Emerson Road - Drainage Easement -Roberts, DeborahCross Reference:
Inst. #200300121453
2015025123 EASE $21.00
05/27/2015 12:04:02PM 5 PGS
Jennifer Hayden
Hamilton County Recorder IN
Recorded as Presented
1111111 1 111111111111111111111111 I I I I I I I I 1 1111111111111111111111111111
DRAINAGE EASEMENT AGREEMENT c� .���•°
KNOW ALL MEN BY THESE PRESENTS that the undersigned, Deborah L. Roberts, as tiles
fee simple owners of certain real estate, (hereinafter collectively referred to as "Grantor "), for
and in consideration of the sum of ____$1,725 . Dollar and no cent, in hand paid, the receipt and
sufficiency of which is hereby acknowledged and confessed, does hereby GRANT, BARGAIN,
SELL AND CONVEY UNTO The City of Carmel, Indiana, an Indiana municipal corporation,
its successors and assigns (hereinafter referred to as "GRANTEE "), a perpetual drainage
easement upon, over, under and across the real estate located in Hamilton County, Indiana, and
described and depicted in Exhibit "A ", of which is attached hereto and hereby made part hereof,
for the purpose of laying, installing, constructing, maintaining, operating, inspecting, altering,
replacing and removing the drainage facilities.
Grantee shall have the right of ingress and egress over, under, upon and across any land,
driveways and roadways located on the surface of the lands owned by Grantors, their successors
and assigns, upon and within the boundaries of the easement area, for purposes of access to the
easement area. Said easement also includes the rights and privileges to temporarily use, from
time to time, additional space, where available and necessary, that is adjacent to the
easement area for equipment and materials necessary for the installation, repair and maintenance
of Grantee's facilities located in, under, upon, over, and/or across the easement area, to do all
acts and things requisite and necessary for the full enjoyment of the easement hereby granted,
provided Grantee, their successors, agents, or employees restore the portion of the Grantors'
property disturbed by their work to a condition that is as near the condition that existed just prior
to the time the portion was disturbed by them as is practicable. Grantee also shall have the right
from time to time to remove all trees, undergrowth, structures and/or other obstructions above,
within, under, or immediately surrounding the easement area which may injure, endanger or
interfere with Grantee's use and enjoyment of this easement, all of which work shall be done at
Grantee's sole cost and expense, except as otherwise set forth herein.
Grantors, their successors or assigns, shall not erect or maintain any permanent
EXEMPT FROM
SALES DISCLOSURES
PE
Cross Reference:
Inst. #200300121453
DRAINAGE EASEMENT AGREEMENT
KNOW ALL MEN BY THESE PRESENTS that the undersigned, Deborah L. Roberts, as the ¢D
fee simple owners of certain real estate, (hereinafter collectively referred to as "Grantor "), for
and in consideration of the sum of $1,725 Dollar and no cent, in hand paid, the receipt and
sufficiency of which is hereby acknowledged and confessed, does hereby GRANT, BARGAIN,
SELL AND CONVEY UNTO The City of Carmel, Indiana, an Indiana municipal corporation,
its successors and assigns (hereinafter referred to as "GRANTEE "), a perpetual drainage
easement upon, over, under and across the real estate located in Hamilton County, Indiana, and
described and depicted in Exhibit "A ", of which is attached hereto and hereby made part hereof,
for the purpose of laying, installing, constructing, maintaining, operating, inspecting, altering,
replacing and removing the drainage facilities.
Grantee shall have the right of ingress and egress over, under, upon and across any land,
driveways and roadways located on the surface of the lands owned by Grantors, their successors
and assigns, upon and within the boundaries of the easement area, for purposes of access to the
easement area. Said easement also includes the rights and privileges to temporarily use, from
time to time, additional space, where available and necessary, that is adjacent to the
easement area for equipment and materials necessary for the installation, repair and maintenance
of Grantee's facilities located in, under, upon, over, and /or across the easement area, to do all
acts and things requisite and necessary for the full enjoyment of the easement hereby granted,
provided Grantee, their successors, agents, or employees restore the portion of the Grantors'
property disturbed by their work to a condition that is as near the condition that existed just prior
to the time the portion was disturbed by them as is practicable. Grantee also shall have the right
from time to time to remove all trees, undergrowth, structures and /or other obstructions above,
within, under, or immediately surrounding the easement area which may injure, endanger or
interfere with Grantee's use and enjoyment of this easement. all of which work shall be done at
Grantee's sole cost and expense, except as otherwise set forth herein.
