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2012-R-3
JEFFERSONVILLE PARK AUTHORITY RESOLUTION NO. 2012-R- 3 A RESOLUTION GIVING THE MAYOR AUTHORITY TO EXECUTE DOCUMENTS FOR THE SALE OF PROPERTY Whereas, certain properties as further described in attached Exhibit "A ", owned by the Jeffersonville Parks Department are subject to acquisition from the Indiana Department of Transportation (INDOT) for purposes of construction of the new downtown Ohio River Bridges project; and Whereas, these properties are to be conveyed to INDOT for the Ohio River Bridges project; and Whereas, INDOT has made offers to purchase in amounts consistent with the appraised values; and Whereas, INDOT pursuant to the attached Exhibit "A" requires that any documents to effectuate the sale and transfer must be executed by the Chief Executive for the City of Jeffersonville; and Now, therefore, it is hereby resolved that the Parks Authority authorizes the Mayor of Jeffersonville, as the duly elected Chief Executive Officer, to execute any and all documents necessary to effectuate the sale and transfer of property from the Jeffersonville Parks Department to. INDOT necessary for the purposes of the Ohio River Bridges project according to the terms of the agreement between the City of Jeffersonville and the INDOT (see attached Exhibit "A "). Adopted this day of October, 2012 p Y Jeffersonville Parks Authority A r it iot/ Ma ew Owen, President ATTEST: %iir/` ( 6Ak/vV) 214 Secretary OWN LA Code 4839/ 1 -65/ Clark Co. 03/08 STATEMENT OF THE BASIS FOR JUST COMPENSATION Code 4839 1 1. This is a written statement of and summary of the basis for the establishment of the amount believed to be through a valuation i process, just compensation for the purchase of this right -of -way for highway purposes. The amount set forth in Item 5 below is not less than the approved estimate of value. In accordance with Public Law 91 -646 as amended, the "Uniform Act ", and as codified in Indiana It at IC 8- 23 -17 -1 through 8- 23- 17 -35, this value disregards any decrease or increase in fair market value of the property prior to the date of valuation caused by the public improvement for which the property is acquired other than physical deterioration within reasonable control of the owner. 1 2. The legal description of this acquisition is set forth in the instrument of conveyance in the following identified parcel and this acquisition is identified in the Acquiring Agency's records as: Part of Lot 8 in Barnett & Ray's Subdivision & part of Block 13 Des. # 0300798 Parcel 8 Road 1 -65 County Clark , t. Owner(s) Department of Parks and Recreation City of Jeffersonville 3. The area and type of interest being acquired: 2,530 square feet in fee / full limitation of access [Total Take] t The amount in Item 5 below includes payment for the purchase of all interests in the real property and no separately held interest is being acquired separately in whole or part, except as may be explained in Item 8 below. 4. This acquisition is (Check one): a. ® A total acquisition of the real property. b. ❑ A partial acquisition of the real property. 5. The Agency's Offer: Just compensation has been determined to be and the Acquiring Agency's offer for the purchase of this real property is as follows: i 6 a. Total Land, Land Improvements and Buildings $900.00 b. Severance Damages NONE $0.00 C. Other Damages (Itemize) Cost -To -Cure estimates: NONE $0.00 a Temporary RJW N ONE $0.00 a Total Damages $0.00 31 Total amount believed to be Just Compensation offered for this Acquisition is: . 00 1 k 6. The amount in Item 5 above may include payment for the purchase of certain buildings and improvements and their ownership shall pass to the Acquiring Agency. These buildings and improvements are identified as follows: 1 NONE 7. The amount in Item 5 above may include payment for the purchase of certain Land Improvements, Fixtures, Equipment, Machinery, Signs, Etc., and their ownership shall pass to the Acquiring Agency. These items are identified as follows: it t NONE 8. Items owned by others (i.e.: lessee, tenants, etc.) included in Item 5 above are identified as follows: NONE 9.Remarks: Indiana Departmen •f Tr. ns• --rtat'. Reviewer: 4 4, / Signature / Signature: - / — : %I /iiJ ,, Name Printed: 4 /,„ Name Printed: Will L. Stump, MAI 06,�,f�. Company: Will L. Stump Title: �LbT AIOC7 7�C' P Y� P & Associates Date: 8 --1 -12 Date: July 17, 2012 I 6 I . i , i N .,.. --....L.,„,„ . , i n_____.L. ., .----- ..., ....„, , , , - _ 1 ...laat9---._ - : . i \ 1 -1-•->4,....., ' ''''''' / Lb.', L ...:' ., ,;:r:ostal%- taac.,,,too • 1 , II-Ci ) \ ''', ' I - 1 i . 1-1 ),,,,,„ .,.; . - • .,. ,... 4/ i-;/1 , c:r) f, . , J 4-1 L 1 0-) _ 1 ., .711 1 i : a '4Z) , ' t . , .. i i . A �i S \ �Y ! { ,. r \ , • rte' \ t t i j . •V 3 l.i, 'r ////' ri (.4,`...t.;-. , 1 :. '1011 i I , _.............._ l ',. i 7' / ocr 1 „cE,1... . ki A , . i N .: .1 , * • , 4, * ,„ ; .,,,„„,' i . "v ., ',‘ '' - (c 1 , :..' -- ( . r s ,..., ,/,,z i . ip , 1 . li !,,,,. ' ' ' : 1 C Q ( \ l ,.. 1Z16 --.. .. Is, ' ' • 1 4:1 . . : 81-' i ' -• ,,,, 1 ,, `P c 3/ ' .., 1 ill 1 • i .; : r .,/ e --- -.I. ....; 31 i - Jo q•P' .;::)/ c , r .,:c i . t i on �; 0z 0 ,J N. ° h CI r1 i 1 J it/ 8 III • ; r •7 ' i ' o 2 �1 r ■ k Nii 6 Il II i ii. _ _ . 1 1 (f) ‘si ki o •. N I ' *tt-' %I t. oilfr °(- /- 1 i. - n 4 is o , ilia( ..', ill/ - -- .., 1,?, gy. ■ v. a ;11 . S o j 1 0 • lit v I . , iit . . � ), � 0 0 1 4 .,„ 14 f ro D ,, ft yr - - ,,,. (, \ ` ` 1 1 11)• r f l oil' 1 ► 0 r i k I hi i ' t i n... c., f 4 INDIANA DEPARTMENT OF TRANSPORTATION, LAND ACQUISITION DIVISION BUYER'S REPORT 1 PROJECT: I -65 LSIORBP PARCEL: 8 COUNTY: Clark CODE: 4839 Name & Address of Owner: The Board of Parks and Recreation of the City of Jeffersonville, IN 400 W. Maple Street, Jeffersonville, IN 47130 Phone: Name & Address of Person Contacted: Rob Waiz, Director of Economic/Redevelopment 500 Quartermaster Court, Suite 205, Jeffersonville, IN 47130 812- 280 -4704 (List other interested parties on reverse side including nature of their interest) Date Assigned: 8/6/12 Date of Contact: 2/ - , - 2. Time of Contact: Offer $ l Type of Contact: ('—}'' Visit ( ) Phone ( ) Mail Write: Yes, No, or N/A (for not applicable), as appropriate in each numbered blank space: 1 Checked Abstract w/ owner? 14 Yes Secured W -9 Form? 2 Any affidavits taken: Left following papers w/ owners: 3 Any mortgage(s)? 4 Any liens, jugements, etc.? 15 Written Offer? 5 Showed plans? Exp. take? 16 Land Acquisition Brochure? 6 Explained about retentions? 17 Retention Letter? 7 Any major item retained? 