ham who acknowledged the execution of the foregoing Warranty Deed for and on behalf of such Grantor, and who, having been duly sworn, stated that the representations therein contained are true. WITNESS my hand and Notarial Seal this q day of b --1 20/2- My Commission Expires: County of Residence: Notary Signature tom* STEPHEN J. KLINEMAN Hamilton i aunty ray Commissi +?n Expires April 16, 2016 Notary Printed Name This instrument was prepared by Douglas C. Haney, Carmel City Attorney, City Hall, One Civic Square, Carmel, Indiana 46032 Send tax bills to: One Civic Square, Carmel, IN 46032 After recording, return deed to: Douglas C. Haney, Carmel City Attorney, 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, Doliglas C. Haney. 831464v1 2 0 EXHIBIT "A" Project: 11 -09 Sheet 1 of 1 Parcel: 10 Fee Simple Tax ID: 29- 09 -34- 000 020.000 -018 A part of Section 34, Township 18 North, Range 3 East, Hamilton County, Indiana and being that part of the grantors' land lying within the right -of -way lines depicted on the attached Right -of -Way Parcel Plat, marked Exhibit "B described as follows: Beginning at a point on the south line of said section South 89 degrees 17 minutes 57 seconds West 439.57 feet from the southeast corner of said section, said southeast corner being designated as point "9902" on said plat, which point of beginning is the southeast corner of the grantors' land; thence South 89 degrees 17 minutes 57 seconds West 191.20 feet along said south line to the southwest corner of the grantors' land; thence North 0 degrees 00 minutes 16 seconds East 25.00 feet along the west line of the grantors' land to point "635" designated on said plat; thence North 86 degrees 17 minutes 24 seconds East 191.59 feet to the east line of the grantors' land; thence South 0 degrees 00 minutes 16 seconds West 35.07 feet along said east line to the point of beginning and containing 0.132 acres, more or less, inclusive of the presently existing right -of -way which contains 0.048 acres, more or less, This description was prepared for the City of Carmel, Indiana by Jessica L. Stapleton, Indiana Registered Land Surveyor, License Number LS20600032, on the 2nd day of November, 2011. 1 1 0 1 I M sTfJE OF 1 n �1+ .711 St t: i i;iUittt``t�� EXHIBIT "B" SHEET 10F2 RIGHT -OF -WAY PARCEL PLAT o so 1 00 Prepared For the City of Carmel, Indiana SCALE: 1 =100' by: AMERICAN STRUCTUREPOINT INC. 1 X06 34 )35 34 1 I f I S 191.2' Ln ti I �I �I l� I RESIDUE "A" M I Nr c; v 0 JI J g l Z I H 636 635 I 517 R/W 917 34 34 324 +00 325 00 439.57 326 +00 7 +00 35 LINE "E" 32 00 176 634 116TH STREET 3 2 9902 EPP. IX. R ICJ HATCHED AREA IS THE APPROXIMATE TAKING OWNER: Cunningham, William.T. Et ux. DRAWN BY: JLS PARCEL: 10 CHECKED BY: JLS CODE: N/A DES. NO.: N/A PROJECT: 11-09 ROAD: Illinois Street Deed Record 165, page 595, dated August 31, 1960 COUNTY: Hamilton SECTION: 34 TOWNSHIP: 18 North RANGE: 3 East THIS PLAT WAS PREPARED FROM PUBLIC DOCUMENTS AND NOT CHECKED BY A FIELD SURVEY. EXHIBIT "B" SHEET 2 OF 2 RIGHT -OF -WAY PARCEL PLAT Prepared For the City of Carmel, Indiana by- AMERICAN STRUCTUREPOINT INC. POINT REFERENCE CHART (Feet) Point North East Station Offset 176 517 917 SEE LOCATION CONTROL ROUTE SURVEY PLAT 1900 9902 634 105003.2101 104369.2780 +jt(321 +69.37) Ex RW(11' Lt.) Line E 635 105017.2111 104369.2791 +t(321 +69.54) 25' Lt. Line E 636 105041.8636 104749.4683 325 +50 45' Lt. Line E SURVEYOR'S STATEMENT s T Location L• ��fl� fl To the best of my knowledge and belief, this pCat, together with the Location Control Route Survey" recorded as Instrument Number 2011049824 in the Office of the �F s Recorder of Hamilton County, Indiana, incorporated and made a part hereof by reference, comprise a Route Survey executed in accordance with Indiana Administrative Code 865 IAC 1 -12 "Rule 12 /I Da G���/ S TATE OF i, essica L. Staple n Date r:� 9 Re g Land Surveyor No. LS20600032 State of Indiana NOTE: STATIONS AND OFFSETS ARE TO CONTROL OVER NORTH AND EAST COORDINATES. OWNER: Cunningham, William T. Et ux. DRAWN BY: JLS PARCEL: 10 CHECKED BY: JLS CODE: N/A DES. NO.: N/A PROJECT: 11 -09 ROAD: Illinois Street COUNTY: Hamilton SECTION: 34 TOWNSHIP: 18 North RANGE: 3 East AMERICAN STRUCTUREPOINT, INC PROJECT NO. 2009.01768 THIS PLAT WAS PREPARED FROM PUBLIC DOCUMENTS AND NOT CHECKED BY A FIELD SURVEY. 