HomeMy WebLinkAboutA010 - Real Estate Transfer Declaration of Value (Instrument No. 2012-00014223) 09 , S 3" 1 too - aA ( Instrument:2012- 00014223
0 Elate:Nov 28,2012 01:16:24P
C G Rec Fee: 10.00 E-Cam Fee: l]0
1 [3 - �C� +1ud Fee: 5"00 Trans Tax: 1.- C5l v R Rec Management Fish. 1599.20
Non-Standard Pace Fee: 1.00
Filed for record in Story County,
Susan L. Vande Kamp, County Recorder
REAL ESTATE TRANSFER-DECLARATION OF VALUE
Please read the instructions on the reverse side BEFORE completing and filing this form.
Part I-TO BE COMPLETED BY BUYER, SELLER OR AGENT
SELLER: Family Realty,L.L.C.
SSN or FEIN.
Seller Address: PO Box 763,Ames, IA 50010 e-mail/phone- 515-451-5951
BUYER: Deery, Deery and Deery,LLC
SSN or FEIN:
Buyer Address:200 S Gear Ave.,West Burlington IA 52655 3, _� — �j
y e-mail/phone:
Address of Property Conveyed: 1400-1698 SE 16th St.,Ames, IA 50010
Date of Instrument:
11/20/2012 A freed_1 UContract_2
Legal Description: Parcel"E"a part of the NW1/4 of the NEt/4 and the NE1/4 of the NW1/4,all in Section 13,Township 83 North,Range 24 West,of the 5th P.M.Ames,Story County
Iowa,as shown on the"Patent"filed in the office of the Recorder of Story County,Iowa on September 3,1998 as Inst.98-12413,except the North 10 feet thereof.
Type of Sale(check all that apply): ❑Fulfillment of prior year(s)contract ❑ Sale to/by Exempt Organization ❑ Auction Sale
❑ Corporate merger or reorganization ❑ Purchase of adjoining land ❑ Transfer of partial interest ❑ Quit Claim Deed
❑ Sale between family members or related parties ❑ Foreclosure,forfeitures,or transfers arising from default;forced sale
Was this a sale of AG LAND to: ❑ Corporation ❑Trust ❑ Alien ❑ Non-Resident Alien ❑Limited Partnership
. ,., DECLARATION OF VALUE STATEMENT
1.Total Amount Paid $$1,000,000.00
2.Amount Paid for Personal Property(see instructions) $
3.Amount Paid for Real Property Only(1 minus 2) $$1,000,000.00 -
ioR•oov
Contract Sale Information: Down Payment$ Interest Rate % Monthly Payment$
Length of Contract years Balloon Payment Date(if applicable)
I HEREBY DECLARE THAT THE INFORMATION CONTAINED IN PART I OF THIS FWM IS TRUE AND CORRECT AS
kLFJMTH BACK F THIS FORM . Printed Name: 00�ry-i'p__-k'�Rrw&s Phone
Sin e uyer or eller or gent or Otto
PART II-TO BE COMPLETED BY THE ASSESSOR
Classification of Property: ❑ Res_4_ ❑ Com_5_ ❑ Ind_2_ ❑ Ag_1_ ♦ Deeded Acres:
OCC ♦TLA/GBA ♦ Tax District
Primary Parcel Number A (attach list of additional parcels)
Full Assessed Value Land Building Dwelling Total
January 1 of Year of Sale
Good for study? ❑Yes ❑ No NUTC ♦If No,give reason:
Effective Date of Form 09/30/12 Iowa Department of Revenue 57006a(03/23/12)