18 Statement of Just Compensation? 8 Any minor item retained? 19 Tax memo (interim period)? 9 _ Walked over property? 20 Yes Receipt of Conveyance Instrument? 10 Yes Owner to pay taxes? 21 Yes Copy of Conveyance Instrument? 11 Secured Right -of -Entry 22 Owner's Appraisal Letter? 12 Secured Driveway R/E 23 Brochure, "Relocation & You "? 13 Sent Daily Notice to Relocation? 24 E.D.D.? jai mARKs This buyer met with the property owner(s) or representative so all securing documents for this parcel could be signed. After all documents were signed and notarized, as needed, I presented copies of all documents. ( ) These documents were received in the mail rather than in person. I then assured the owner(s) or representative that payment may be expected within 90 days after clear title is obtained and the parcel cleared by the INDOT legal department. Clear title involves all taxes being paid to date, any and all judgments being satisfied, partial mortgage release(s) obtained, if applicable, and satisfaction of any other encumbrance on the title. The state will take possession of any permanent acquisition 30 days after payment is received. Any retentions in a permanent and/or temporary acquisition area must be removed during the mentioned 30 day period. At the end of this 30 days, INDOT's property management section will investigate to see if these items have been taken care of Property management will also determine the fate of cost -to -cure items that must be handled by property owner(s), within the 30 days after payment. This buyer certifies that 1) the written agreement secured embodies all considerations agreed to by the property owner; 2) the BUYER has no direct or indirect, present or contemplated future personal interest in the property or in any monetary benefit from the acquisition of the property; 3) the agreement was reached without coercion of any type. Status of Parcel Secured, ( ) Condemned, ( ) Other Distribution: S :. ) Parcel (,<I) Owner ( ) Weekly Summary ( ) Attorney 1 ) Spec'fy Other THIS DOS '140T CONSTI TE A CONTRACT Property Owner Initials David B. Patterson Obn Pa_e 1 of 1 -,pky INDIANA DEPARTMENT OF TRANSPORTATION LAND ACQUISITION DIVISION RECEIPT OF CONVEYANCE INSTRUMENT The undersigned being a Land Agent for the Department of Transportation of the State of Indiana, does hereby acknowledge receipt this date, of one Warranty Deed signed by: For: The Board of Parks and Recreation of the City of Jeffersonville, IN and conveying certain rights, title and/or interest in real estate located in Clark County to the State of Indiana for transportation purposes and which is identified as Parcel 8 on Transportation Project I -65 LSIORBP. I further acknowledge that said instruments) has/have been executed and acknowledged by the grantors without payment by me of any consideration and that I am transmitting such instrument(s) to the appropriate transportation authority for review subject to approval. It is understood and agreed that this conveyance instrument will either be returned to the grantor not approved or the State of Indiana through its proper agencies will cause such instrument to be processed for payment in the amount of $ � — 1 ) , a You may expect payment in full within ninety (90) days after signing the documents accepting this offer and executing the deed, grant, or easement, and provided there are no difficulties in clearing liens or other problems with title to the land. The 90 days begin when INDOT's legal department approves all documents. INDIANA DEPARTMENT OF TRANSPORTATION David B. Patterson Date Acquisition Specialist { t ,- `_ `" j} REAL ESTATE CLAIM - VOUCHER INDIANA DEPARTMENT OF TRANSPORTATION fans State Form 9929 (R2 / 4 .12) Instructions: This agency is requesting disclosure of your Social Voucher # RECEIVED DATE Security number in accordance with I.C. 4-14 VENDOR INFORMATION AGENCY INFORMATION J VENDOR NAME(S) AGENCY NAME SOCIAL SECURITY NUMBER City Of Jeffersonville 1 INDOT AGENCY NUMBER FEDERAL I.D. NUMBER x 800 4 i ADDRESS (NUMBER, STREET) PROJECT NUMBER CODE PARCEL 500 Quartermaster Court 0651179 4839 8 4 CITY STATE ZIP PS VENDOR ID VENDOR LOCATION DES NUMBER Jeffersonville IN 47130 0300798 AREA BELOW TO BE COMPLETED BY AGENCY FUND DEPARTMENT LOCALITY INVOICE DATE AMOUNT 1099 CODE I 4 i 4 GROSS AMOUNT $2,671.00 INDOT ACCOUNTING LINE DISTRIBUTION LN INVOICE NUMBER ACCOUNT PROGRAM PROFILE ACTIVITY PERCENTAGE AMOUNT i 01 20130850 t 02 03 04 = CLAIMANTS r LEINHOLDERS P ursuant to the provisions and penalties of Indiana Code 6-11 -10-1 I hereby 1 hereby sign this claim voucher as leinholder and only certify to the extent certify that the foregoing aca is just and correct, that the amount of my Internet therein and authorize paymnets to be made as Indicated claimed is legally due alipwing all Just credits, and that no part of the above. same has been paid.1 also a raze payment to be mad as indicated above. D ATE ` \ 'r,.'!,'``, t/ LEINHOLDER NAME ,t / i1 - \ f ��`° --� ' LEINHOLDER NAME DATE 'k' V,- f ,r1..._, 7 r( 4'4! i r"; `.((.r4 instrument Approved as to Form, preliminary only Excepting i I Real Estate Description. , DATE DATE DEPUTY ATTORNEY GENERAL DATE s 1 certify that this claim is correct and valid and is a proper f charge against the State Agency and Account indicated. PAYMENT TYPE - MESSAGE INDOT DIVISION OF ACCOUNTING AND CONTROL DATE Recommended Ap \ poval: Approved, Indiana Department of Transportation :`)f, \ � j d 1 DATE '7 , I.,,._.. DIRECTOR: DATE ORIGINATOR �, a �, - ...J - < j 1 r 1 i INDIANA SALES DISCLOSURE FORM SDF ID: Page 3 I PART 2 - COUNTY ASSESSOR The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending to the auditor: 1. Property 2. AV Land 3. AV Improvement 4. Value ofPersonal 5 AV Total 6. Property 7. Neighborhood 8. Tax District 9. Acreage Property Class Code Code A.) B.) 1 0. I dentify physical changes to property between March 1 and YES NO CONDITION Assessor Stamp date of sale. � ❑ ❑ 11. Is form completed. ❑ ❑ 12. State sales fee required? l 13. Date of sale (MM /DD/YYrh: 14. Date form received MM /DD 4 i Items 15 through 18 are to be completed by the assessor when validating this sale: 15. If applicable, identify any additional special circumstances relating to validation of sale. YES I NO 1 CONDITION W ❑ ❑ 16. Sale valid for trending? ❑ ❑ 17. Validation of sale complete? 18. Validated by: t i 1 PART 3 - `COUNTY.AUDITOR Auditor Stamp 1. Disclosure fee amount collected: $ YES NO CONDITION 2.Other Local Fee: $ ❑ ❑ 6. Is form completed? 3. Total Fee Collected: $ ❑ ❑ 7. Is state fee collected? 4. Auditor receipt book number. ❑ ❑ 8. Attachments complete? 