Grantors, their successors or assigns, shall not erect or maintain any permanent
structures, obstructions, or other improvements under and /or upon the surface of or over the
easement area or perform any act which would impair or interfere with Grantee's use and
enjoyment of the easement herein granted.
TO HAVE AND TO HOLD unto Grantee, its successors and assigns, so long as the
rights and easements herein granted shall be used by Grantee upon the terms and conditions
specified herein, with ingress to and egress from the easement area, for the purposes of
constructing, installing, repairing, maintaining, replacing and removing the facilities of Grantee
herein described, but subject to all liens, encumbrances, restrictions and prior easements of
record.
It is agreed that this grant covers all the agreements between the parties and no
representations or statements, verbal or written, have been made modifying, adding to or
changing the terms of this agreement.
The Grantors represent and certify that they are the fee simple owners of the easement
area and real estate surrounding the easement area; that Grantors guarantee the quiet possession
of the easement area to the Grantee; that the easement area is free of any liens or encumbrances,
except the lien of current taxes and any other lien or encumbrance that, as of the date of
execution hereof, appears of public record; and that, subject to the foregoing, Grantors will
warrant and defend Grantee's title to the easement granted hereby against all claims thereon.
The person or persons executing this instrument on behalf of Grantors hereby represent
that they have the authority to bind Grantors, jointly and individually, to the terms and conditions
set forth herein.
This instrument may be executed by Grantors in separate counterparts, each of which
shall constitute a duplicate original.
IN TESTIMONY WHEREOF, Grantors herein have executed this conveyance
Individually this, the 1 day of /1441/
//'
toiert O.�
STATE OF INDIANA
) SS:
COUNTY OF HAMILTON
, 2015.
Before me, a Notary Public in and for said County and State personally appeared
Deborah L. Roberts known to me to be the individual whose name is subscribed to the
foregoing instrument and consideration therein expressed, and in the capacity therein stated.
Given under my hand and seal of office, this / Sr—
day of /r v , 2015.
ary Public
Notary Public Seal
State of Indian
Lance Stahley a
Marton Count .
s°,= • Y 6 is n Expires De ri 201
Commission Expiration:
/1/Z0/
County County of Residence:
/141g/OA/
cier
ignature
r
CITY OF CARMEL, INDIANA
BY ITS BOARD OF PUBLIC WORKS
AND SAFETY
Ames Brainard, Presi i�ng Of tc r
Date:
Maly Ann Buy e, Member
Date:
Lori Watso
Date:
ATTEST:
ember
Sandra M ioi -wsa>J
Deputy a14 -u
STATE OF INDIANA
COUNTY OF
SS:
Before e, a Notary Public in and for said County and State, personally appeared James
Brainard Mary Ann Burke, and Lori Watson by me known to be the Members of the City of
Scu\aro SJ ohron , De lat
Carmel Board of Public Works and Safety, and , Clerk- Treasure of the City of
Carmel, who acknowledged the execution of the foregoing "Easement Agreement" on
behalf of the City of Carmel, Indiana.
Witness my hand and Notarial Seal this `' day of
My Commission Expires:
2015.
