2008-07-07 Cert of Non Foreign Status
CERTIFICATE OF
NON FOREIGN STATUS
Chicago Title Insurance Company
Section 1445 of the Internal Revenue Code provides that a transferee (buyer) of a U.S. real
property interest must withhold tax if the transferor (seller) is a foreign person. To inform _
~~1t~"f~4 I>IU.>(the "Transferee") that WithholdiZ of tax is not required
upon the disposition of a U.S. real property interest by ;!0?4i(/~,. ,.flt!
(the "Transferor/'), the undersigned hereby certifies the following on behalf of the Transferor:
1. That the Transferor is the owner of the following described property, to wit: ,1
/lu.f/U( {(714( ",,.,,,/f ( I'~"~
Block: I Lot: I (: 'Rn/: J,.! ~)i'~1 If /Jll'fl/l/(~
M-1/
Premises:
2. The Transferor is not a non-resident alien for purposes of the U.S. income taxation (as such
term is defined in the Internal Revenue Code and Income Tax Regulations).
3. The Transferor's U.S. taxpayer identification number (Social Security Number) is
:17/ -~ If - ?tJll~ .
,
4. The Transferor's address is
1711.7 ~/~.7;~
Lff!I~~~ ~()/
5. The Transferor understands that this certification be disclosed to the Internal Revenue
Service by the Transferee and that any false statement contained herein could be punished
by fine, imprisonment or both.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS CERTIFICATION AND TO THE
BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE, AND I FURTHER DECLARE
THAT I HAVE AUTHORITY TO SIGN THIS DOCUMENT ON BEHALF OF THE TRANSFEROR,
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By:
By:
By:
By:
School DistricVBarthel Property Closing
Projected closing date: July 7, 2008
Allocations
Barthel
School District City of
Albertville
Purchase Price
$ 458,000.00 $ (458,000.00)
Real Estate Taxes $ 2,513.37 $ (2,513.37)
Transfer taxes $ (1,511.40) $ 1,511.:40
Earnest Money $ (5,000.00) $ 5,boo.00
Special Assessments $ (158,054.85) $ 158,054.85
Recording fees $ (143.00) $ 143.00
Joint Powers water fees $ (3,275.48) $ 3,275.48
Net Proceeds
$ 292,528.64 $ (455,583.49) $ 163,054.85
SCHOOL DISTRICT NO. 885
DONALD G. BARTHEL
~
CITY OF ALBERTVILLE
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By: Bridge Iller, City Clerk
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COURI MACARTHUR & RUPPE P L L P
TRUST ACCOUNT
P.O. BOX 369
705 CENTRAL AVE. EAST
~~1:J~r~~~#/~;nH~2~!:~:;
JI'f'J!"l7; 12725 43rd SL NE
4~~:~=_~55376 . A;/ -/
FOR ~//f;;:;.o...~m ~ ~
III 0 0 50 . 3111+1: 0 q . q . 'i' 0 ~ .1: . 0 ~ 0 0 ~ . q 3111
75-17021919
M'
WARRANTY DEED
INDIVIDUAL TO CORPORATION
No delinquent taxes and transfer entered;
Certificate of real estate value ( ) filed
( ) not required; Certificate of Real Estate
Value Number
County Auditor
by
Deputy
STATE DEED TAX DUE: $
J;, Ir
7
,2008
FOR VALUABLE CONSIDERATION, Donald G. Barthel, a widower, Grantor, hereby conveys
and warrants to Independent School District No. 885, a municipal corporation organized under the
laws of the State of Minnesota, Grantee, real property in Wright County, Minnesota described as
follows:
Lot 1, Block 1, Barthel Commercial Park Third Addition according to the plat recorded at
the Wright County Recorder's Office.
Subject to the terms of the conditional right of repurchase set forth on the attached Exhibit A.
Grantor certifies that there are no wells on the property.
Don~
--'
STATE OF MINNESOTA
ss.
COUNTY OF WRIGHT
The foregoing instrument was acknowledged before me this M day of rl./
2008, by Donald G. Barthel, Grantor. /1
MICHAEL C. CaURI
NOTARY PUBLIC - MINNESOTA
My Commission Expires Jan. 31, 2010
7k;dr:~,
Notary Public
THIS INSTRUMENT WAS DRAFTED BY:
Couri, MacArthur & Ruppe, P.L.L.P.
P.O. Box 369, 705 Central Avenue E.
