2004-08-06 Cert of Real Estate Value
MINNESOTA Department of Revenue
Certificate of Real Estate Value Supplemental Schedule
Complete this form for apartment, commercial/industrial or farm sales only.
?
Certificate of Real Estate Value sequence number
StolfI ~.
~L/t> m~---
1 If the sale price includes any personal property (e.g., furniture, appliances, supplies, fixtures,
machinery or stock inventories) or other items (e.g., the goodwill of the business, the name of the
business, franchise, or an agreement not to compete), fill in the total value of those items here . . . . . . . $
2 If the buyer or seller paid someone to make an appraisal of the property's value prior to its sale,
check this box D and, if known, fill in the appraised value ............................... $
3 Commercial/industrial properties: From the list of property uses on the back of this form, fill
in the number for the use that best describes how the property was used just before it was' sold .......
Fill in the number that best describes what the property will be used for after the sale ..............
4 Apartment properties: If the property sold was an apartment building, fill in the total number
of apartment buildings included in the sale price .......................................
Fill in the total number of rental units in all buildings
5 Farm properties: How many acres are irrigated?
How many acres are enrolled in Reinvest in Minnesota (RIM)? ..............................
How many acres are enrolled in the Conservation Reserve Program (CRP)?
All properties
6 Was the buyer of this property an owner of a property adjacent to it? . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, in your opinion, did the buyer pay a higher price for the property than other potential buyers
would have likely paid for it? ..................................................... .~. . . . . . .
7 Does the total purchase price listed on line 2 of the Certificate of Real Estate Value represent the allocation
of a sale price that includes another property or properties sold to this buyer at the same time? ................
8 Did the buyer lease the property from the seller before the purchase? .................................
Did the seller lease the property from the buyer after the purchase? ..................................
9 Was this sale announced and/or promoted through realtor listings, newspaper or other publications,
advertisements, or through brochure or other promotional or informational mailings? ......................
If you answered no, how did you learn that the property was for sale?
10 If the property was rental property! was the buyer guaranteed a minimum level of rental income? .............
11 Were the buyer and seller family members, business partners, business affiliates, one subsidiary to the
other, joint owners of the property or stockholders of the business? ...................................
12 When the property was sold, was a foreclosure, court judgment, order or other legal proceeding
pending in connection with the property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 In your opinion, is the price the property was sold for considerably different from what you believe
other similar properties would sell for? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, explain briefly:
~~-OJ- ~
Signature of buyer
~
'~K.
-...i()~Y\.'~
~ 1<J~4
,
l Co3-479- 4-~Gz1
Daytime phone
Print nome
Dote
PE-20A
Yes ~
D
D D
D )t
D ~
D ~
~ D
D ~
D
D )g
D )(
\) ~l\.t\ 1-. ~ 0 \4.;) .! 11 ~ ..S &:c..
^^,...;I ......... ",......., ,.. ....................-h, ....,I...J:f.........'~ ........ .............."......J.......J... "",U:-._ .. .:.LL . ___._ .J_ _ _I __ _ _ _L__. _L [_ _ _1_ _ _I _..__1
r .,.r. . rn I r-. . \1 I
~61) <.\1Cf -48"U>
MINNESOTA Department of Reve~ue
Certificate of Real Estate Value
Buyers' last name(s), lirst, middle initial
~ffd~4'~Ih~
Rl/b..'m't::"" '-u;...i.r}illL..~ ..~.
' V!tri - . ~fi
Street address or rural route of property purchased
PE-20
Daytime phone
(7614"- $lKz.o
Daytime phone
Fin nci I arrangements
,. Total purchase price
, ;-C:;Z) rrTlJ, If?} .
II Down ptyment
.---
. City or tQwnship
'h r'-t1' ,
Legal description q( property purchased (lot, block and plot, or 011 ch 3 copies of the legal description)
...... I~_ ~d-ec/
Was personal property such os furniture, inventory or equipment included in the purchase price?
If yes, describe below and list current (not replacement) value. (Use the bock of tliis page it needed.)
o yes )8ko
$
$
.
$
$
Total personal property
current value:
Points or prepaid interest paid by seller
$
$
11$
Type of acquisition (check all that apply)
o
o
Buyer and seller are relatives or
related businesses
o
o
Transaction involved the trade of
property
Buyer is 0 religious or charitable
organization
o
o
o
Condemnation or foreclosure
transaction
Buyer is 0 unit of government
o
o
o
Nome added to or co-owner's nome
removed from deed (not 0 sole)
Buyer purchased partial interest only
Property is 0 gift or inheritance
Payoff or resole of contract
Purchase agreem<;nt signed over two
years ago. Year SIgned:
Type of property transferred (check all that apply)
1"\71 Land only 0 Land and buildings 0 Construction of 0 new building
~ after January 1 of year of sole
II Planned use of property (check one)
o Residential, single family If you check one of the four boxes below, you must complete schedule PE-20A and attach it to this certificate.
O 0 Agricultural 0 Commercial-industrial
Residential duplex, triplex (number of acresJ: (type of business):
O Cobin or recreational 0 Apartment building 1'Vr. "D "". ___ \ -4
(non-commercial) (number of units): ~ Other (describe): ~~\))c..;)"\c.c... UU.... O'\I~\.
. Will this property be the buyer's principal residence?
Oyes ~
Method of financing (complete only if seller-financed, including a contract for deed or assumed mortgage)
Check:
Assumed Contract
Mortgage for Deed
Mortgage or contract for
deed amount at purchase
Monthly payment for
principal and interest
Interest rate
now in effect
Total number
of payments
Dote of any lump sum
(balloon) payments
o 0
.0 0
I declare that the information on this form is ~rue, correct, and complete to the best of m
Name (print or Iype)
1)~.., 1.::r 0 H ,J ,- .:> S-.c...
o C Yr Bit SD
OT
eo..- ~
Bldg
knowledge and belief.
Daytime phone
Date
Co
Yr
1<f- ~8~
Primary property identification #
Acres Tillable
CRP RIM Use Deed
Yr
land
Bldg
Tot
Secondary parcel identification #
Good for study
o no If no, give reason/code
b
x
HC
ST
Adic Adjs
Use
Tillable EMV
Apt
GA
C
MV
2
MV
ID
d
n n