5. Date of transfer MM DD { i 1 l 1 p PART 4- RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION Y 1 SDF ID SDF Date (MM /DD /YYYY) Buyer 1- Name as appears on conveyance document 1 Parcel Number Address of Property (Number and Street) I Check all that apply: City, State, and ZIP Code of Property ❑ Homestead ❑ Solar Energy ❑ Wind Power I ❑ Hydroelectric ❑ Geothermal ❑ Rental Property Auditor Signature Date (MM /DD/YYYY) l' a i ❑ Electronic Statement (e -mail) _ A person who knowingly and intentionally falsifies value of transferred real property, or omits or falsifies any information required to be provided in the sales disclosure form commits a Class C felony. i 7 , COPY i ., 1 1 I INDIANA SALES DISCLOSURE FORM SDF ID: _ Page 2 1 D. PREPARER David B. Patterson Contract Fee Buyer Preparer of the Sales Disclosure Form Title 100 N Senate Avenue Rm 642 INDOT Address (Number and Street) Company Indianapolis, IN 46204 317- 233 -9090 rhazzardaindot.in.gov City, State, and ZIP Code Telephone Number E -mail I E. SELLERS) /GRANTOR(S) Board of Parks & Rerreatinn of the City of Jeffersonville, IN Seller 1- Name as appears on conveyance document Seller 2 - Name as appears on conveyance document 500 Ouartermaster Court, Suite205 Address (Number and Street) Address (Number and Street) I Jeffersonville, IN 47130 City, State, and ZIP Code City, State, and ZIP Code 812- 280 -4704 n Telephone Number ; i E -mail Telephone Number E -mail Under penalties 9f,erjury, I ereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as/required b law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act ". Signature of Seller, Signature of Seller 1 k"r's ‘ v . i c - - 1 0.----1/4., SI (-- 1 V) 0 ,ce--- 09/2 Tj-S=r, i 4---- Printed Name of Seller Sign Date (MM /DD/YYYY) Printed Name ofSeller Sign Date (MM` F . BUYERS) /GRANTEE(S) APPLICATION FOR PROPERTY TAX DEDUCTIONS- I ALL ITEMS THAT APPLY 1 State of Indiana $ Buyer 1- Name as appears on conveyance document Buyer 2 - Name as appears on conveyance document 100 N Senate Avenue Rm 642 Address (Number and Street) Address (Number and Street) Indianapolis, IN 46204 City, State, and ZIP Code City, State, and ZIP Code 317- 233 -9090 rhazzard as indot.in.gov 4 Telephone Number E -mail Telephone Number E-mail 1 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION 6 0 Q 1. Will this property be the buyer's primary ❑ 51 3. Homestead residence? Provide complete address of primary ❑ © 4. Solar Energy Heating /Cooling System residence, including county: ❑ igi 5. Wind Power Device 100 N Senage Avenue Rm 642 Address (Number and Street) ❑ r 6. Hydroelectric Power Device Indianapolis, IN 46204 Marion ❑ Q 7. Geothermal Energy Heating /Cooling Device City, State ZIP Code County ❑ Q 8. Is this property a residential rental property? ❑ 0 2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide ❑ 51 9. Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail? (Provide contact information i ncluding c ounty: below. Please see instructions for more information. Not available in all counties.) Address (Number and Street) City, State ZIP Code County Primary property owner contact name E -mail 1 . y certify Under penalties of perjury, 1 hereb that this Sales Disclosure, to t best of my knowledge and belief, is true, correct fy and complete as required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". (Note: Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is t being flirt r- , ; ' fi t Vi,-- Sign—caiireofBuyerl Signature of Buyer2 /Spouse Printed Legal Name of Buyer 1 Sign Date (MM /DD/YYYY) Printed Legal Name of Buyer2 /Spouse Sign Date (MM /DD /YYYY) David B. Patterson, Agent 0 c1 /.. 7/1 -.4 ) Last 5 digits of Buyer 1 Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2 /Spouse Driver's State Last 5 Digits of Social Security License /ID /Other Number Number License /ID /Other Number 1 C AI. py 1 1 i SALES DISCLOSURE FORM State Form 46021 (R10/10-09) SDF ID I I I I i r•'1 t, ' . 1,4 Prescribed by Department of Local Government Finance County Year Unique ID 1 ' `„4.,* PursuanttolC 6- 1.1 -5.5 , '�L_ ;`s GET COUNTED IN 2010! LEARN MORE AT WWW.CENSUSJNDIANA.EDU SDF Date: 1 se PRIVACY NOTICE The telephone numbers and Social Security numbers of the parties on this form are confidential according to IC 6- 1.1.5.5 -3(d). PART 1- To be completed by BUYER /GRANTEE and SELLER /GRANTOR j A. PROPERTY TRANSFERRED - MUST BE CONVEYED ON A SINGLE CONVEYANCE DOCUMENT 1 I. Property Number Check box if applicable to 5. Complete Address of Property 6. Complete Tax Billing Address (if differentfrom parcel property address) 1 A • ) 10-19-00-100-3(4.000-010 ❑ Z. Split 400 W. Maple Street 100 N. Senate Avenue p 3. Land Jeffersonville, IN 47130 Rm 642 0 4- Improvement Indianapolis, IN 46204 1 . 7. L egal Description of Parcel A: Lots 9, 10 and 11 Barnett and Ray Subdivision, City of Jeffersonville Township, Clark Co. Jeffersonville, IN 47130 1 B.) ❑ Z. Split ❑ 3. Land ❑ 4. Improvement { 7. Legal Description of Parcel B: B. CONDITIONS - IDENTIFY ALL THAT APPLY C. SALES DATA - DISCLOSE VALUE OF ITEMS LISTED IN TABLE B, ITEMS 1 -15 If condition 1 applies, filer is subject to disclosure and a disclosure filing fee. 1. Conveyance date (MM /OD/YYYY)' YES NO CONDITION r ❑ 1. A transfer of real property interest for valuable 2. Total number of parcels: 1 consideration. 3. Describe any unusual or special circumstances related to this ❑ 0 2. Buyer is an adjacent property owner. sale, including the specification of any less - than - complete Q ❑ 3 . Vacant land. ownership interest and terms of seller financing. 1 ❑ 0 4. Exchange for other real property ( "Trade "). B6) Acquired for highway use ❑ 0 5. Seller paid points. (Provide the value Table Cltem 12.) 0 ❑ 6. Change planned in the primary use of the property? (Describe In special circumstances in Table C Item 3.) ❑ 0 7. Existence of family or business relationship between buyer and seller. (Complete Table C Item 4.) s 1 ❑ © 8. Land contract. Contract term (YY): and contract date (MM /DD/YYYY): 1 ❑ NI 9. Personal property included in transfer. (Provide the value YES NO CONDITION t, Table C Item 5.) ❑ 0 1 0. Physical changes to property between March 1 ❑ Q 4. Family or business relationship existing between and date of sale. (Describe in special circumstances in Table Chem 3.) buyer and seller? Amount of discount: $ ❑ 11. Partial Interest [Describeln special circumstances in Table C Item 3.] Disclose actual value in money, property, a service, an agreement, or other consideration. ❑ !► 12. Easements or right -of -way grants. 1 If conditions 13 -15 apply, tilers are subject to disclosure, but no disclosure filing fee. 5. Estimated value of personal property: $ 0.00 1 1 YES NO CONDITION 6. Sales price: $ t - 7 4 , ro 1 1 1' ❑ 13. Document for compulsory transactions as a YES NO CONDITION result of foreclosure or express threat of ❑ © 7. Is the seller financing sale? If yes, answer 1 foreclosure, divorce, court order, judgment, questions (8 -13). condemnation, or probate. El 14. Documents involving the partition of land ❑ ❑ 8. Is buyer /borrower personally liable for loan? .4 between tenants in common, joint tenants, or ❑ ❑ 9. Is this a mortgage loan? tenants by the entirety. 10. Amount of loan: $ 0 ❑ 15. Transfer to a charity, not - for -profit organization, D 11. Interest rate: /o 1 or government 12. Amount in points: $ 13. Amortization period: 1 1 PARCEL NO. : 8 OWNER : DEPT. OF PARKS AND RECREATION DRAWN BY: CVS 03/05/201 1 PROJECT NO. 0300798 CITY OF JEFFERSONVILLE CHECKED BY: SMW 03/09/2c ROAD NAME : LSIORBP (I -65) DEED DRAWER 3, PAGE 145, DATED 12/31/1970 SHEET :110= 1 n= 00' COUNTY : CLARK 1 GRANT ILLINOIS GRANT ,1 APPROXIMATE TAKING TOWNSHIP : JEFFERSON THIS PLAT WAS PREPARED FROM INFORMATION OBTAINED FROM THE RECORDER'S OFFICE 1 CODE : 4839 AND OTHER SOURCES WHICH WERE NOT NECESSARILY CHECKED BY A FIELD SURVEY. 1 EXH /B /T "B" GRAPHIC SCALE 100 0 50 100 f 1 P1. 110/48.34 'A" 0 ( IN FEET ) = 022400" Lt. f 1 inch . = 100 ft. 1 £ \I \ \\ LOT 12 0 1104- R AY'S No . , r il :A ;D� LOT 11 LOT 10 94- 00 .z 1 .. 10 0 81. �' LOT 9 3 z 7.8' 1....F:,, '� 1 EXCEPTION LOT , 8 , 24.5' , / . � 0 0 100.2 Q LOT 7 VI 10 i P.C. 1071-6030 'A" i 7 co 1 o 7 00 o " i { i AI 6 + MARKET STREET ry 1 0 P0.1: 100/50.00 "A " 0 ! 0 0 111 1111/ 0 SEE LOCATION CONTROL ROUTE SURVEY PLAT FOR POINTS: 1 and 3 � \ \ ` c' �E I TH / j / / , � J ( � - G 1STtie � - c3. N o. ° c SURVEYORS STATEMENT * SO468 � - STATE OF a To the best of my knowledge a and belief, this plat, together with the "Location Control Route Survey Plat" recorded as Instrument #201116107 in the Office of ', < *r O P �\ the Recorder of CLARK County, Indiana, (incorporated and made a part hereof / / ' v S'U� `\��" 1 by reference) comprise a Route Survey executed in accordance with Indiana ' Administrative Code 865 IAC 1 -12, ( "Rule 12 "). 1 ROUTE SURVEY PLAT _ , , 4 I Prepared for — INDOT r..G by Butler, Fairman and Seufert, Inc. (Job #5275.0601) Doug/OS Herendeen Dote 1 . Project = 5275 03 -27 -12 A T 11.• 41 OKy 1 L. S. SO468 U.• 1 52751Prop evelopment` ROWIRW£ NG\ Co /cu /otionDrowings�Londp /ots1Por. 008.dwg i EXHIBIT "A" M Project: 0300798 Sheet: 1 of 1 Parcel: 8 Fee with Full Limitation of Access Code: 4839 Key No.: 10- 19 -00- 100 - 388.000 - 010 Lot Number Eight (8) in Barnett & Ray's Subdivision of Old Prison Lot and Part of } Block No. 13 adjoining and lying immediately west thereof; Excepting therefrom 1 that portion thereof conveyed to the State of Indiana on September 28, 1961 and described as follows: Commencing at the Northwest corner of Lot #8 in Barnett and I Ray's Subdivision of Old Prison Lot and Part of Block #13 in the City of Jeffersonville, Indiana, Jeffersonville Township, Clark County, Indiana, the point of beginning of Parcel No. 334 L.A.; thence South 85° 34' East, 81.4 feet ti along the north property line of the grantors lands to a point; thence in an Southeasterly direction 17.8 feet along an arc deflecting right and having a radius of 13,891 feet and subtended by a long chord having a bearing of South 21° 45' East and a length of 17.8 feet to a point; thence South 21° 42' East, 24.° 1 feet to the south property line of grantor's lands; thence North 85° 34' West, 100.2 feet along said property to the west property line of grantor's lands; thence North 4° 26' East 38.3 feet along said property line to the point of beginning and containing Three Thousand Four Hundred Eight (3,480) square feet, more or less. 4 The above - described parcel being that parcel of land conveyed December 31, 197C 4 by virtue of Quit Claim Deed Recorded January 07, 1971 1 . in Deed Drawer 3, Instrument Number 145 in the office of the Recorder of Clark County, Indiana. 4 z 1 This description was prepared for the Indiana *VH lit A. ::nc T - - •ortation b But er, Fairman & ., �- ,. ! . 1 ■ 41. ( 5 0468 i *1 Indiana Registered La d Surveyor, License Number SO468 1 <4% . . STATE OF ; s. on this 1,7 day of f / 2012. t 1 ANP I.,rr ; •*„; suRNIN-,0 4 { i i 3 1 F w i I i 1 1 u: 152751projdevelopmentlrowlrwengVega lslpar08.doc 1 I i I I 1 I Project: I -65 LSIORBP Code: 4839 Parcel: 8 Page: 3 of 3 This instrument prepared by and I 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. , Deputy Attorney General Attorney No Office of the Indiana Attorney General 302 W. Washington Street, 5 Floor Indianapolis, IN 46204 -2770 Grantee Tax Mailing Address: INDOT $ 100 N. Senate Avenue, Room N642 Indianapolis, IN 46204 , - 1 .4', _ i ,, '- 5 1 s R Project: I -65 LSIORBP Code: 4839 { Parcel: 8 Page: 2 of 3 The undersigned represents and warrants that he is the Mayor of the Grantor, that pursuant to resolution of the City Council he has full authority to manage the affairs of said City and sign and execute documents on its behalf and that said authority has not been revoked, and that he is therefore, fully authorized and empowered to convey to the State of Indiana real estate of the City, and that on the date of execution of said conveyance instrument(s) he had full authority to so act. IN WITNESS WHEREOF, the said Grantor(s) has executed this instrument this day of y The Boar . of',P and R creation of the City of Jeffersonville, IN J ; t , -------------- _ - -- --- ,(Sr Y (Seal) Signatur Signature o STATE OF t SS: COUNTY OF ( r -, { ; Before me, a Notary Public in and for said State and County, personally appeared For: The Board of Parks and Recreation of the City of Jeffersonville, IN the Grantor(s) in the above conveyance, and acknowledged the execution of the same on the date aforesaid to be their voluntary act and deed and who, being duly sworn, stated that any representations contained therein are true. Witness my hand and Notarial Seal this - day of . < r ._. Signature \\‘‘, ` Y._ , Printed Name • , av R - a arson dent O. My Co o� My Commission expires pl Aiwy g x/20, County. I am a resident of i 4 ' -S Form WL -2 (mod.) WARRANTY DEED 8/98 WITH LIMITATION OF ACCESS Project: I -65 LSIORBP Code: 4839 Parcel: 9 Page: 1 of 3 THIS INDENTURE WITNESSETH, That Department of Parks and Recreation of the City of Jeffersonville, Indiana of Clark County, State of Indiana, the Grantor(s), Convey(s) and Warrant(s) to the STATE