CLu.c,
NOTARY PUBLIC
Printed Name /L
My County of Residence: r/71'/7? /.CjU,f)
Date: /Zi,/•S"
This instrument was prepared by Douglas C. Haney, Esquire, City Attorney, One Civic Square, Carmel, Indiana
46032. 1 affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security
Number in this document, unless required by law. ����� _, { et/
COUNTY: HAMILTON
SECTION: 25
TOWNSHIP: 18 NORTH
RANGE: 3 EAST
"
HATCHED AREA IS THE
APPROXIMATE EASEMENT
EXHIBIT 'A"
EASEMENT EXHIBIT
OWNER: DEBORAH L. ROBERTS
EASEMENT DESCRIPTION
DRAWN BY : CJL 01 -21 -15
CHECKED BY : GWC
20'
0
20'
SCALE: 1'
TEN FEET BY PARALLEL LINES OFF OF THE ENTIRE NORTHEASTERLY SIDE OF LOT 29 IN JOHNSON
ADDITION RECORDED IN PLAT BOOK 2, PAGE 26 IN THE HAMILTON COUNTY RECORDER'S OFFICE.
CONTAINING 0.020 ACRES, MORE OR LESS.
"
CO
DEBORAH L. ROBERTS
INST. #200300121453
LOT 29
JOHNSON ADDITION
P.B. 2 PG. 26
I, GEORGE W. CHARLES II, A REGISTERED LAND SURVEYOR IN
THE STATE OF INDIANA, DO HEREBY CERTIFY THAT THIS PLOT
IS BASED ON THE PLAT OF JOHNSON ADDITION RECORDED IN PLAT
BOOK 2, PAGE 26 IN THE HAMILTON COUNTY RECORDER'S OFFICE.
NO FIELDWORK WAS PERFORMED AND THEREFORE, THIS DESCRIPTION IS
SUBJECT TO ANY OVERLAPS, GAPS OR INCONSISTENCIES THAT A FIELD
SURVEY MIGHT REVEAL.
5' UTILITY
STRIP
GEORGE W. CHARLES II
gwcharles @crossroadengineers.com
INDIANA LAND SURVEYOR
NO. LS 20800117
25'
N
NORTH
PREPARED BY:
Transportation &
Development Consultants
3417 9ERWY Ul Mai W.f. 01 46107 1317) 733-1536
Form W"9
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
Print or type
S Specific Instructions on page 2.
Name (as shown on your income tax retum)
14e10 orc -h ,. - Rabe-)
Business name, if different from above
Check appropriate box: 1 IndividuaVSole proprietor 1 Corporation 1 Partnership
• Limited liability company. Enter the tax classification (D= disregarded entity, C= corporation, P= partnership) ■
• Other (see instructions) ■
Exempt
• Exem
Address (number, and apt. or suite n•.)
Requester's name and address (optional)
:-
/7S'ty, state, and ZIP code
l �i+ *&7 .5 071
List account number(s) Are (opt •nal)
Part
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 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 entities, it is
your employer identification number (EIN). If you do not have a number, see How to get — -
Note. If the account is in more than one name, see the chart on page 4 for guidelines c
number to enter.
Mao Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I ar
2. I am not subject to backup withholding because: (a) I am exempt from backup with
Revenue Service (IRS) that I am subject to backup withholding as a result of a failun
notified me that I am no longer subject to backup withholding, and
3. I 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 b
withholding because you have failed to report all interest and dividends on your tax retui
For mortgage interest paid, acquisition or abandonment of secured property, cancellatioi
arrangement (IRA), and generally, p. ments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the ' ructions on page 4
Social security number
, 6a4s
4245
-p zb o 6e r4 5
0- 311.709 •6o49
Sign
Here
Signature of
U.S. person •
4 , 4,PP
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W -9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying 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 withholding tax on
foreign partners' share of effectively connected income.
Note. 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 to this Form W -9.
Date • �f Q 1
do/5-
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section
301.7701 -7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W -9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W -9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W -9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
• The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W -9 (Rev. 10 -2007)
LETTER OF TRANSMITTAL
Date: May 11, 2015
To: Doug Haney
Department of Law
From: Jeremy Kashman SA'
Department of Engineering
RE: Little Cool Creek — Emerson Drive Drainage Project
Doug, please see the attached parcel easement agreement, W -9, and easement exhibit for Deborah L.
Roberts to be approved at the May 20th BPW meeting.
Thank you.