HomeMy WebLinkAboutA013 - Real Estate Transfer - Groundwater Hazard Statement REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
Please read the filing instructions on the reverse side BEFORE completing this form.
PART I - TO BE COMPLETED BY TRANSFEROR
(PEea4e Type on Pn i nt Leg:i6Ly)
Social Security No.
TRANSFEROR Name Farnham and Manci Partnership (or Federal I.D. No. ) 42-1 �4E2_94
Address 821 Delaware, Ames, IA 50010
Number and Street or RR City, Town or P.O. State zip
�-' � t►
���� t Social Security No.
TRANSFEREE Name ramho q- AR01 ' Q� (or Federal I .D. No. )
Address
Number and Street or RR City, Town or P.O. State zip
Address of Property Transferred J
Number and Street City, Town or P.O. State zip
Legal Description of Property
1. Wells. (check one)
M .There are no known wells situated on this property. .
13 There is a well or wells situated on this property. The type(s), location(s), and
legal status are stated below.
2. Solid Waste Disposal. (check one)
IX3 There is no known solid waste disposal site on this property.
[3 There is a solid waste disposal site on this property, but no notice has been received
from the department of natural resources that the site is deemed to be. potentially
hazardous.
[3 There is a solid waste disposal site on this property which has been deemed to be
potentially hazardous by the department of natural resources. The location(s) of the
siteCs) is stated below.
3. Hazardous Wastes. (check one)
0 There is no known hazardous waste on this property.
[] There is hazardous waste on this property and it is being managed in accordance with
department of natural resources rules.
••4. Underground-Storage Tanks. (check one)
DO There are no underground storage tanks on this property. (Note exclusions such as
small farm and residential motor fuel tanks, most heating oil tanks, cisterns, and
septic tanks, in instructions. )
13 There is an underground storage tank or tanks on this property. The type(s), size(s),
and substance(s) contained are described below.
Information, if any, required by statements checked above:
N/A
Attachment for Additional Information? Y/N If so, number of pages
I HEREBY DECLARE THAT THE INFOR TION CONTAINED IN PART,I OF THIS STATEMENT IS TRUE AND
CORRECT.
A-1
Signatures Telephone Number, C J IS) Z?Z- SS/7
(Tr sfe ,or)
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ART II - TO BE COMPLETED BY RECORDER
Date of Instrument jllpq6 Book/I.D. 1' A&q I Page/I .D.
Date of Recording
City or Township
Deed E
Contract r County F�
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DNR form (Jul 87) FILE 3 •6nPTFS WTTN PFrnonry cAv_nntn