5'a* SALES DISCLOSURE FORM State Form 46021(RI0 /10 -09) Y SDFID p PresaribedbyDepammentol'LnolGovernmentFinance Launsty Year Un[ ue10 Pursuant to LC 6.1.1.5.5 q GET COUNTED IN 20101 LEARN MORE AT WWW .CENSUS.INDIANA.EDU SOF Date; PRIVACY NOTICE: The telephone numbers and Social Security numbers orthepardes on this form are confidential accordin W IC 6.1.1.5.5 -3 Er t"� SL'K 1'.t'•rA1'iTw iv d PA}t�T1t -Tto be£com eI ed fi..IBUIER ?T Eta LL}z r Vii tir' :�;�s rIr n p n,uzs a .�t��. r x S /GRAN` ©Rl• t� t�� s rt�` `�,t� k v ,at fA`,' PRQPEjZ�TY�TRANSFEk�R?E .12��v1US7'� E�C,'N ;�t,�• �^�7.. e�.���,�. 1 zu_. ARM a ,-s �w�'� x�ir�r 1�!�i r,$ 1_ �XED�QNx�S[NGL�G��;N3�.E. •YAI�[GE;i7,4GUMENT:�.� :�;�:��,s. =I:� 1. Property Number Check box lfappllnubleto S. Complete Addresso /Property Complete Tax BMIng Address #fdlfferentfrom parcel property address) A•) 29- 09-34- 000 020.000 -018 2. split 510 W. 116th St. One Civic Square 3. Land Carmel, IN 46032 Carmel, IN 46032 4. Improvement 7 Legal DescrlpuonofParcelA: Pt SE SE 34- 18N -3E, SEE ATTACHED B•j 2. Spilt 3. Land 4. improvement Z Legal Descriptlon of Parcel B: B <COIT1QIVr.I Fij T]FXr'AL BHA�PPL'1' %fi Yl a s... 1?�. "r° r, �Ilr_ ray AIN R .0 SALES DATA DISCLOSj VA UE FAIT m a "y* t`'✓. .a;Yli•4"c�•rk:ktxt!("f.�it+'*f Mi dM,,•+t Y.'4. 1.Cxt' 1 y d� .,.ITEM�S:J� If condition 1 applies, later is subject to disclosure and a disclosure filing fee. YES NO CONDITION 1. Conveyance date (MMIDD/YYM: 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 3. Vacant land. Ownership interest and terms of seller financing, 0 4. Exchange for other real property "Trade RaIP/Pur hasp of 0 4 t air s for hia A�q �Ir uses_ PrirP Inrjnr,Pc Fv 5. Seller paid points. (Provide the value Table C Item 12.) land land imnroypments and ;pvpranrp Harnage Q 6. Change planned in the primary use of the p r0 p e r (Describe in special circumstances in Table C Item 3) 7. Existence of family or business relationship between buyer and seller. (compieteTwecitem4.) Q 8. Land contract. Contract term (n7: and contract date (MM /DD/rYYr): 9. Personal property included in transfer. (Pravide the value YES NO CONDITION Table C Item 5.) 10. Physical changes to property between March 1 0 4, Family or business relationship existing between and date of sale. (Describe in special circumstances in Table cifem3.) buyer and seller? 11. Partial InterQ$t (Descrlbeln special clrcum Amount of discount: 0.00 12. Easements or right- grants. stancrs In Table Cltem 3.] Disclose actual value in money, property, a service, an agreement. or otherccnslderatlon. IfcondIdons 13 -15 apply, fliers are subject to disclosure, but no disclosure filing fee. 5. Estimated value of personal prop 0.00 YES NO CONDITION 6. Sales rice: Ls 15 000.00 Q 13. Document for compulsory transactions as a YES N 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 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 15. Transfer to a chart .00 charity, not- for -profit organization, 11. Interest rate: or government 0.00 12. Amount in points: 0.00 13. Amortization period: NA INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2 cD. P„P�1RE Steohen J. Klineman Land Anent Prepa rer of the Sales Disclosure Form Title 630 N. Rangeline Rd., Ste. C Specialized Land Services; Inc. Address (Number and Street) Company Carmel, IN 46032 317 -218 -0583 sklinemanlDmsn.com City State, and ZIP Code Telephone Number E -mail ER 1S f(iIZA .'iAOR Fmma Lou nninnham Seller 1- Name as appears on conveyance document Seller 2 -Name as appears on conveyance document 510 A 1 1 61h 81, Address (Number and Street) Address (Number and Street) CArrnpl IN 