St. Michael, Minnesota 55376
Tax statements for the real property
described in this instrument should
be sent to:
Return to: Couri, MacArthur & Ruppe, P.L.L.P.
P.O. Box 369, 705 Central Avenue East
St. Michael, MN 55376
ISD 885
11343 50th Street N.E.
Albertville, MN 55301
EXHIBIT A -
Conditional Right of Repurchase.
In the event the Grantee or its successors in interest do not construct on the Property 1) an ice
arena, or 2) an outdoor sheet of ice, or 3) a parking lot for use by the patrons of the ice arena
abutting the Property on its north side (collectively "Arena Improvements "), Grantor shall have
the right to repurchase the Property from the Grantee for the sum of the following amounts
subject to the conditions set out below:
A. The purchase price paid by Grantee under this Agreement; and
B. The cost of any soil correction performed by Grantee upon the Property; and
C. The sum of A and B above multiplied by the percentage cumulative change in the
Consumer Price Index as measured by the federal government from the date of this
deed to the date Grantor repurchases the Property from Grantee.
In the event no such Arena Improvements have been constructed on the Property as
required under this Exhibit A and Grantee either 1) declares its intent to construct
improvements on the Property other than Arena Improvements; or 2) proposes to sell the
Property to a third party for use other than for Arena Improvements, Grantor shall be
entitled to repurchase the Property as described in this Exhibit A. Within 60 days of Grantee's
written notification to Grantor (personally delivered) of Grantee's intent to sell the Property or to
use it for other than Arena Improvements, Grantor shall notify Grantee in writing of its intent to
repurchase the Property by personally delivering such notice to the Superintendent of
Independent School District No. 885. Upon proper exercise of such right Grantee and Grantor
shall close on such sale within 90 days of exercise by Grantor. This conditional right of
repurchase shall expire and be null and void upon 1) the construction of Arena Improvements; or
2) Grantor's failure to exercise its right of repurchase within 60 days after notice of Grantee's
intent to sell the Property or to use it for other than Arena Improvements.
l1S-M AFFIDAVIT REGARDING PURCHASERS
Individual
Minnesota Conveyancing Forms-1l5-mv J - rgValley PC Services (9/99)
STATE OF MINNESOTA
)
)ss.
)
Affidavit Regarding Purchaser(s)
COUNTY OF WRIGHT
Donald G. Barthel
being first duly sworn, on oath say(s) that:
1. He is the person( s) named as Grantor in the document dated
as Document Number (or in Book
in the office of the County Recorder of Wright County, Minnesota.
and filed for record,
of page
),
2. Said person(s) (is) (are) oflegal age and under no legal disability with place ofbusiness(es) (respectively at)
and for the last ten years (have) (has) resided at:
1/1-317 f,tJ~k t1~~1 ~)3()1
3. There are no: jJ/-73 I)~ ~~J(~ ~#1~, f.>;ltJ!
a. Bankruptcy, divorce or dissolution proceedings involving said person(s) during the time period in which
said person(s) have had any interest in the premises described in the above document ("Premises");
b. Unsatisfied judgments of record against said person(s) nor, to your Affiant(s) knowledge, any actions
pending in any courts which affect the Premises;
c. Tax liens filed against said person(s); except as herein stated:
4. Any bankruptcy, divorce or dissolution proceedings of record against parties with the same or similar names,
during the time period in which the above named person( s) (has) (have) had any interest in the Premises, are not
against the above named person(s).
5. Any judgments or tax liens of record against parties with the same or similar names are not against the above
named person(s).
6. Said person(s) (has) (have) not ordered or arranged for any labor or materials to be furnished to the Premises
for which payment has not been made.
7. There are no persons in possession of any portion of the Premises of which Affiant(s) (has) (have) knowledge,
other than pursuant to a recorded document, except as stated herein:
That Affiant(s) know(s) the matters herein stated are true and make(s) this Affidavit for the purpose of
inducing the acceptance of title to the Premises. L
~
Subscribed and sworn to before me ou this '];!{J, ~
NO< AROAUT AM' 0",",' (OR ornER un> OR~) . - <. - L "
SIGNATURE OF PERSON TAKING ACKNOWLEDGEMENT
MICHAEL C. CaURI
NOTARY PUBLIC - MINNESOTA
My Commission Expires Jan. 31,2010
THIS DOCUMENT WAS DRAFTED BY (NAME AND ADDRESS)