OF INDIANA, the Grantee, for and in consideration of the sum of Three Thousand One Hundred Seventy one and no /100 Dollars ($3,171.00) (of which said sum $3,171.00 represents land and improvements acquired and $ -0- represents damages) and other valuable consideration, the receipt of which is hereby acknowledged, certain Real Estate situated in the County of Clark, State of Indiana, and which is more particularly described in the legal description(s) attached hereto as Exhibit "A" and depicted upon the Right of Way Parcel Plat attached hereto as Exhibit "B ", both of which exhibits are incorporated herein by reference. TOGETHER with the permanent extinguishment of all rights and easements of ingress and egress to, from and across the highway facility known as I -65 and as Project LSIORBP -4839 to and from the Grantor(s) remaining lands along the line or lines specifically described in the said exhibits. This restriction is a covenant running with the land and shall be binding on the Grantor(s) and on all successors in title to the said abutting lands. This conveyance is subject to any and all easements, conditions and restrictions of record. The Grantor(s) hereby specifically acknowledge(s) and agree(s) that the Real Estate conveyed herein is conveyed in fee simple and that no reversionary rights whatsoever shall remain with the Grantor(s), or any successors in title to the abutting lands of the Grantor(s), notwithstanding any subsequent abandonment, vacation, disuse, nonuse, change of use, conveyance, lease and/or transfer by the Grantee or its successors in title, of a portion or all of the said Real Estate or any right of way, roadway or roadway appurtenances established thereupon. This acknowledgement and agreement is a covenant running with the land and shall be binding upon the Grantor(s) and all successors and assigns. "As an inducement for the State to close this real estate transaction, the grantor(s) assume(s) and agrees(s) to pay the 2011 payable 2012 real estate taxes and assessments on the above described real estate. This obligation to pay shall survive the said closing and shall be enforceable by the State in the event of any non - payment." Interests in land acquired by the Indiana Department of Transportation This Instrument Prepared By Grantee mailing address: Attorney at Law 100 North Senat • enue Indianapolis, 462 t 4 I.C. 8- 23 -7 -31 *), \ , { } k . Page 4 Project: 1-65 LSIORBP Parcel: 8 If you decide to accept the offer of $900.00* made by the Indiana Department of Transportation, sign your name below and mail this form to the address indicated above. An additional 1 copy of this offer has been provided for your file. ACCEPTANCE OF OFFER I UWE: Department of Parks and Recreation of the City of Jeffersonville, IN t landowners) of the above described property or interest in property, hereby accept the offer of $900.00* made by the Indiana Department of Transportation on this 0 - day of t '---- - :. " R , d;;:.! % 20 ` 2 6 c: , , - r. ....dr, r . .. . ; r',.4.- i y; t Department of Parks , and Recreation of Ole City ofJeffeiron I IN J + i 4 r,,., •, ..,. fat s: ,` ,.f # 5' NOTARY'S CERTIFICATE STATE OF , ....J�" ' . .. �. ) i , k ) SS: COUNTY OF C 1 , .. , ) Subscribed and sworn to before me this ) < day of C ,20 i -1_ . i s My commission expires: Y P My county of residence is '''� sav • - a arson .c am ( , , - v �, _ Resident Of Flo Co M commission un xplres (Signature) F 2./201 I 1 C WI, iii t fT47s o REAL ESTATE CLAIM VOUCHER i` INDIANA DEPARTMENT OF TRANSPORTATION Iz•�•c• tom ` State Form 9929 (R2 / 4 -12) Instructions: This agency is requesting disclosure of your Social Voucher* RECEIVED DATE Security number in accordance with I.C. 4-1-8 VENDOR INFORMATION AGENCY INFORMATION VENDOR NAME(S) AGENCY NAME SOCIAL SECURITY NUMBER City Of Jeffersonville INDOT AGENCY NUMBER FEDERAL I.D. NUMBER 800 ADDRESS (NUMBER, STREET) PROJECT NUMBER CODE PARCEL ..5 61 voNcec'E•C� Prs-:sz- C-okx 0651179 4839 39 CITY STATE DP PS VENDOR ID VENDOR LOCATION DES NUMBER Jeffersonville IN 47130 0300798 AREA BELOW TO BE COMPLETED BY AGENCY FUND DEPARTMENT LOCAUTY INVOICE DATE AMOUNT 1099 CODE ti GROSS AMOUNT $500.00 INDOT ACCOUNTING UNE DISTRIBUTION LN INVOICE NUMBER ACCOUNT PROGRAM PROFILE ACTIVITY PERCENTAGE AMOUNT 01 20131338 02 03 "` 04 CLAIMANTS LEINHOLDERS Pursuant to the provisions and penalties of Indiana Code 5- 11 -10-1I hereby 1 hereby sign this claim voucher as lelnholder and only certify to the extent certify that the foregoing account Is Just and correct, that the amount of my interest therein and authorize paymnets to be made as Indicated claimed is legally due after allowing all Just credits, and that no part of the above. same has been paid. l also authorize payment to b- ade as indicated above. LEINHOLDER NAME DATE C t y O -. ZO ta LEINHOLDER NAME DATE / — �Z r instrument Approved as to Form, preliminary only. Excepting V \\.,/ DATE � 1 k� "o \ v CE —4. 'iv y a tL.. Real Estate Description. DATE DEPUTY ATTORNEY GENERAL DATE 1 certify that this claim is correct and valid and is a proper charge against the State Agency and Account indicated. PAYMENT TYPE - MESSAGE INDOT DIVISION OF ACCOUNTING AND CONTROL DATE Recommended Approval: Approved, Indiana Department of Transportation ORIGIN ATORJJ . pti3 DATE / J % 1 2 DIRECTOR: A LA Code 4839/1-65/ Clark Co. 03/08 STATEMENT OF THE BASIS FOR JUST COMPENSATION Code 4839 1. This is a written statement of, and summary of the basis for, the establishment of the amount believed to be, through a valuation process, just compensation for the purchase of this right -of -way for highway purposes. The amount set forth in Item 5 below is not less than the approved estimate of value. In accordance with Public Law 91 -646 as amended, the "Uniform Act ", and as codified in Indiana at IC 8- 23 -17 -1 through 8- 23- 17 -35, this value disregards any decrease or increase in fair market value of the property prior to the date of valuation caused by the public improvement for which the property is acquired other than physical deterioration within reasonable control of the owner. 2. The legal description of this acquisition is set forth in the instrument of conveyance in the following identified parcel and this acquisition is identified in the Acquiring Agency's records as: Part of Lots 7, 9, 10 & 11 in Block 13/ City of Jerffersonville Des. # 0300798 Parcel 9 Road 1 -65 County Clark Owner(s) Department of Parks and Recreation City of Jeffersonville 3. The area and type of interest being acquired: 10,490 square feet in fee/ full limitation of access [Total Take] The amount in Item 5 below includes payment for the purchase of all interests in the real property and no separately held interest is being acquired separately in whole or part, except as may be explained in Item 8 below. 4. This acquisition is (Check one): a. ® A total acquisition of the real property. b. ❑ A partial acquisition of the real property. 5. The Agency's Offer: Just compensation has been determined to be and the Acquiring Agency's offer for the purchase of this real property is as follows: a. Total Land, Land Improvements and Buildings $3,700.00 } b. Severance Damages NONE $0.00 c. Other Damages (Itemize) Cost -To -Cure estimates: NONE $0.00 Temporary R/W NONE $0.00 9/5d `' Total Damages $0.00 Total amount believed to be Just Compensation offered for this Acquisition is: $ 0 6. The amount in Item 5 above may include payment for the purchase of certain buildings and improvements and their ownership shall pass to the Acquiring Agency. These buildings and improvements are identified as follows: NONE 7. The amount in Item 5 above may include payment for the purchase of certain Land Improvements, Fixtures, Equipment, Machinery, Signs, Etc., and their ownership shall pass to the Acquiring Agency. These items are identified as follows: NONE 8. Items owned by others (i.e.: lessee, tenants, etc.) included in Item 5 above are identified as follows: NONE 9.Remarks: { Indiana Department of ran.po tion =1'•p al: Reviewer: Ae Signature: e - /�, - Signature: „ SP2:4 Name Printed: R� Name Printed: Will L. Stump, MAI /% Title: 7/4107 P o624A. /dREeree Company: Will L. Stump & Associates Date: g�'l"�- Date: July 17, 2012 E 4' 8 ; k N- I Page 4 ' k Project: I -65 LSIORBP Parcel: 9 i ` If you decide to accept the offer of $3,700.00* made by the Indiana Department of Transportation, sign your name below and mail this form to the address indicated above. An additional copy of this offer has been provided for your file. ACCEPTANCE OF OFFER 1 i UWE: The Board of Parks and Recreation of the City of Jeffersonville, IN f 1 landowners) of the above described property or interest in property, hereby accept the offer of $3,700.00* made by the Indiana Department of Transportation on this - day of 7 _ , . . z - - , 20 , t M1 i i The Board of Pa4s 1 and Recrea on of the 1 , City of Jeff oiville, IN r' � _... 1 n NOTARY'S CERTIFICATE i ■• STATE OF ) 0 \ -' SS: COUNTY OF , ) . c'. 3 0 7,2 " \ Subscribed and sworn to before me this day of ,20 I My commission expires: ^ 1 My county of residence is: l f'� i. t C .ay'.:. -a arson iResident Of Flo county (Signature nAy Camissio1 pirN ) t i e ' -; 1T -,, ,.. , i Project: I -65 LSIORBP Code: 4839 Parcel: 9 Page: 3 of 3 This instrument prepared by and I 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. { , Deputy Attorney General Attorney No. Office of the Indiana Attorney General 302 W. Washington Street, 5 Floor Indianapolis, IN 46204 -2770 Grantee Tax Mailing Address: INDOT 100 N. Senate Avenue, Room N642 Indianapolis, IN 46204 i °° EXHIBIT "A" Project: 0300798 Sheet: 1 of 4 Parcel: 9 Fee with Full Limitation of Access Code: 4839 Key No.: 10- 19 -00- 100 - 387.000 -010 Commencing at the Northwest corner of Lot #10 in Barnett and Ray's Subdivision o the Old Prison Lot of Block #13 in the City of Jeffersonville, Indiana Jeffersonville Township, Clark County, Indiana; thence Easterly forty -three an four tenths feet along the North line of said Lot to the point of beginning o Parcel No. 336 Temp. Thence South eighty -five degrees, thirty -five minutes East, fifty -three and si tenths feet along the North property line of Grantor's lands to a point; thenc South four degrees, twenty -three minutes West, thirty -eight and three tenths fee to the South property line of Grantor's lands; thence North eight -five degrees thirty -four minutes West, thirty -four and six tenths feet along said propert line to a point; thence in a Northwesterly direction, forty -two and eight tenth feet along an arc deflecting left and having a radius of thirteen thousand eigh } hundred ninety -one feet. The above - described parcel being that parcel of land conveyed December 21, 196 by virtue of Warranty Deed Recorded January 18, 1964 in Deed Record 259, page 2 in the office of the Recorder of Clark County, Indiana. 4 01111111Ih 0 K TH y NF * 0, This description was prepared for the Indiana U PS •G►sriq• •4Fy - 4 y { f '•Q'� 6O\ •�►a Department of .por . do • Bu ler, Fairman & z o o ! N0. t 2 L / , _�`_ SO468 Seufert, Inc., - �� i ' STATE Of Indiana Registered Land Surveyor, License Number SO468 • 27 day o f //ff 2 0 12. 0 9on thi y j��/G , �„/11IIN1� u: 152751projdevelopmentlrowlrwengVega lslpar09. doc EXHIBIT "A" Project: 0300798 Sheet: 2 of 4 Parcel: 9A Fee with Full Limitation of Access Code: 4839 Key No.: 10- 19 -00- 100 - 387.000 -010 Lot No. 9 in Barnett and Ray's Subdivision of Old Prison Lot, excepting therefro that part previously conveyed to the State of Indiana for highway purposes. The above - described parcel being that parcel of land conveyed December 21, 196 1 by virtue of Warranty Deed Recorded January 18, 1964 in Deed Record 259, page 2 in the office of the Recorder of Clark County, Indiana. 0 EITH f 10. This description was prepared for the Indiana 'r P S G• •.... • •• • R F i �JV ST " 4' 7 4 °1 Department of an•.por atio • Bu ler, Fairman & S � o ; P No. \ % Seufert, Inc., �� . ►'' ' -� VA( Registered Land Surveyor, STATE Of Indiana Re g Sur eyor, License Number SO468 /� \ \.../ M DfANP.r' Q� on this Z� day of j� G2.�t,r�'( , 2012. • 4 ° , ......•• y Q ` , , ti- u: 152751projdevelopmentlrowlrwengllegalslpar09. doc EXHIBIT "A" Project: 0300798 Sheet: 3 of 4 Parcel: 9B Fee with Full Limitation of Access Code: 4839 Key No.: 10 19 - 00- 100 - 389.000 -010 Being lot number seven of Barnett and Rays Subdivision of old prison lot, an part of block thirteen in the City of Jeffersonville. The above - described parcel being that parcel of land conveyed January 24, 1964 b virtue of Warranty Deed Recorded January 24, 1964 in Deed Record 259, page 69 i the office of the Recorder of Clark County, Indiana. .00 This description was prepared for the Indiana ` Q,S c; i •. sTF 6 Department of Tr. •� ►rt. / ion by Butler, Fairman & ; a o; 'P" Fo:14 -∎t No. Seufert, Inc., ,��_ • / �i * _ _ SO4 68 )* Indiana Registered Land Surveyor License Numbe SO468 STATE OF on this 27� day of /' /Gx , 2012. V � NN��i � %,,li$m 1 yy { rr { u: 152 751projdevelopmenflrowlrwengvegalslpar09. doc 'q EXHIBIT "A" Project: 0300798 Sheet: 4 of 4 Parcel: 9C Fee with Full Limitation of Access Code: 4839 Key No.: 10 19 -00- 100 - 387.000 -010 Lot No. Eleven (11) of Barnett and Ray's Subdivision of Old Prison Lot and par of Block Thirteen (13) in the City of Jeffersonville, State of Indiana, as pe Plat recorded in Order Book No. 30, page 33, in the office of the Clerk of th' x Clark Circuit Court. Excepting therefrom that portion herebefore conveyed to thi State Highway Department, State of Indiana. The above - described parcel being that parcel of land conveyed January 27, 1964 b Fi virtue of Warranty Deed Recorded January 28, 1964 in Deed Record 259, page 99 is the office of the Recorder of Clark County, Indiana. x . 0 0, $Sttst P KEITH lit • 1 This description was prepared for the Indiana G,, ,i.,'- Gyg , �i Department of a sportation Butler, Fairman & J , 1 Seufert, Inc., _ .- �[• 1 SO468 4 I Indiana Registered Land Surveyor, License Number SO468 * STATE Of f 1 on this 27i1 day of 2�c�'t-tyC , 2012. ' • • 4 ' 4 � 0 % i 1 f 0 1 i t 1 i f r 1 kG ` i t. u: 152751projdevelopmentlrowl rwengvegalslpar09. doc Ili 1 PARCEL NO. : 9 OWNER : THE BOARD OF PARKS AND RECREATION DRAWN BY: CVS 03/05/20 PROJECT NO • 0300798 CIVIL CITY OF ✓EFFERSONV /LLE, /ND /ANA CHECKED BY SMW 03/09/< ROAD NAME : LS /ORBP (I -65) DEED REC. 259, PAGE 22, DATED 12/21/1963 SCALE: 1"= 100" COUNTY : CLARK DEED REC. 259, PAGE 27, DATED 12/21/1963 SHEET 1 OF 1 GRANT : ILL/NO/5 GRANT /1 DEED REC. 259, PAGE 69, DATED 01/24/1964 TOWNSHIP : JEFFERSONV /LLE DEED REC. 259, PAGE 99, DATED 01/27/1964 CODE : 4839 DEED REC. 242, PAGE 185 DATED 11/28/1961 (SELL-OFF) HATCHED AREA IS E APPROXIMATE TAKING THIS PLAT WAS PREPARED FROM INFORMATION OBTAINED FROM THE RECORDER'S OFFICE AND OTHER SOURCES WHICH WERE NOT NECESSARILY CHECKED BY A FIELD SURVEY. PL 1107¢5.34 A" 3 E /B/ 'B" GRAPHIC A = 0224'00 Lt. O SCALE , Da 0 50 1 H v\ 1 1 I 1 M . w II 1 . I L 1 . II isi 6 I M. . I \ \ LOT 12 ( IN FEET ) 5 1 inch = 100 ft. 0 o \\ 1 Y'S BO O 13 -I' 0 aR NEtr . N rr SU 1 1 EXCEPTION LOT 11 Illik_ 6' ,, — %LOT 107/ ,34.6 .,, 9+ 00 EXCEPTION I J 1 0 % 0T 9 v o o LOT 8 0 O 0 (SELL -OFF) •I O 8,I-- .1 LOT 1 P.C. 107760,30 'A" 1 o 7 00 z , Ali 1 6 MARKE STREET POT 100750.00 "A' � V I SEE LOCATION CONTROL ROUTE SURVEY PLAT FOR POINTS: 1 and 3 \\\ �\\ \ 111 I I I I I I I / / / / /// .1 - " S T � �i . E L ▪ k SURVEYORS STATEMENT ▪ . S O468 * • To the best of my knowledge and belief, this plat, together with the "Location STATE OF (' Control Route Survey Plat" recorded as Instrument #201116107 in the Office of �e,9 /NpiANP (:) `•-' Q;`� the Recorder of CLARK County, Indiana, (incorporated and made a part hereof � /i'v \\\ reference) comprise a Route Survey executed in accordance with Indiana / /��� S U II RV \ \\\�� Administrative Code 865 IAC 1 -12, ("Rule 12"). i i • ROUTE SURVEY PLAT t Prepared for — INDOT '✓ 0 / Y s7/.0/2 by Butler, Fairman and Seufert, Inc. (Job #5275.0601) Project = 5275 03-27-12 AT f3. 46 DKH 1 Doug /o - K. Herendeen Dofe U.• 1 5275 Pro ae velopment \ROWIRW£NG I Co /cu/otionDrowings 1L ondp %ots `Por. 009. dwg Z.,5: SO468 1 I i 4f . yo147P-..43F,:-.?.41:!:\4; "' SALES DISCLOSURE FORM State Form 46021(R10/10 -09) SDF ID I � �, Prescribed by Department of Local Government Finance County Year Unique ID ti Pursuant to IC 6- 1.1 -5.5 SDF Date: 1 u < '4,* GET COUNTED IN 2010! LEARN MORE AT WWW.CENSUS.INDIANA.EDU PRIVACY NOTICE The telephone numbers and Sodal Security numbers of the parties on this form are confidential according to IC 6- 1.1.5.5 -3(d). PART 1 - To be com A N BUYER GRANTEE and SELLER GRTO 1 A. PROPERTY TRANSFERRED = MUSTBE CONVEYED ON A SINGLE.CONVEYANCE DOCUMENT ' .; I 1. Property Number Check box if applicable to 5. Complete Address of Property 6. Complete Tax Billing Address (if different from parcel property address) A.) 10 19 - 00- 100- 387.000 -010 ❑ 2. Split 400 W. Maple Street 100 N. Senate Avenue fa 3. Land Jeffersonville, IN 47130 Rm 642 i 0 4. Improvement Indianapolis, IN 46204 7. Legal Description of Parcel A: 2 Lots 9, 10 and 11 Barnett and Ray's Subdivision, City of Jeffersonville Township, Clark Co. Jeffersonville, IN 47130 I B.) ❑ 2. Split ❑ 3. Land ❑ 4. Improvement 7. Legal Description of Parcel B: B : - b DIT � � ;: , C,,,. N . II ENT1EY ALL TOAT;'APPLY - ` C. SALES ;D.ATA: t DISC VALUE SC ' VA E OF I TEMS L IS` ED IN TABLE E , ., ITEMS =5< If condition 1 applies, filer is subject to disclosure and a disclosure filing fee. YES NO CONDITION 1. Conveyance date (MM /DD/YYYY): ❑ 1. A transfer of real property interest for valuable 2. Total number of parcels: 1 consideration. 3. Describe any unusual or special circumstances related to this p © 2. Buyer is an adjacent property owner. sale, including the specification of any less - than - complete 0 ❑ 3. Vacant land. ownership interest and terms of seller financing. ❑ ig 4. Exchange for other real property ( "Trade "). B6) Acgiiired fqr highway use ❑ 151 5. Seller paid points. (Provide the value Table C Item l2) 4 ❑ 6. Change planned in the primary use of the property? (Describe In special circumstances in Table C Item 3.) ❑ 0 7. Existence of family or business relationship between buyer and seller. (Complete Table C Item 4.) ❑ III 8. Land contract. Contract term (rh: and contract date (MM /DD/YYY'): ❑ [✓,J 9. Personal property included in transfer. (Provide the value YES NO CONDITION Table C Item 5.) ❑ 0 10. Physical changes to property between March 1 ❑ Q 4. Family or business relationship existing between and date of sale. (Describe in special circumstances in Table C Item 3.) buyer and seller? ❑ Amount of discount: $ NI 11. Partial Interest (Describe in special circumstances in Table C Item 3.) Disclose actual value in money, property, a service, an agreement, or other consideration. ❑ 0 12. Easements or right -of -way grants. If conditions 13 -15 apply, filers are subject to disclosure, but no disclosure filing fee. 5. Estimated value of personal property: $ 0.00 YES NO CONDITION 6. Sales price: ' . 0 ❑ 13. Document for compulsory transactions as a YES NO CONDITION result of foreclosure or express threat of ❑ © 7. Is the seller financing sale? If yes, answer foreclosure, divorce, court order, judgment questions (8 -13). condemnation, or probate. ❑ 14. Documents involving the partition of land ❑ ❑ 8. Is buyer /borrower personally liable for loan? n between tenants in common, joint tenants, or ❑ ❑ 9. Is this a mortgage loan? tenants by the entirety. 10. Amount of loan: $ is ❑ 15. Transfer to a charity, not - for -profit organization, 11. Interest rate: % x or government 12. Amount in points: $ - i 13. Amortization period: I 1 1 c Qv g INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 .11 PREPARER David B. Patterson Contract Fee Buyer t Preparer of the Sales Disclosure Form Title 1 100 N Senate Avenue Rm 642 1NDOT Address (Number and Street) Company 1 Indianapolis, IN 46204 317 - 233 -9090 rhazzard(7a.indot.in.gov 1, City, State, and ZIP Code Telephone Number E -mail E. SELLER(S) /GRANTOR(S) ` . Board of Parks_& Recreation of the City of Jeffersonville, IN ' Seller 1- Name as appears on conveyance document Seller 2 - Name as appears on conveyance document 500 Quartermaster Court, Suite205 Address (Number and Street) Address (Number and Street) Jeffersonville, IN 47130 I City, State, and ZIP Code City, State, and ZIP Code 812- 280 -4704 A T elephone Number E -mail Telephone Number E -mail Under pena# , 'es o perjury, hereby certify that this Sales Disclosure, to the best of i hereb tif th my knowledge and belief, is true, correct and complete as requir d b law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". Signature ofSeller 1 Signature of Seller n') ) 4-- --- x- (• Yr\fxy (1 - CI 9/ 1 Printed Name of Seller Sign Date (MM /DD � ,;� Name ofSellr e ::,.. � .:: (MM�DD/YYYY) t, $Uyti o) /o0No . APFL CATI.ON:.I ;: Sign Date :s. Cpl Q_w RO'ER'Y TAB, bED[J C ,xjONS�- ,IDNTII*YAL(,= ;jTEI THA'TAPFL'Y „ ::. ' State of Indiana Buyer 1- Name as appears on conveyance document Buyer 2 - Name as appears on conveyance document i 100 N Senate Avenue Rm 642 Address (Number and Street) Address (Number and Street) Indianapolis, IN 46204 City, State, and ZIP Code City, State, and ZIP Code i 317 233 - 9090 rhazzardaindot.in.gov Telephone Number E -mail Telephone Number E -mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. 1 YES NO CONDITION YES NO CONDITION ❑ 51 1. Will this property be the buyer's primary ❑ Q 3. Homestead residence? Provide complete address of primary 4. Sol ar Energy Heating/Cooling System residence, including county: ❑ �' g/ g y k 1 100 N Senage Avenue Rm 642 ❑ 19 5. Wind Power Device ! I Address (Number and Street) Indianapolis. IN 46204 Marion ❑ Q 6. Hydroelectric Power Device ' City, State ZIP Code county ❑ 0 7. Geothermal Energy Heating /Cooling Device ❑ A 2. Does the buyer have a homestead in Indiana to be ❑ 0 8. is this property a residential rental property? vacated for this residence? If yes, provide ❑ 19 9. Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail? (Provide contact information including county: below Please see instructions for more information. Not available in all counties.) Address (Number and Street) City, State ZIP Code County Primary property owner contact name E -mail Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". (Note: Spouse information, So ' I Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is being-Rl % _. 7: e : 14 ) an ' I ECU - a-41 ,7V Signature of B Signature of Buyer2 /Spouse 1 0 9/..9--S1.-111— .. . Printed Legal Name of Buyer 1 Sign Date (MM /DD/YYYY) Printed Legal Name o Buyer 2/Spouse . f Y Sign Date (MM/DD/YYYY) David B. Patterson, Agent Last 5 digits of Buyer 1 Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2 /Spouse Driver's State Last 5 Digits of Social Security License /ID /Other Number Number License /1D /Other Number C -41; . if t k. srs f#, _` REAL ESTATE CLAIM- VOUCHER l #� . , , INDIANA DEPARTMENT OF TRANSPORTATION ism State Form 9929 (R2 / 4 - 12) Instructions: This agency is requesting disclosure of your Social Voucher # RECEIVED DATE Security number in accordance with LC. 4-1-8 VENDOR INFORMATION AGENCY INFORMATION VENDOR NAME(S) City Of Jeffersonville AGENCY NAME SOCIAL SECURITY NUMBER INDOT ry AGENCY NUMBER FEDERAL I.D. NUMBER 800 ADDRESS (NUMBER, STREET) 500 Quartermaster Court PROJECT NUMBER CODE PARCEL 0651179 4839 9 CITY STATE ZIP PS VENDOR ID VENDOR LOCATION DES NUMBER Jeffersonville IN 47130 0300798 I AREA BELOW TO BE COMPLETED BY AGENCY FUND DEPARTMENT LOCALITY INVOICE DATE AMOUNT 1099 CODE GROSS AMOUNT $8,650.00 INDOT ACCOUNTING LINE DISTRIBUTION LN INVOICE NUMBER ACCOUNT PROGRAM PROFILE ACTIVITY PERCENTAGE AMOUNT 01 20130817 02 03 04 CLAIMANTS LEINHOLDERS Pursuant to the provisions and aloes of Indiana Code 6-11 -10-11 hereby 1 hereby sign this claim voucher as lelnholder and only certlty to the extent certify that the foregoing accoU t Is just and correct, that the amount of my Interest therein and authorize paymnets to be made as Indicated claimed is legally dire after alloWIng all Just credits, and that no part of the above. same has been paid. I also authorize pay nt to be made as dicated above. ATE i LEINHOLDER NAME LEINHOLDER NAME DATE yl. net L Yr-a as r2 6— , ' im NA-I oVZ... Instrument Approved as to Form, preliminary only. Excepting DATE Real Estate Description. DATE DEPUTY ATTORNEY GENERAL DATE 1 certify that this claim is correct and valid and is a proper PAYMENT TYPE - MESSAGE charge against the State Agency and Account indicated. t INDOT DIVISION OF ACCOUNTING AND CONTROL DATE Recommended Approval: - c --... ------- 7. - Z--fi..N.-A.-A-Q Approved, Indiana Department of Transportation ORIGINATOi A) \: , 0 1 A 7 A-s'\--x ) DATE C // / DIRECTOR: DATE lir 4 COP INDIANA DEPARTMENT OF TRANSPORTATION LAND ACQUISITION DIVISION RECEIPT OF CONVEYANCE INSTRUMENT The undersigned being a Land Agent for the Department of Transportation of the State of Indiana, does hereby acknowledge receipt this date, of one Warranty Deed signed by r 11►L6 pi\ 0 v '&+ , v'P'Y cn(L -- For The Board of Parks and Recreation of the City of Jeffersonville, IN and conveying certain rights, title and/or interest in real estate located in Clark County to the State of Indiana for transportation purposes and which is identified as Parcel 9 on Transportation Project I -65 LSIORBP. I further acknowledge that said instrument(s) has/have been executed and acknowledged by the antors without t payment by me of any consideration and that I am transmitting such instrument(s) to the appropriate transportation authority for review subject to approval. It is understood and agreed that this conveyance instrument will either be returned to the grantor not approved or the State of Indiana through its proper agencies will cause such instrument to be processed for payment in the amount of $ You may expect payment in full within ninety (90) days after signing Y P P Ym ty ( ) y fining the documents accepting this offer and executing the deed, g g ,grant, or easement, and provided there are no difficulties in clearing liens or other problems with title to the land. The 90 days begin when INDOT's legal department approves all documents. INDIANA DEPARTMENT OF TRANSPORTATION -�.. / David B. 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