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HomeMy WebLinkAboutDevelopment Application & Supplemental Materials S City of Oak Park Heights 14168 Oak Park Blvd N.•Box 2007•Oak Park Heights,MN 55082•Phone(651)439-4439•Fax(651)439-0574 Development Application Type of Request(s): ❑ Zoning District Amendment 0 Home Occupation ❑ Conditional Use Permit 0 Site Plan/Design Guidelines Review ❑ Variance:Single Family Residential 0 PUD Amendment ❑ Variance: Other Residential/Commercial ❑ PUD Concept Plan Approval /Industrial 0 PUD General Plan Approval ❑ Subdivision:Major ❑ Street Vacation Subdivision:Minor 0 City Financial Assistance ❑ Comprehensive Plan Amendment Base Fee: a CD Escrow Amount: 500 CIG 36-4, Street Location(Address)of Property: )e/e 5 67 2 Sr rtekVirti Legal Description of Property: /Tirr.��c/,6'/0//0r yl-17i l5 149C* Ej' J eytegS 1)-1,0 )Z) OW Piii24 tke7d017. Property Identification Number(PIN,PID): OWNER INFORMATION Name: `1 Urn,q-g 3,1q is La 6, 771st ei-S Address: Street: f-7.0I 3O 1/L20A) City: TlLL.4AJ4 7 /32_ Stater/) Zip: '----S-�t Email: ►7/11 �/ Mi°�S72DMT11P/1 ' .L�/ Telephone: Home:65J-4J0)3c?Business: 7e9tsOther:('SJ' 51-7(1'3--/0_ APPLICANT INFORMATION c - Name: f theI els J. I e7s Address: Street: , `v/ J® A1,So ) City:C �'—t?L l)19'7G'�t State:MAI Zip: [feL, J Email: 4"xti' CLS LjIJ Telephone: Home: Business: Fax: Other: Owner/Applicant Initials C # Je)g �� (Sy u5 51`1-I'N S4-) • • City of Oak Park Heights 14168 Oak Park Blvd N. • Box 2007 • Oak Park Heights, MN 55082 • Phone (651) 439-4439 • Fax (651) 439-0574 Development Application Page 2 of Description Request(s): 0iJ0614 / e 4 M 6/E t4 '/A P mr-t- 3 to p et A. tlieo,s, If a request for planning/zoning action on the subject site or any part thereof has been previously approved, please describe below: GENERAL CONDITIONS Application Review: The undersigned acknowledges that before this request can be considered and/or approved, all required information and fees, including any deposits shall be paid to the City. An incomplete application will be returned to the applicant. The application approval process commences and an application is considered complete when all required information and fees have been submitted appropriately to the City. Professional Fee Responsibility: It is the understanding of the undersigned that all City incurred professional fees and expenses associated with the processing of this request(s) will be promptly paid upon receipt. If payment is not received from the applicant, the property owner acknowledges and agrees to be responsible for the unpaid fee balance either by direct payment or a special assessment against the property. Applicants will be billed on a monthly basis for Planning, Engineering, Legal and Community Development fees as they are accrued. It is understood that interest will be charged on the account at the maximum rate allowed by the Fair Credit Act if it becomes thirty (30) days past due. Failure to pay administrative and processing fees in a timely manner may result in denial of the application. All fees must be paid at the time of the application and shall be paid prior to the issuance of a building permit. The undersigned applicant further acknowledges and consents that all unpaid fees owing the City of Oak Park Heights shall be treated as unpaid utility fees and may be certified for collection as with delinquent utility billings and may be assesses against the subject real property if unpaid by October 31' of each year. Property Address: 4/P - ILII. /4 6'®1 ZS A % 6 Owner Signature: v.�..•e� Date: � 1 �Jji ' folow g ), Applicant Signature: . _ ��� �-" " ; Date: 3J(e '6/0 � Lt. CERTIFICATE OF SUR Y'FCR TO I PROPERTY ADDRESS DESCRIPTION.• 15405 57TH STREET NORTH Lot 2, 4, 6, 8, 10, & 12, Block 5, BEACH'S ADDITION TO OAK PARK HEIGHTS, MN OAK PARK HEIGHTS, Washington County, Minnesota. 55082 Subject to easements of record, if any. / � . 14 ir Agiv,-Nmilimmit GV SAN • .)'• % 0 Lr.z ,,r, •` of 1 r-0 I PARCEL • x SO h Z •I �Z oQ la C /S89°5r 87"E o OSAN • 1.48.80 - • W CO E0M y * ''.to I O �nn N Lots SrP C3 • 2 QJZ I x— � W L I: E Ni w o,-. PARCEL B cJ`-,`J rI , R • W — — — -- -- -- — -- -- -- -- -- -- — I : I A m- o dddda Z t. MI t ,` 11 • � N89°48'45"E �� 563'H S3'. N_ 'L MlliIllIllilbM PARCEL A: LEGEND Lots 2 and 4, Block 5 BEACH'S ADDITION TO OAK • Iron monument found PARK HEIGHTS, Washington County, Minnesota. co Iron monument set #21292 . , Subject to easements of record, if any. Power Pole II" ' PARCEL B: -4- Hydrant Gate Valve Lots 6, 8. 10. and 12, Block 5 BEACH'S ADDITION as '; TO'OAK PARK HEIGHTS, Washington County, as Curb Stop 0 50 Minnesota. Subject to easements of record, if ® Catch Basin MINIM any. o Sanitary Manhole SCALE IN FEET SAN NOTES Storm Manhole O —x x— Fence Bearings are on assumed datum. OE— Overhead Electric I I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I,am a duly Licensed Land Surveyor under the laws of the State of Minnesota. ® 1440 Arcade St Suite 250 /� P Saint Paul,MN 55106 C>d-�� - J, 0. 0 Phonfax e:651-6-020112 Allen C. chl'pp o DATE ZT- LIC. NO MN 21292 owagnmeeama, .sto warn E-fnail:info@mpasso.com I DRAWN BY MWP PROJECT NUMBER 4013.001 STATE OF MINNESOTA COUNTY OF WASHINGTON SELLER(S): Estate of Helen Peterson; Lois Peterson; and Dale O. Richert and Marilyn G. Richert PURCHASER(S): Thomas J. Thiets and Lisa G. Thiets PROPERTY: 15405 57th Street North, Oak Park Heights, MN 55082 PROPERTY TAX DISCLOSURE . The undersigned Purchaser is responsible for all future taxes due on the above-referenced property. In the event Purchaser is not required to escrow for taxes, and have elected to pay taxes directly to the County Treasurer, tax payments are due May 15th and October 15th. Please call the Treasurer's Office and ask that a duplicate tax statement be mailed to you. It will be your responsibility to obtain this statement and pay the taxes by the due date. The property identification number required by the County Treasurer is: 03.029.20.24.0029. Dated effective this 30th day of May, 2018. PURCHASER: mirt< Thomas J. Thie / Lisa G. Thiets Subscribed and sworn to before me this 30th day of May, 2018. JOHN SCOTT MCDONALD I -�► NOTARY PUBLIC s�G 0-e./1 - MINNESOTA I My NOTARY Expires Jan.31 2020 otary Public • U:\TITLEINS\CLIENT\Thiets-Richert\property-tax-disclosure.wp d Was'lin ton Department of Property Records TAX STATEMENT 2018 Countyand Taxpayer Services 2017 Values for Taxes Payable in 14949 62.,Street North PO Box 200 VALUES MN 55082-0200 AND CLASSIFICATION (651)430-6175 www.co.washington.mn.us Taxes Payable Year: 2017 2018 Estimated Market Value: 170000 150,000 (Property ID: 03.029.20.24.0029 Bill#:1026913 ) Step Homestead Exclusion: 1 Taxable Market Value: 170,000 150,000 New Improvements) Taxpayer: DALE 0&MARILYN G RICHERT Expired Exclusions: 9353 NORELL AVE N Property Classification: Res Non-tiatd Res Non-Hsrd STILLWATER MN 55082-8586 Sent in March 2017 Step PROPOSED TAX 2 Did not include special assessments or referenda $2,330.00 approved by the voters at the November election Sent in November 2017 Step First half taxes PROPERTY TAX STATue EMENT NT $2,176.00 3 Second half taxes due October 15 $2,176.00 Total Taxes Due in 2018: $4,352.00 $$$ Tax Detail for Your Property: Taxes Payable Year. 2017 2018 REFUNDS? 1.Use this amount on Form A41PR to see if you are eligible fora property tae refund.File $0.00 You may be eligible for one or by August 15.If this box is checked,you owe delinquent taxes and are not eligible. even two refunds to reduce 2.Use these amounts on Form MIPR to see if you are eligible for a special refund. $0.00 your property tax.Read the 3. Property taxes before credits $2,704.00 $2,313.75 back of this statement to _ 99 4. Credits that reduce property taxes find out how to apply. m m A.Agricultural and rural land credits $0.00 $0.00 ten` B.Other Credits $0.00 $0.00 5. Property taxes after credits $2,704.00 $2313.75 Property Address: 6. WASHINGTON COUNTY A.County General $647.35 $562.12 15405 57TH ST N B.County Regional Rag Authority $5.17 $4.20 STILLWATER MN 55082 7. CITY OF OAK PARK HEIGHTS $1,193.03 $1,021.17 8. State General Tax $0.00 $0.00 Description: 9. ISD 834 STILLWATER A.Voter approved levies $282.10 $244.40 Block 5 Lot 2 BEACH'S ADD LOTS TWO(2).FOUR a B.10. Special TaxingDistricts B.Other er Local Levies $482.76 $402.48 (4),six(6),EIGIrr(a),TEN(10),AND TWELVE(12) c p Metropolitan $18.23 $15.30 IN BLOCK FIVE(5).OF BEACHS ADDEON TO OAK F o B.Metropolitan Council Transit $27.77 $23.00 FAme C.Metropolitan Mosquito Control $9.83 $8.25 o' D.County CDA $31.33 $27.54 a Line 13 Special Assessment Detail: 2014 STREET RECONSTRUCTION 2,038/5 11. Non-school voter approved referenda levies $6.43 $5.29 12. Total property tax before special assessments $2,704.00 $2313.75 13. Special assessments $2,108.00 $2,038.25 Principal: 1,550.00 14. TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS $4,812.00 $4,352.00 Interest 488.25 PAYABLE 2018 2nd HALF PAYMENT STUB Detach at Perforation&mail this stub with your 2"half payment in the enclosed green envelope TO AVOID PENALTY PAY ON OR BEFORE:October 15 Res Non-Hstd (Property ID:03.029.20.24.0029 Bill#:1026913 ) " SECOND HALF TAX AMT 11lhiIIii1Q1UIJ19I1IIaI II1 $2,176.00 Taxpayer. DALE 0&MARILYN G RICHERT MAKE CHECKS PAYABLE TO: 9353 NORELL AVE N ❑CHECK Washington County STILLWATER MN 55082-8586 P.O.Box 200 0 CASH Stillwater MN 55082-0200 No Receipt sent.Your canceled check is proof of payment.Do not sendpOotdated checks. 0302920240029 2 00000000217600 8 PAYABLE 20181St HALF PAYMENT STUB Detach at Perforation&mail this stub with your 1°half payment in the enclosed green envelope TO AVOID PENALTY PAY ON OR BEFORE:May 15 ) Res Non-Hstd (Property ID:03.029.20.24.0029 Bill#:1026913 FIRST HALF TAX AMT 111111111111111111111111111311111111 $2,176.00 Taxpayer: DALE 0&MARILYN G RICHERT MAKE CHECKS PAYABLE TO: ❑CHECK 9353 NORELL AVE N Washington County STILLWATER MN 55082-8586 P.O.Box 200 ❑CASH Stillwater MN 55082-0200 No Receipt sent.Your canceled check Is proof of payment.Do not send postdated checks. D302920240029 1 00000000217600 0 STATE OF MINNESOTA COUNTY OF WASHINGTON SELLER(S): Estate of Helen Peterson; Lois Peterson; and Dale O. Richert and Marilyn G. Richert CONSUMER(S): Thomas J. Thiets and Lisa G. Thiets LEGAL DESCRIPTION: Lots Two (2), Four (4), Six (6), Eight (8), Ten (10) and Twelve (12), in Block Five (5), of Beach's Addition to Oak Park Washington County, Minnesota COMPLIANCE AGREEMENT The undersigned consumer,in consideration of St.Croix Title disbursing funds for the closing of property located at: 15405 57th Street North, Oak Park Heights, Minnesota 55082 agrees,if requested by St.Croix Title named above to fully cooperate and adjust for clerical errors,any and all loan or title documentation deemed necessary or desirable in the reasonable discretion of St.Croix Title. The undersigned consumer agrees to comply with all above noted requests by St.Croix Title within fifteen (15)days from the date of mailing of said requests. Consumer agrees to assume all costs including,by way of illustration and not limitation,actual expenses,legal fees and marketing losses for failing to comply with correction requests in the above noted time period. The undersigned consumer does hereby so agree and covenant in order to assume that the loan and title documentation executed on this date will conform and be acceptable in the market place in the instance of transfer, sale or conveyance by St. Croix Title of its interest in and to said loan documentation, and to assure marketable title in the said consumer. Consumer waives any rights as a result of St. Croix Title failing to give notice of closing costs as required by Minnesota Statute 507.45, Subd. 3(a). Dated effective this 30th day of May, 2018. "e/ Thomas J. Thiets (Consumer) Lisa G. Thiets (Consumer) Subscribed and sworn to before me this 30th day of May, 2018. JOHN SCOTT MCDONALD NOTARY PUBLIC TMYwrim fission Expires Jan.31I. bN,otary Public • , ,� �: T\Thiets Richert\COMPLILwpd Tracey A.Galowitz GA LO VV I T Z ° O L S O N P L LC Susan D.Olson r.., ``�y ATTORNEYSS AT LAWJohn Scott McDonald Susannah Torseth OLSON MEDIATION CENTER Viet-HanhWinchell Raymond 0.Marshall ofcounset NOTICE OF AVAILABILITY OF OWNER'S TITLE INSURANCE TO: Thomas J. Thiets DATE: May 30, 2018 Lisa G. Thiets FILE NO. P22405-18-P1976 Buying property identified as: 15405 57th Street North, Oak Park Heights, MN 55082 You may obtain an Owner's Policy of title insurance which provides title insurance coverage to you. Two -to you for an Owner's Policy of title insurance in the amount of$168,000.00 is $ <3/6 , if you request it at this time. If you are uncertain as to whether you should obtain an Owner's Policy of title insurance, you are urged to seek independent advice. ' B //t-L, j� (John S./McDonald / .j7 I/We do request an Owner's Policy of title insurance. I/We do not request an Owner's Policy of title insurance. Dated: s/)/1 7 T.-- ./ /, .e Thomas J. Thiets Lisa G. Thiets P. 651.777.6960 F. 651.777.8937 e—mail: info@galowitzolson.com, 10390 39th St N, Lake Elmo, MN 55042 EXHIBIT A Lots Two(2),Four(4),Six(6),Eight(8),Ten(10)and Twelve(12),in Block Five(5),of Beach's Addition to Oak Park,Washington County,Minnesota. , ,.......„,-4 Invoice Number : 28173 Invoice Date : Sep 28 , 201 Page : 1 MANTYLA WELL DRILLING INC. Phone: 651-436-7600 • Fax: 651-436-5106 1392 St. Croix Trail N. Lakeland, Minnesota 55043-0797 Bill To :RICHERT, DALE • Re : ABANDONMENT 9353 NORELL AVE NO HELEN PETERSON STILLWATER, MN 55082. 15405 57TH ST NO STILLWATER, MN 55082 Customer ID PO JNFORMATI ON 15405_ ' 57TH ST SO _ --�---- � Pa ent Terias ,-...,.,-,::7.,--„,..-.....,,,....,-- -,:-..,... -- ... .SY-"�'y ...1 - ....-.+ - _ ... .y, .-`K�Rn ,M.l �ry�'-.rMF+�..Y.l^fv,•[!..,w�.-.... r. f 1 i .s,. mwa•- ..-�;er'•'4.Pw+—, fid"`-S�i$9avr=_:_,'•-zr i—^—n• ^a"'arz:.s.::r^�:_---Ne'V--- I°-_' - - . ..-...---''''l ..._ may' Work Date Due Date Quantity Item10/8/12 Description € Unit Price l Amount MN WELL SEALING RECORD #H305365 , DATE SEALED i SEPTEMBER 27 , 2012 , 75 ' DEPTH REMOVE PUMP, MEASURE ALL, CHLORINATE AND ABANDON AS 1 PER MN STATE CODE WITH UP TO 10 BAGS GROUT 750 .0 STATE PERMIT u: 65 . 0 THANK YOU ! 1 1 a • tO -."""'" t)) -4 0 / 0-...... . . . . .,-. _,.. - - 1 i at44 ‹ fA)rlk. ' 1 ;s We accept VISA, MASTERCARD , DISCOVER & AMEX! ! !! ! Subtotal 815 . 0 Sales Tax , 1 Past due balances are subject to a finance Total Invoice Amount 815 . 0 charge of 1 . 5% per month , including all Payments Received costs of collection and any attorney fees in the event payment is not made . Check/Credit No : t t.fr `'--J TOTAL a - 815: ,0. J f ' i '..int:[,,�44�.', rklo co �_�, . it ! I ,err ..irr 1 I I z. gy t t nr,'AkrS? i ,..;r ,r.. •t'' • t�ESQT�17EPARTMENT OF HEALTH �(m"T ^*�r� h I g� r s , ".`i;,� 4 (,o r(' �,.,' u BORING ;Minnesota Well and Boring pmii lr rrti, ic,f;', "' �,' SEALING REP:ORD s alingNo. �H ,i, o- r'I ���n`rf�u „,,,w4S t+ii i Minnesota Statutes; Chapter 1031 Minnesoia Unigue Well No a °'' , G1 �,'�it rr TdlVnship Name To nshi No. Or W-series No � ' PRange No.Section No. _ °aoDate W lloo r; S iFraction(sit.-,Ig) Da e Sealed —� _-- __ - -a"`. 2.0.. Date Well or Benhg Constructed _ a v! *it GPS Latitude degrees minutes ,titre LOCATION Latitude _ ,de tees seconds Depth Before Sealing4H, g Y_ minutes _ seconds 7JD Tor7:::apth '' h, Numerical Street Address or Fire Number and City of Well or Bering Location AQUIFER(S)Single i tt. fl 5 ;Single Aquifer []MulhagUifai STATIC WATER LEVEL ` "- 5 7 t 'St• No• S t 1 7 w _ WELUBORING '- Show exact location of well or boring' 1 - �gl,Measureq `� in section gnd with"X,^ �V Water-SIN ly Well 1-:'Montt.Wel li LI Estimated Date Measured I j i j�,, Sketch map of well or boring location,showing property (l Env.Bore Hole N lines,roads and buildings Other I 3 t ..Jt O 'below - da tar a `x' i� ,t _- _ __ ^• CASING TYPE 5 _ _-- ft J above land settee i i r�tt '�N"t, 3I r__,,,,..,.. _,!._,,....... _ __ Steel rj Plastic �- ❑Tile [-J Other__ „i. W I E WELLHEAD COMPLETION -- Outside: -- 'h le 1.\ L1 Well Ho e At Gr --- -- `� Pule AdaPeeriU'rrci 8 , l S n !Pr i- - t MI �.- Web PR %,s�F' • �� »��,. 'tn�f Hf� H� N tg. t 4in ,.�,f �, ; X 14'6'f .;,,,;:,,,,,,:...,1„,„..,,!,,,p,. J \+i3)o tf `, r ,,�,�tlN ''V''''`'..'24..,,,,',,'.,s'• <,�z • ,, wua:�,^f".i,^ x,�r� i•, h'4-:.•,,,,,.:::;',',• d;$w_ w sil 6r•,5?n ';,i;'/!.. {I§...�^' u-r t . Nl i en ''pet Property owners walling address it different than well location addr Diameter ess indicated.above tl Depth tL_____.5. _ m.front__.][..__ �'1 Setn ex,,h�w� .e,,i4 4,ri.,t 1 -� it ^` h ��kFn a x� '4 Sy r xr h � +a'✓k& l;�h����p�s to r! S aM � � .+G��. L'�•� fig- �t�i rte' i i ik :' t �1 t : n t r* ? }, 6� y i•� 4i'[v'4laY„ta` il -dry ,,:',,: ` I "ti f i v(�i r.�t'�'� ��),� r r l /h `tsF��}�, �. �-?":11,',,,.,.,' l,'.:� � 4 +!' in.fiom •`' :_ _ L,•4 ti� i i }rix i At I ,,.) 'L 1°'�y 1 z• f tti 'h �F` + lD-- -, -'f + v ',', r 6,--,i 1' •:�ka.'rt*.s'x �� r �..,„...4..,.,;4, ,,....,,,,a_. � q .�•.' +. ':; i i. �' �� \'t� alb fi ' L,,,,......„,i, }f h ! .:� + f-• rt "k v) v A i 4 t ,;;,,,,,r,,,,„ t r i,e`.`L y.y I f � ,l r, f i r�fn, a .ii z + M ,u E,«,f o'f Ew �Y,i. ln.Irg�t '',+ >, � i ,ir i t� �”) � �`^�� I Mt! 0.,d S}lw ti a sie v4r ` ; i--,--^_ t0 !u 1 } 1 R ,, f!•'r ,g , ( , t i L ' Ir YfS t�'t� � tif.. tV o �'r y 9 � ,: !{ i r !r - WOPEN�HOLE a u t�it v�"Fx s ..� Well owner s mailin address It different than property owner's address indicated above i q { H a kr{ t i P P y �� ,' i i'',".:.`,j,,');'';',.''.,',?;;;',','' i i >rt} id', i Screen from ry S 044 r ru`sa s 6 auxa� to 7_ -ft, Open Hole from a. i�r . It , r OBSTRUCTIONS _ __- to h a{`+ 1,?' ` i �':` [�Rods'Drop FI pe — -- �]Check Valve(s) [� •Debris Ftp (�;• ` ! i No Obstruction . .. Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS oR FORMATION FROM TO Obstructions removed? Yes II not known,indicate estimated formation log from nearby well or boring. L No Describe _ ________ * yp S_t ©�C tpyi '------------- — j _nO • s • ��T dem t - - - � Removed [�Not Present [j1 Other -_ - - rMETHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASING (.l.Nd Annular Space E'xfsts 5,OR CASING AND BORE HOLE: IIIIIIIIII® �.,�Annular Space Grouted with Tremle Pipe `l Casing Perforation/Remoea in,from o _ —ft i Pe Grated Ci Remgyet r In.from -to d :.., . ' ff— .■ _ ------------------ft• 1 I Perforated n Removed d 9 r„ ..,,.q,,,,,, • ��ag® Type of Perforator , 5v w y i g tk S Y X91 i' nm r � i q{' n ya --` -•-- t� _ i 79'"'",!�o � {•tai, t61"rAry�t""M€;'K1Y a. s a n t t �'z W iC� 'i?i+alb ,1: . ! GROUTING MATERIAL(S) c !, ,',',;',,,1,.,1.1:',' ,� «+ y t 1 (One.bag of cement-94 Ips.,one bag o•bentonite=50 lbs,)' + ev' �i GroutingMaterial -_Ce1 n�„ from_ __. yards-- 1 (_ bags. ®® `rpm to- - - - bags ft , Yards_ rors to ft ®®OTHER WELLS Af'D BORINGS. - --- __ --- Yards _ bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property?. []Yes T.No How many?__ ______ LICENSED OR REGISTERED CONTRACTOR CERTIFICATION _ This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report , is true to the best'of my knowledge, - .-_-Y-----—--- 1 ire , Inc. Licensee Business Name _ '� (� License or Reglstratlon No, Certi/ted :, r.d_• -- -- - e -Z3._ a9f IMPORTANT-FILE WITH PROPERTY Ce�'fied Rep.No,- pa"te -- --- Richard PAPERS WELL OWNER COPY H 305365 A F hr©n ;- ruy. Name or Person Se ng Well or Boring - HE-07434 t2 IC#.140-0423 - - -"-- - (Top 3 inches reserved for recording data) DEED OF SALE Minnesota Uniform Conveyancing Blanks by Individual Personal Representative to Joint Tenants Form 10.5.4(2011) DEED TAX DUE:$ DATE: /47,7/ 3e� 7f (monk fday/yean) FOR VALUABLE CONSIDERATION, Dale Richert Insert name of each Personal Represevtauve) as Personal Representative of the Estate of Helen Peterson,aka Helen M.Peterson,aka Helen Mae Peterson ,Decedent, single•married 0 at the time of death (check applicable box), (if"mamed'is checked then attache Consent of Spouse(Form 7a1.13) ("Grantor"),hereby conveys and quitclaims to Thomas J.Thiets and Lisa G.Thiets (insert name of each Grantee) ("Grantee"),as joint tenants,real property in Washington County,Minnesota,legally described as follows: See attached Exhibit A Check here if all or part of the described real property is Registered(Torrens)0 together with all hereditaments and appurtenances belonging thereto. Check SelSeller ller le box: Grantor ,Ri� O The certifies that the Seller does not know of any wells on the described real property. ❑ A well disclosure certificate accompanies this document or has (signature ofPersonal Represenlasye)Dale Richert been electronically filed.(If electronically filed,insert WDC number: :) ❑ I am familiar with the property described in this instrument and (signature of Personal Representative) I certify that the status and number of wells on the described real property have not changed since the last previously filed well disclosure certificate. Page 1 of2 Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 10.5.4 State of Minnesota, County of Washington This instrument was acknowledged before me on M,4 3Z-1,/ , by Dale Richert (m, fh/day/ye� (insert name and of each Personal Representative) as Personal Representative of the Estate of Helen Peterson, aka Helen M. Peterson, aka Helen Mae Peterson Decedent. (Stamp) Y/ -frl(7isi:ure tarial officer) ` Title (and Rank): JOHN SCOTT MCao .. .� = -� My commission expires: NOTARY PUBLIC 4 = MIN tESOTA (month/day/year) Commission Expires Jan.3t.2020 THIS INSTRUMENT WAS DRAFTED BY: TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS (insert name and address) INSTRUMENT SHOULD BE SENT TO: (insert legal name and residential or business address of Grantee) Galowitz Olson, PLLC Thomas and Lisa Thiets Lawyers 1701 Johnson Drive Tracey A. Galowitz Stillwater, MN 55082 10390 39th Street North Lake Elmo, MN 55042 651-777-6960 (Top 3 inches reserved for recording data) WARRANTY DEED Minnesota Uniform Conveyancing Blanks Individual(s)to Individual(s) Form 10.1.1(2016) eCRV number: DEED TAX DUE:$ DATE: May 30,2018 (monWday/year FOR VALUABLE CONSIDERATION, Lois Peterson,a single person;and Dale 0.Richert and Marilyn G.Richert,husband and wife (Wart name and marital status of each Grantor) ("Grantor'), hereby conveys and warrants to Thomas J.Thiets and Lisa G.Thiets (insert name of each Grantee) ("Grantee"),as (Check only one box) Eltenants in common, (If more than one Grantee is named above and either no box is checked or both boxes are checked, IN joint tenants, this conveyance is made to the named Grantees as tenants in common.) real property in Washington County,Minnesota,legally described as follows: Lots Two(2),Four(4),Six(6),Eight(8),Ten(10)and Twelve(12),in Block Five(5),of Beach's Addition to Oak Park,Washington County,Minnesota. Check here if all or part of the described real property is Registered(Torrens)❑ together with all hereditaments and appurtenances belonging thereto,subject to the following exceptions: Page 1 of 2 Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 10.1.1 Check applicable box: Grantor ■ The Seller certifies that the Seller does not know of any wells on the described real property. ❑ A well disclosure certificate accompanies this document or has (signature)Lp Peterson \ - been electronically filed. (If electronically filed,insert WDC / _ �, number: ) •9/ �- , (if `I�,)r- ,r 1,_; ❑ I am familiar with the property described in this instrument and I (signature)Dale 0. Richert Marilyn/G. Richert certify that the status and number of wells on the described real property have not changed since the last previously filed well disclosure certificate. State of Minnesota,County of Washington This instrument was acknowledged before me on May 30,2018 ,by (month/.day/year) Lois Peterson, a single person; and Dale 0. Richert and Marilyn G. Richert, husband and wife (insert name and marital status of each Grantor) (Stamp) (sign r of notarial officer) ohn S tt McDonald JOHN SCOTT MCDONALD Title(and Rank): NOTARY PUBLIC � ;. my I�NESOTA My commission expires: Expires Jae.3!,2020 (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS (insert name and address) INSTRUMENT SHOULD BE SENT TO: (insert legal name and residential or business address of Grantee) GALOWITZ•OLSON, PLLC Thomas J. Thiets Lawyers Lisa G.Thiets 10390 39th Street North 1701 Johnson Drive Lake Elmo, MN 55042 Stillwater, MN 55082 Telephone: (651)777-6960 JSM (Top 3 inches reserved for recording data) AFFIDAVIT REGARDING PURCHASER Minnesota Uniform Conveyancing Blanks by Individual(s) Form 50.1.1 (2006) State of Minnesota, County of Washington Thomas J. Thiets and Lisa G.Thiets being first duly sworn on oath say(s)that: (insert name of each afiant) 1. (They are)( he is)( he knows) Thomas J.Thiets and Lisa G. Thiets, husband and wife the person(s)named as Grantees in the document dated May 30, 2018 and filed for record as Document Number (month/day/year) (month/day/year) (or in Book of ,Page ),in the Office of the • County Recorder o Registrar of Titles (check the applicable boxes) of Washington County,Minnesota. 2. Said person(s)(is)(are)of legal age and under no legal disability with place of business(es)respectively at and for the last ten(10)years(has)(have)resided at: 1701 Johnson Drive, Stillwater, MN 55082 3. There are no: 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: Page 1 of 2 Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 50.1.1 4. Any bankruptcy,divorce or dissolution proceeding 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: 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. Affi (signature) Thomas J.Thiets (signature)Lisa G.Thiets Signed and sworn to before me on May 30, 2018 by Thomas J.Thiets and Lisa G.Thiets, (month/day/year) husband and wife (insert name of person making statement) (Seal,if any) if it•/ ?/-) 7,177/// �� ti. !ig tureofnotarialoffrce John Scott McDonald - JOHN SCOTT MCDONALD Title(and Rank): -6,7•16.1 NOTARY PUBLIC _1`• , MINNESOTA My commission expires: Itily Commission Expires Jar,.31,2020 (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) GALOWITZ OLSON, PLLC Lawyers 10390 39th Street North Lake Elmo, MN 55042 Telephone: (651)777-6960 JSM (Top 3 inches reserved for recording data) AFFIDAVIT REGARDING SELLER Minnesota Uniform Conveyancing Blanks by Individual(s) Form 50.1.2(2011) State of Minnesota,County of Washington Dale 0. Richert and Marilyn G. Richert being first duly sworn on oath say(s)that: (insert name of each affiant) 1. (They are)( he is)( he knows) Dale 0. Richert and Marilyn G. Richert, husband and wife the person(s)named as Grantors in the document dated May 30,2018 and filed for record as Document Number (month/day/year) (month/day/year) (or in Book of ,Page ),in the Office of the I County Recorder 0 Registrar of Titles (check the applicable boxes) of Washington County,Minnesota. 2. Said person(s)(is)(are)of legal age and under no legal disability with place of business(es)respectively at and for the last ten(10)years(has)(have)resided at: 9353 Norell Avenue North, Stillwater, MN 55082 3. There are no: 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: Page 1 of 2 Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 50.1.2 4. Any bankruptcy,divorce or dissolution proceeding 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. There has been no labor or materials furnished to the Premises for which payment has not been made. 7. There are no unrecorded contracts,leases,easements,or other agreements or interests relating to the Premises except as stated herein: 8. There are no persons in possession of any portion of the Premises other than pursuant to a recorded document except as stated herein: 9. There are no encroachments or boundary line questions affecting the Premises of which Affiant(s)(has)(have)knowledge. 10.The person(s)(has)(have)not received medical assistance from the State of Minnesota or any county medical assistance agency. 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. Affiant f-- / (signature) Dale 0. Richert yyyll ¢¢¢/// `k 4;;'1 ,•J� a) LI (signature) Marilyn G. Richert Signed and sworn to before me on May 30, 2018 ,by Dale 0. Richert and Marilyn G. Richert, (month/day/year) husband and wife (insert name of person making statement) • • (Stamp) si ature of notarial officer) John SEott McDonald JOHN N SCOTT MCDONALD Title(and Rank): t^ . a: # NOTARY PUBLIC My commission expires: MINNESOTA (monthrday/year) My Commission Expires Jan.31,2020 THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) GALOWITZ•OLSON, PLLC Lawyers 10390 39th Street North Lake Elmo, MN 55042 Telephone: (651)777-6960 JSM (Top 3 inches reserved for recording data) AFFIDAVIT REGARDING SELLER Minnesota Uniform Conveyancing Blanks by Individual(s) Form 50.1.2(2011) State of Minnesota,County of Washington Lois Peterson being first duly sworn on oath say(s)that: (insert name of each afflant) 1. (They are)( s he is)( he knows) Lois Peterson, a single person the person(s)named as Grantor in the document dated May 30, 2018 and filed for record as Document Number (month/day/year) (monthrday/year) (or in Book of ,Page ), in the Office of the IN County Recorder CI Registrar of Titles (check the applicable boxes) of Washington County,Minnesota. 2. Said person(s)(is)(are)of legal age and under no legal disability with place of business(es)respectively at and for the last ten(10)years(has)(have)resided at: 3. There are no: 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: Page 1 of 2 Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 50.1.2 4. Any bankruptcy,divorce or dissolution proceeding 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. There has been no labor or materials furnished to the Premises for which payment has not been made. 7. There are no unrecorded contracts,leases,easements,or other agreements or interests relating to the Premises except as stated herein: 8. There are no persons in possession of any portion of the Premises other than pursuant to a recorded document except as stated herein: 9. There are no encroachments or boundary line questions affecting the Premises of which Affiant(s)(has)(have)knowledge. 10.The person(s)(has) (have)not received medical assistance from the State of Minnesota or any county medical assistance agency. 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. Affiant (signature) ois Peterson (signature) Signed and sworn to before me on May 30,2018 ,by Lois Peterson, a single person (montt✓day{year) (insert name of person making statement) fzr (Stamp) " / _ (signal rew6ffnotanatofficer) John Sco McDonal ' - JOHN SCOTT MCDONALD Title(and Rank): ' NOTARY PUBUC My commission expires: MFNNESOTA (montiydayyear) My Cerror>tssion Expires Jan.31.2020 THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) GALOWITZ•OLSON, PLLC Lawyers 10390 39th Street North Lake Elmo, MN 55042 Telephone: (651)777-6960 JSM (Top 3 inches reserved for recording data) AFFIDAVIT OF IDENTITY AND SURVIVORSHIP Minnesota Uniform Conveyancing Blanks Form 50.2.2(2006) • State of Minnesota, County of Washington Name of Decedent: Amanda Richert I, Dale O. Richert (insert name and address of affiant) 9353 Norell Avenue North, Stillwater, MN 55082 being first duly sworn,on oath state from personal knowledge: 1. That Decedent is the person named in the certified copy of the Certificate of Death attached hereto and made a part hereof. 2. That the name(s)of the survivor(s)is/are: Oscar Richert • 3. That on the date of death,Decedent was an owner as a joint tenant/life tenant of the land legally described as follows: See attached Exhibit"A,"Washington County, Minnesota Check here if all or part of the described real properly is Registered(Torrens) 0 as shown by instrument recorded on November 13, 1945 ,as Document Number (or in Book 146 (month/day/year) of Deeds Page 524 ),in the Office of the ■County Recorder 0 Registrar of Titles of Washington (check the applicable boxes) County, Minnesota. (If filed with the Registrar of Titles,insert the Certificate of Title number .) Affiant (signature)Dale O. Richert Page 1 of 2 Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 50.2.2 Signed and sworn to before me on May 30, 2018 , by Dale O. Richert (month/day/year) (insert name of person making statement) ,./1-/V6 ��V (Seal, if any) � �, ,. (sigr1atureofnotarial officer)John Scott McDonald Title(and Rank): JOHN SC OTT MCDO NOTARY p�$ My commission expires: -�; . MINNESOTq C 31.2020 Foy corn� �on (month/day/year) Aires Jan THIS INSTRUMENT WAS DRAFTED BY: TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS (insert name and address) INSTRUMENT SHOULD BE SENT TO: (insert name and address of person to whom tax statements should be sent) GALOWITZ OLSON, PLLC Lawyers 10390 39th Street North Lake Elmo, MN 55042 Telephone: (651) 777-6960 II 2-46 �.°rurous� FORM NO.25.3 0.5.1" Duplicate Certificate of Death MINNESOTA D PAR (vMENT OF HEALTH EXACT DUPLICATE 1 1966 Rev. Section of Vital Statistics l'•' - -- CERTIFICATE OF DEATH -- - - -_- h----- -- - - - ri. PLACE OF DEATH:STATE OF MIFINE f� it USUAL RERECENC-f 1W:are deceesei3-lived.IlTnifffu(;orire---.'d----':t nnco before a. COUNTY I' e. STATE b.COUNTY tdmission.) !,_ Washington I' Minnesota Washin ton I; b.CITY,V4L4LA rGGR-TGWIi611I.6 r .LENGTH OF c etT4,VILLAGEOR4CIWY1iStiW I I STAY in I b. Stillwater 2 days I' Oak Park Heightsjj-1 __- I, d.NAME OF(If not in hospital or institution,give street address) i d. STREET ADDRESS POST OFFICE HOSPITAL OR i I' "'S e"°''_ Lake_Yi eN_MeTnorj sl __.-_._.. .. 11. rMinnesata_ _ e. IS PLACE OF DEATH INSIDE CORPORATE LIMITS? a. 1S RESIDENCE INSIDE CORPORATE LIMITS? 'I. IS RESIDENCE ON A--AF RM? il YES([ NO❑ l' xi Y ❑N YES❑ NO IX • I, 3. NAME OF T 4. DATE Month Day Year I DECEASED OF II (Type or Print) Mrs . Amanda-__ M. Richert _......-_..., DEATH _March 214_196 - rc i 5. SEX 76. COLOR OR RACE i 7. MARRIED EVER MARRIED[] 8. DATE OF BIRTH 9. AGE(In year,-{j����J�NOER 1 YEAR_E UNDER 24 tHRS • p last�7birthdayl'teonthti-Days I-Flours Min. :. Female _.I -_. White .•1__WIDOWED DIVORCED I May 121-189- 1 0 I 111 1, IOP. USUAL OCCUPATION (Give kind of work !Ob. KIND OF BUSINESS OR ' !I. BIRTHPLACE(State or foreign country) 12.CITIZEN OF WHAT done during most of working life,even if retired) INDUSTRY I I COUNTRY? a Housewife ------ -- Home I .Stillwatgr�.Minnesot_.a-1---- USA ---' Iia. FATHER'S NAME 13b. MOTHER'S MAIDEN NAME 14. SPOUSES NAME m 7_ L--Au- s_=-1'ehl_o1 -- - _----Minn ae: 0s�: r= -' Highq ==_ II 0 Ur I IS..WAS DECEASED EVER IN U.S.ARMED FORCES? 16. SOCIAL SECURITY NO. 1 17. INFORMANT'S OWN SIGNATURE ADDRESS RFD 1 (Yes,no,or O z I (If yes,give Richert Mime- o zINTERVAL BETWEEN r z m 18. CAUSE OF DEATH(Enter only one cause per line for(a),(b),and(c).) ONSET AND DEATH ' a t.7 LL O PART I.DEATH WAS CAUSED BY: tr Z a . _ > I IMMEDIATE CAUSE (a)-_Coronary-_occlusion....-.---_-----.--.-. -.---.-----.----.. -- •.--.-.-- mia_ as rY Fl 1 w 3 z i Conditions,Conditions,tionc, if any, DUE TO(b) ._.-__ tr3ET' SCOT'Ot1 cornr7.ary. .heax't__d- seapc� 12- yrs ...l z - which gave rise to I < I above cause (a), .,, < 1 stating the under- 3 Ii lying cause on line OUE TO(c) ______.._. ._ . .. . .. . .... -._.. - Z PART II. OTHER SIGNIFICANT CONDITIONS CONTRIhUTING TO '.1l.TH GUI- NOT RELATED TC THE IMMEDIATE CAUSE GIVEN. 17. `NAS AUTOP:(Y o' 'f1!s 0 ® Cs..ID - = Q IN PAR , 1(a) PERFORMED? CL o I. o Diabetes mellitus - 12 yrs } YES Noe a �' I. 5L i9e. DATE OF OPERA. 119b. MAJOR FINDINGS OF OPERAI1ON - "' - -- -'_.._.___ ___.__._ . 0 §3 , cr , s vhl 1 I - • w I_ 3 G rJ . n J 20a, ACCIDENT, SUICIDE OR HOMICIDE. (SPECIFY): ?Ob. DESCRIRE HOW INJURY OCCURRED.(Enter'mime of injury,u Port I or Pert II of lien' i8.) IN ,,, .... ... .7., r.•-.. . C _ - - - O t7 20c. TIME OF Hour Month. Dey, Year o r�Y w INJURY a.m. 5 :'� ca 20d. INJURY OC'URRED 1 20e. PLACE OF INJURY (c. 9., in a• about ) 20f.CITY,VILLAGE OR TOWNSHIP COUNTY STATE I•, 2�y' ,`j3 r S,Sl I; WHILE AT 0 NOT WHILE 0 I home,farm,factory,street office bldg.,etc.) 1 :.--.77( WORK AT WORK I 1 '0 �`��ii%�s r-'.. I; 21. I cert fy I attended The deceased from Mare moi_j_3,• to tare �,.�1 last sew theaeceose a rve on arch .[T-( 1 = it and that death occurred at _ 2:60 Al"� m.on the date Jetted above end to the best of my knowledge,from the causes stated. + ' w _ W 7 I 22a. SIGNATURE -- -- - (Degree or title) - - 22b..ADDRESS- - -- 22c. DATE s PO = in" i` J E Jenson M.D. Stillwater, Minn J March 21,1965: z° 230. REMOVAL(Specify) 1 BURIAL CREMATION I 23b. DATE 23c. NAME OF CEMETERY GR.GR6M .a .RTDAY 23d. LOCATION (Gifyrvillage oroen y)- (State) 13 .- af I' I� _Burial 3/22/66 illrist LutheranLake Llr oMinnesota _`74 DATEFILED 8Y 25. REGISTRAR'S SIGNRE Y6. SIGNATURE OF MORTICIAN OR FUNERAL DIRECTOR AODRS I: 3_-2 65 AudreyB. rglEeoht i Earl Jones Stillwa'ter, Minnesota h