46032 City, State and ZIP Code City, State, and ZIP Code 317 -846 -0407 TO hone Number E•mall E-mail Tele hone Number 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 re uired b law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act (lrn. Signature of Seller Signature of Seller 02 z.of 'L Prfnted Name a Seller S n Date MM DD Printed Nameo Seller n Date MM DD City of Carmel NA Buyer 1. Name as appears on Conveyance document Buyer 2 Name as appears on conveyance document One Civic S u r Address (Number and Street) Address (Number and Street) Carmel IN 46032 City. State, and VP Code CIty, State and ZIP Code 317 571 2441 Tele hone Number £mail Telep Number E -mail THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CCRTAINDEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION 1. Will this property be the buyer's primary Q 3. Homestead residence? Provide complete address of primary 4. Solar Energy Heating /Cooling System residence, including county: One reyffirRqimrP 5. Wind Power Device Address (Number and Street) Q 6. Hydroelectric Power Device Carmel Hamilton City, State ZI P Code County El z 7, Geothermal Energy Heating /Cooling Device Z! Code 2. Does the buyer have a homestead in Indiana to be 8• Is this property a residential rental property? vacated for this residence? I f yes, provide 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 con tact 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.) F Signature of Buyert S(gnature ofBuyerZ1Spouse a-a rC1l z. Printed Legal Name of Buyer I Sign Date (MM/DDIYYYY) Printed Legal Name of Buyer Z /Spouse Sign Date (MM/DD/YYM Last 5 digits ofBuyerIDriver's State Lasts Digits ofSocialSecurityNumber Last 5 digits ofBuyer2 /Spouse Driver's State Lost 5 Digits ofSocialSecurity License /1DlOtherNumber Number. License/iD /Other Number Il DIANA SALES DISCLOSURE FORM SDF ID- Page 3 The county assessor must verify and complete Items 1 through 14 and stamp the sales &closure form before sending bD the auditor: I. Property ZAVLand 1AYlmprovement 4. Value ofPersonai S.AVTataf 6. Property 1 Neighborhood aT`axDistrict 9. Acreage Properly Prop Class Code code A.) 8.1 Assessor Stamp 10. identify physical changes to property between March land YES No CONDITION date ofsale. 11. Is form completed? D 12 State sales fee required? 13. Date of sale (mminDlryrn: 14. Date form received (mm1Do1rA Items 15 throw b iB hre t0 be com leted b the assessorwben val[darin lhlssale z 15 If applltable Identify anyddliional speaal circu;rtstances relatng to valictahon of sale YES CO N0 NUlT10N t a n ,Sa e.Vt Ld a t ,r s 1 r 0 alI 9tl4jn of sale complete? �t 6 t Z f.!`•� Y, l a t .18 anda by l 1 t 1 \I C a. t Auditor Stamp 1 .Disclosurefee 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. R. Attachments complete? S. Date of transfer (mm1vD1rrrrl: $AE'IR9. t�iTigT�E B t QpI E(1G 10. QP A SH$ 6 TI 0 N i. SDFID SDF Date (mmlp/rmm Buyerl -Name as appears on conveyance document Parcel Number Address of Property (Number and Street) Check all that apply: E] ❑S Homestead C1 State and ZIP Code of Property olar Energy Wind Power Q Hydroelectric Geothermal Rental Property Auditor 51, pate 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 felon Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 Emma Lou Cunningham Purchase Order No. 510 W 116th St. Terms Carmel, IN 46032 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) n/a n/a ROW Acquisition (Cunningham) $15,000.00 Illinois St. Project 11-09 Parcel approved by Resolution 2-19-11 p ease send check o Engineering uepartment Total 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Emma_ Lou Cunningham IN SUM OF 510 W 116th St. Carmel, IN 46032 $15,000.00 ON ACCOUNT OF APPROPRIATION FOR Department of Engineering Board Members Pot# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the na na materials or services itemized thereon for which charge is made were ordered and received except 2 0 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund