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AF-AG - 47506J (Printed on Nov 28, 2011 (d10H:09) � B. Type of Loan 1. ❑ FHA 2. [] RHS 3. � Conv. Unins. 4. ❑ VA 5. � Conv. Ins. C. NOTE: Is torm Ia fumished to give you a atatement of adual aeWe here for Irdgrme8on purpoaea end are not Included In the totais D. NAM� AND ADDRESS OF BORROWER: CITY O� FRIDLEY HRA, 6431 UI�IVERSITYAVE NE FRIDLE�' MN, 55432 G. PROPERTY LOCATION: 561 IRONTON ST NE FRIDLEY MN, 55432-1634 J. SUMMARY OF t 9nn r.Rncc enn I�l�iti TRANSACTION A. Setttement Statement (HUD-1) OMB Approval No. 2502-0265 6. File Number: 7. Loan Number: 8. Mortgage Ins. Case 20-00155869 t coats. Amounta peid to and by the settlement agant are shown. Items marked'POC' were paid outalde the Gosing: they are E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: SEC OF HOUSING AND URBAN DEVELOPMT, CASH 1670 BROADWAY, 21 ST FLOOR M a ry DENVER CO3 80202-4801 271-879685 �i H: SETTLEMENT AGENT: I. SETTLEMENT DATE: NORTHWEST TITLE AGENCY, INC. KCOCHRAI 12/02l2011 PLACE OF SETTLEMENT: DISBURSEMENT DATE 2125 2ND ST#200 WHITE BEAR LAKE MN,5511( 12lOZ/2011 K. SUMMA.s�i' OF SELLER(S) TRANSACTION 11:36:34 -OB'00' -�-......��... v� r-��v rr � VI\ 11\ ocnr��r Vf' OURRIJYVI"K � hllll N4.Ill lf`TI/l1�IC IIU A11A/'111\IT I11 tr T� nr�� � �e� . ••� ..�+ �.�� �� �.cmc�� � rRV�v1/ 1 V 6VKKVYVtK : 600. CASH AT SETTLEMENT TO/FROM SELLER : 301. Gross Amount due from borrower (line 120) $47,365.26 601. Gross amount due to seller {line 420) $46,932.26 302. Less amounts paid by/for borrower (line 220)� $500.00 602. Less reductions in amt. due seller (line 520) $4,019.84 303. Cash [X] From � To Borrower $46,865.26 603. Cash 0 From [X] To Seller $42,912.42 The Public Reporting Burden fo� th(a collectlon of informetlon ie estlmated at 35 minutas per reaponae for colleciing, ravlewing, and reporting tha data. Thls agency may not collect this infortne0on, and you are not required to complete lhia form, unless it dlaplays a currently valid OMB conVol number. No confidentialiry Is asaured; thie diaclosure Is mandatory. Thle Is dealgned to provlde the paNes to a RESPA covered lransadlon wlth informatfon during the aetUement procesa. The HU0.1 Settlement Statemenl which I have prepered fs a trua end eccurate accounl of fhis Vensacfion. I have causetl or will cause funda to be disbursed In accordance with ihia statement SELLER(S • � . X /°�--�1� SEC OF HOUSING AND URBAN DEVELOPMT �. 8 (Printed on Nov 28, 2017 � 08:09) L.SETTLEMENT CHARGES 700. Total Real Estate Broker fees Division of commission as foilows: 701. • 702. ': 703. Commission paid at settlement to Counselor Realty Inc 704. Commission paid at settlement to Schimmel Noe and Associates LLC 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. O � origination charge 802. Yo�ar credit or charge points for the specific interest rate chosen - GFE 2 803. Yo��r adjusted origination charges 804. Ap�raisal Fee GFE 3 805. Cr�dit Report 806. Tab Service 807. Flo°pd Cert 808. 809. 810. - 811. ' 901. Dayy Interest 902. Mo�tgage Insurance Premium 903. Ho�neowners Insurance 904. ' 905. 1000. I�ESERVES DEPOSITED WITH LENDER 1001. Initial Deposit for escrow account 1002. Hpmeowners Insurance 1003. NJortgage Insurance 1004. Property Taxes 1005. ° 1006. 1007. Aggregate Adjustment 1008. ` 1009. 1010. , 1100. T�TLE CHARGES 1101. TjUe Services and lenders tiUe insurance 1102. Settlement or Closing Fee TO NWT $346.00 to Seller e 1103. Owners title Insurance 1104. L`'enders Title Insurance 1105: L�nders Title Policy Limit 1106. dwners title policy Iimit ,$46,810.00 1107. Agents Portion of the total title insurance premium, $150.40 1108. Underwriters portion of the total title insurance premium, $37.60 1109. Exam Fee $175 to Northwest Title (Included in Iine 1101) 1110. Assessment search and review $45/Name Search $25 to Northwest Title 1111. 1112. 1113. 1201. Govemment Recording charges 1202. Deed POC-S $ 46.00 Mortgage $ Release $ 1203. Transfertaxes 1204. State Filing fee to NWT State Deed Tax - Seller Exempt , 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Required services that you can shop for 1302. 1303. 1304. 1305. OMB Approval No. 2502-0265 Paid From BorrowePs Funds at Settlement (from GFE #1) (from GFE #2) (from GFE #A) (from GFE #3) (from GFE #3) (from GFE #3) (from GFE #3) (from GFE #10) (from GFE #3) (from GFE #11) GFE #9) Paid From SellePs Funds at Settlement $1,404.30 $1,404.30 GFE #4) $245.00 $346.00 GFE #5) $188.00 Inc (included in line 1101) (from GFE #7) (from GFE #8) (from GFE #6) 1400. Total Settlement Charges (enter on lines 903, Section J and 502, Section I have car reviewed the HU0.1 Settlement Statementand to the best of my knowiedge and belief, it Is a We and accurat transacC n. furlher certify t I h received a copy of HUD-1 Sefllement Statement BO 1�ER(�): � �. Tha Code OF FRIDLEY $433.00 � $3,154.60 ide on my account or by me in this Se rt�p Ye�ent whi I h e pre (s e We and exurate eccount of thia trensacdon. I hava ceuaed or will cauae the funda lo be dtebureed In eccortlence wlth lhis stalemenl . , � - , ` l�-��.�,, I TITL AGE COC '�' Date e hava been proreted beaed on t�ea for the yeer. Any re-proretion will be hendled behveen the buyer and eelier, All uNlity bllle (weter, sewer, electric, eeble and meintenance fees) have been I�b�e paid upon reeelpt of flnel bills. B: It ie e crime to knowinQiy meke false elatemente to the United 6letes on thls or eny other slmilar form, PanalUee upon convlollon cen Include e Ane or imprlsonmenL For delalle eae: Title 1 B U.S. don 1001 and Sectlon 1010. / , MINNESOTA• REVENUE PE20 Certificate of Real Estate Value : . r_v � � Names of buyers (last, ftrst, MI) dr , 1 Daytime phone : �� / �or s i�i�s m�t,,�,� ��.c,,o I l(l f�"�'J.� F}'� �!.�! `," 1- �,� „4,����a ,,��,.� �a L4i�.i�� ��'���i'YT�N�' ���� C� �t���2 �2�1'�G ! -�2�� Street address or rural route of propertypurchased City or township County �l� 1 � Ro�J� �r �� �2.r DL� �I� 1. Date of deed or contract L�gal description of property purchased (lot, block and plat) or attach 3 copies of the legal descripUon Financial arrangements 2. Total aurchase p�ice Down Points or pPepaid interest paid by seller Was personal property (ncluded in purchase price (e.g., fumiture, irnentory, equipment)1 ❑ Yes � No If yes, Iist property and current (not replacement) value at right, and enter total in Box 5 below. Use back of forrn if needed. 5. Current,�ua,Jwe of personal property 6. Type of acqulsltlon (check all that apply) ❑ 1031 exchange ❑ Buyer purchased partial interest only ❑ Buyer and seller are relatives or related businesses ❑ Contract paid off or resold ❑ Buyer or seller is religfous or charitabie organization Name added or removed from deed �Buyer or seller is unit of govemment Property condemned or foreclosed upon (' 7. Type of property transferred (check all that apply) ❑ Properly recetved as gift or inheritance ❑ Property received in trade ❑ Purchase agreement signed over two years ago ❑ Land only �Land and bulidings ❑ Construction of new building aiter Jan. 1 of year of sale 8. Planned use of property (check one) �Residential: single family ❑ Residential: duplex, triplex ❑ Cabin or recreational (noncommercial) 8. Will this property be the buyer's principai residence? ❑ Agricultural. Number of acres: (attach Schedule PEZOA). ❑ Apartment (residential, four or more units). Number of unfts: (attach Schedule PE20A). ❑ Commercial-industrial. Type of business: (attach Schedule PE20A): ❑ Other. Describe: (attach Schedule PE20A). ❑ Yes � No Method Of flnancing (complete only if seller-flnanced, including contracts-for-deed and assumed mortgages) Assumed ConVact Mortgage or contract for-deed Monthly payment Interest wte Number of Date of any lump- mortgage for deed amount at purchase (principal & interest) now in effect payments sum (balloon) payments 9. ❑ ❑ 10. ❑ ❑ Slgn here. I deciare under penalry of law that the infori Pdnt name ' Sign � +T� DF �2�d�(��► . �'�-�' � C uo ntles: Complete thls sectlon. Co ❑ C Yr BIt SD Yr Lend Acres �Tlllable �C[R �CRP RIM � Use � Deed � Yr � Land � Good tor atudy ❑ Yea ❑ No If no, give reason/code a � z �X HC ST AdJc AdJs � GA C 1 MV 0 z on thts form is true, correcf and complete to the best of my knowledge and bellef. �-� Date Daytlme phone �. ��C� l Z/a/�� � �� S�2 3S�'� Use I Tlllable EMV �� Bldg Tot Bldg Tot Apt FM ID Prlmary property ID number Secondary parcel IO number b. c. d. Are there more parcels7 0 Yes � No Put eddlUonel ID numbera on beck of torm. .� Minnesota Limit�:d Warranty Deed State deed tax due hereon: EXEMPT MN tat. 287.2?) FHA Case #: 271-879685 THIS INDENTURE, made on the � by the Secretary of Housing and Urban Development, of Washington, D.C., herein called the Gran or, and HC USING AND REDEV6LpPMENT AUTI{ORITY IN AND FOR THE CITY OF FRIDLEY , of the County of ANOKA, 5tate of MINNESOTA, herein called the Gran:ee whether one or more, (Mailing address of said Grantee is 6431 UNIVERSI7Y AVE NE FRIDLEY MN 5! 432). WITNESSED: THAT SAID GRANTOR, in consideratior of the sum of $10.00 and other valuable consideration to be paid by Grantee (the receipt of which is hereby acknowledged), does by these presents, Grant, Bargain and Sell, Convey and ConfiRn unto the said Grantee, his heirs and assigns, the following described lots, tracts or parcels of land lying, being and situated in the Count y of ANOKA and State of MINNESOTA, to wit: LOT 23 AND 24, SECTION OR BLOCK F, RIVERVIEVJ HEIC HTS INCIUDING AN EASEMENT EIGHT (8) FEET IN WIDTH ALONG THE REAR OF LOTS 25 AND 26 IN SAID BLOCK T�) BE USED IN COMMON WITH OTHERS FOR THE PURPOSE OF HAVING ACCESS TO AND REiURNING FROM A WELL _OCATED ON LOTS 25 AND 26 INCLUDING A RIGHT TO TAKE WATER FROM SAID WELL AND SUBJECT TO AN EAiEMENT E3GHT FEET IN WIDTH ALONG THE REAR OF SAID LOTS 23 AND 24 FOR THE USE OF OTHER OWNERS IN S��ID BLOCK IN GOING TO AND REi'URNING FROM SAID WELL AND LOT 22, BLOCK F, RIVERVIEW HEIGHTS, ANC KA COUNTY, MINNESOTA with property address of: 561 IRONTON ST NE, FRIDLEY, MN 55432-1634. Check Applicabie Box: � The Seller certifies that the Seller does not kno re of any walls on the described real property. ❑ A weli disclosure certificate accompanies this document. ❑ I am familiar with the property described in this instrument and I certify that the status and number of welis on the described real property have not c ianged since the last previously filed well disclosure cert�cate. SUBJECT TO covenants, conditions, easements, restri;tions and reserva6ons of record, if any. Togather with all hereditaments and appurtenances belonging theretc. Grantor covenants and represents that: (1) This deed conveys after-acquired title, and (2) Grantor has not made, done, executed or si ifFered any act or thing whereby the above-described property or any part thereof, now or at any :ime hereafter, shall or may be imperfled, charged, or encumbered in any manner, and Grantor will warrant the title to the above-described property against all persons claiming the same from or through the Grantor as a result of any such act or thing, EXCEPT: the lien of taxes payable ir 2041 and thereafter, and the Ilen of ail unpaid special assessments and interest thereon. _u�uni�sanaio� Page 1 of 2 TO HAVE AND TO HOLD, The premises aforesaid witP ail and singular, the rights, privileges, appurtenances and immunities thereto belonging or in any wise appert�aining unto said Grantee and unto his heirs and assigns forever, said Grantor covenanting that he is lawfully sei.ced of an indefeasible estate in fee of the premises herein conveyed; that he has good right to convey the � ame; WORDS and phrases herein, including acknowledgem.nt hereof, shall be construed as in the singular or piural number, and as masculine or feminine gender, accordi� ig to the contexk IN WITNESS WHEREOF, the undersigned has set his! ier hand on the date written as principal and/or officer of Best Assets, Inc., Management and Marketing contractor of the U.S. Department of Housing and Urben Development, for and on behalf of the Secretary of Ho� sing and Urban Development, under re-delegation of authority published at 70 Fed. 43, 171 (July 26, 2005). Secreta�of Housing and Urban Development gY: -�-�,c,��.�v�-�.��'' �� � � • /,,�+.r � �� �� � ; • � State of Texas Gounty of Fort Bend On this �'� day of 2011, fore me, the undersigned, a Notary Public, personally appeared to ma, � , as HUD Representative known to be the person(s) describe m and who execu:ed the foregoing instrument on behalf of the 5ecretary of Housing and Urban Development, and acknowledged that helshe executed the same as his/her free act and deed. Witness my hand and notarial seal subscribed and affired in said County and State, the d y and year first above written. � My Term Expires: ,�,:►.�o: k NELCY Y. MUNQZ � �•°' GO� Note�v PuBbc, S'ate of 7e pubGC :��� M r Commis;�on Expire '°.;�;;�'.`` AuguH �u� 2014 �� ... . . . Retum to and Drafted Northwest Title Agency Inc. AND FOR 7HE CITY OF FRIDLEY 2125 2nd St., Ste 100 White Bear Lake, MN 55110 651-490-9056 Fax:651-249-2786 ?a.qU� SSa6a�a da Page 2 of 2 Send tax statements for this property to: HOUSIiVG AND REDEYELOPMENT AUTHORITY IN 6431 UNIVERSITY AVE NE FRIDLEY MN 55432 Application for Property Tax Exemption Please read the back of this form before comp/eting. lf you are app/ying for exempaon as an institution of pure/y public charlty, p/ease B/l out the °Insdtufion of Purely Public Charity Application for Property Tax F�cemption" form. ..,_... .__.-�-�___-______ ._._ __.._.------ . - _ Thls section !s to be comp/eteal by a/l applicants. P/ease provide the following information for the organiza6on thai owns the properiy on which exemption is being claimed. Name of organizatfon Name of representative or 4Vt,l� U` pli w address of organizetion �t39 (1�; ver. City �'r i Is the above Date prope�ty acquired by organization �or � of � L �i 'it ate of application �. e.c.- �i,►dc�t'oi l Z/ Z% �� NG State Zip County from federal incflme tax under section 501(c)(3)? ❑ Yes �j No The a�ve organization is seeking exemp6on from property tax under the following category (please check one): ❑ Academy, college, university or seminary of leaming ❑ Public hospital ❑�hurch, church properly or house of wo�ship ❑ Public school house �public property used exclusively for public purposes ❑ Other (specify) � Public burying ground � Institufion of purely public charity (If yes, please file for exemption using the "Ins6tution of Pu�ely Public Charity Application for Property Tax Exemption" form ) .._ �_.._..... ___—.-..".___..._.._.._._..._........_.�...._.__��..._......_..__.._.....__......�...._...___.. ..._�_�.._ ......._..._.__.___...._ ...................---_............_...�..... ... ..........__.... Thls sectlon is to be completed by all applicants. P/ease fill out the following information abouf the proper[y on which exemption is being c/aimed. Mailing address �G, I ��n� T�rJ ST Ai'� City ✓�O � Legal Desc�iption of tF� property Parcel ID number Z� r � F �/IkI'��� �1 � � � ' � �� ��3 � O�� `.....�..._ ..«.-�_.__.""��...._.-.._........_.__.___...'_'_..._ ..__._.._._..._._ ........... ......._. .......__"_"_"_...._..____......_.._....__,—.._..__�.__.__...__..—.�_._.....�___.....� Thls secflon Is to be comp/eted by all applicants. P/ease answer the following ques6ons abouf the use of the property. What is the principal use of the above�iescribed property? 4/�0`�.°�'�"r e dQ.i OQC.1� i OQ �i.�'e� �Ovv�� ��L.°— � vr.D �i 5��_ Additional uses of the above-described property (please give percentage of use): Ilio v� � Are these uses directly related to the mission of the_or Is any pa�t of this propetty used for commercial purposes? If yes, please explain. Why is ownership of this propeKy necessary? -I— � ❑ No ❑ Yes �la / �� c �i � 'f' /'e.�n�•� U'� � Is any part of this property used for residential purposes? ❑ Yes �No if yes� please fill out next section. __. .. . .. _. .._....._... ...- ----.....�..._....._ __ _ _ _.. .. ._.__...._.._.....__.___.. _... ___ _.... _ _. _._._____._._..�__._.. _._ ........._____... _..........__ .. . . ... This section is to be comp/eted if any part of the property is useal for residentfal purposes. ease fill out the following informa6on foreach person who occupies the above-described prdperty. List addi�onal ���nanrs information on a seaarate sheet and aftach it to this applicafion. Name of occupant Nature of service/employment I� Full time OP ❑ Part time Is ocxupant required to �eside on this properly as a condition of employment? If yes, why is this required? Does ocxupant pay rent, either in cash or as a pa�t of salary? ❑ Yes ❑ No If yes, please give details. Why is ovmership of this residence necessary? ❑ Yes � No _.._. _ ----..�.__.___�__-----_�...___..._ ___�. _.._...__........_..--._.._�..__._...._._...._......---.......�___..____.__..__...�._.__..__.,._ Slgnature of owner or authorhed representatfve. By signing below,l cerdfy t�af the above info►maaon is bve and con�ect to the best of my know/edge, and 1 am the owner of the prnperiy or authorized representa We of the o►vaniza6on fhat owns fhe property_ for which exemp6on is being c/aimed. Applicant's [7evinarl M/(14 Making false statements on this applicatlon is against the law. Minnesota Statute 609.41 states that anyone giving false information in order to avoid or reduce thejyt�x obliga6ons is s�ect to a fine of up to $3,000 and/or up to one year in prison. Daytime phone �63 S?Z 3��' �--� � , ; c : ; , ; , ; � ; �� � .I : ----Z � �' �; , ; ; ., �' . : ; � ; ; ; �' �� �' , v� �' ; , y � � � 00; ; �7�� � ��� , ��; �' -, � � � ; ; N � , �' ; ; , ; , ; ; ; 4� I m; �, ' ; ; : . � ; ; ; � : ------, Nor�hwest Txt�a A.gency �x�c. 2125 2"d Street, Suite 200 � White Bear Lake � PH: 65i_4g0�9056 '� M�nnesofa corporallon � M� 55110 FAX: 651-490-9pp2 /Nq��@T�TLEMASTE/�, COM PRO,PERTY A,DDRES,S,�(� i � �' �� �id1� CASE N0: � _ �j--�P � FZN.A�, W.A�TER.11�S� ���. �.A.�zNG/�'O,�T CLOSXNG INVOZCES �� 5�z $uYez has, or wi11 zz��.11zediatel . Y x�.otiFy tl�e water de�artznezat o:Ctl�ezr ��u�cl�ase i:o swzi:ch.service iz�to tl�eix z�alne(s), NO'Z'�: Le��e�'s and owner's policies clo. x�o� cover de ' Z� you receive a bi1l:Foz• work ref . �'�l�ez�.l watez� balls, az�d date of closxn � o1med that was �ot billable or duc 1fi fi1�e .lizne g(i.e. snow rezx�oval, znowizlg, weed rez�oval, etc. �ontact Best Assets at 281-�{9�-8233, Re�'exei�ce t��.e c�Se x�L� ) p�e�.se Tlzeze zS a• e z��be�� above, 1� x�ding assessment that is not yei: billable oz xnyoieecL �'or t1 following �e Z� you xeceive the Fizaal Watex Bi11 a:fl:er closing, ple�.se c� 28�`4`��'8233� Re:Cexence tlae case number above. 0z�taci; Best�s �t �----� Ux�dexszg���d buyex(s) agr.ee to l�old Nol-t��we��; �itle A enc ]3rokers and Agen.ts harznless for�any Xoss or da�1age axisiz1 :Cro b y azzd Re�1 �sta•l•e watez bilis or post closing invozces tl��,t were i1ot due ox' pay�ble�t .�eliz�quez�t da1;e o�' closing, �1� �:1111� i111C� DUY�R: BUYER; DUYER; � � �/C.�_ D��'E � 2 /Z.%1 J DAT�; bAT�; �. �� .,�r}, rthwest Title ,.�:. Hold Harmless Agreement FHA #: 271-879685 City and County Required Point of Sale and Truth in Housing Requirements Assumption of Responsibility Property address: 561 IRONTON ST NE, FRIDLEY, MN 55432-1634 The undersigned buyer(s), HOUSING AND REDEVELOPMENT ATHORITY IN AND FOR THE CITY OF FRIDLEY, of the above referenced property, hereby acknowledge that they are purchasing said property `as is.' In addition, buyer(s) and realtor(s) on this transaction, acknowledge that the city in which the property is located, as a condition of sale, may require certain property inspections and / or repairs. These requirements may include, but are not necessarily limited to the following: • Truth in Housing Inspection • Code Compliance Inspection and Approvat • Time of Sale Inspections � Certificate of Occupancy / Certificate of Compliance / Certificate of Approval • Notice of Violation(s) work orders All parties acknowledge that the burden of compliance with a city/county point of sale requirements rests with the realtor and buyer on this transaction. In acknowledgement of the above statements, all parties elect to accept this property `as is' and to proceed with closing. The buyer(s) of this property herby agree(s) to assume any code compliance/truth in housing/city/county required repairs as required by the city/county in which this property is located. Alt parties acknowledge that in the closing of this transaction, Northwest Title Agency, Inc. is not responsible to ensure buyer's and /or realtor's compliance with the city's/county's requirements, and all parties hereby hold Northwest Title Agency, Inc. harmless and free of liability in the closing of the above property. Buyer Signature �� �, �✓'-= Date: � 2� � I r i HOUSING AND REDEVELOPMENT ATHORITY IN AND FOR THE CITY OF FRIDLEY Buyer 5ignature Buyer Signature Date: Date: Realtor Signature ��/%� (/� ��tGw--- Date: �a D 2�24/l TIMOTHY AN AUKEN Northwest Title Agency, Inc. 2125 2nd St, Ste 200, White Bear Lake, MN 55110-3509 mai l@ti tlemaster. com P:651-490-9056 Fax:651-490-9002 � } � � � 1.� � , 1 ADDENDUM TO HUD-1 SETTLEMENT STATEMENT Closing Date: Borrower: Lender: Loan No: Premises: December 2, 201 ] HOUSING AND REDEVELOPMENT ATHORITY IN AND FOR THE CITY OF FRIDLEY CASH 561 IRONTON ST NE, FR1DL`EY, MN 55432-1634 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my accoutlt or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settle ent Statement A. �.�. �� �, Z ,� `� , �� Borrower Date Seller Date Borrower Borrower Date Seller Date Seller Date Date To the best of my knowledge, the HUD-1 Settlement Sta.tement which I 11ave prepared is a true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction I/C�rT��% �'1/: . — �s� '- �. WCA:1�l�I tl� G: It is a cYinae to knowingly rr�crke false stalements to the United State on this or any otlzer simalar fo�•m. Penalties Upon ��ecefpt ofpayment, a copy of the policy will be for�warded to your conapany. Conviction ca�z include a fine and imprisonnaent. For details see: Title 18 U.S. Code Sections 1001 and Section 1010. �� �;�� rthwest Title Closing date: Parties: Address: Acknowledgement / Disbursement Authorization December 2, 2011 File number: 271-879685 HOUSING AND REDEVELOPMENT ATHORITY IN AND FOR THE CIT1( OF FRIDLEY 561 IRONTON ST NE, FRIDLEY, MN 55432-1634 1. The undersigned Borrowers of the above described property state that they are aware that Northwest Title Agency, Inc. is handling part or all of the closing of the above PROPERTY ADDRESS and that Northwest Title Agency, Inc. cannot give Borrowers any legal advice or counsel in connection with the mortgage or on any other matter. 2. The undersigned Borrowers agree if requested by Lender or Closing Agent, to fulty cooperate and adjust for clerical errors or oversights on any or all closing documentation deemed necessary or desirable in the reasonable discretion of Lender or Closing Agent. The undersigned Borrowers do hereby agree and covenant in order to assure that all documentation executed this date will conform and be acceptable in the market place in the instance of transfer, sale or conveyance. This includes, but is not limited to; typographical errors, omissions, missed or incorrect fees or expenses, verifications, etc. 3. The undersigned Bor e hereby agree to hold Northwest Title Agency, Inc., harmless from any loss due to an incorrect mortga ayoff or assumption information with the exception of additional per diem interest owing becau of te delivery, 4. The undersigned Borrowers acknowledg th t they are aware that the next tax payment for the above referenced property will be due on � . In the event taxes are not escrowed by the lender, it will be the Borrowers res�onsibilitv to remit aavment d9recttv to the countv. Courier Fee / Messenger Authorization I/we, the owner(s)/setler(s)/purchaser(s) of the above referenced property direct that the payoff for our current loan be sent via courier, wire, or overnight to the mortgage company in order for the payoff to meet the payoff deadline. Our new lender package must be overnighted also, therefore, a courier fee is charged. I/we authorize the courier fees that will be charged to us at closing. Recording Service Fee / Document Handling Disclosure The undersigned owner(s)/purchaser(s)/setler(s)/builder(s) of the above referenced property understand that Northwest Title Agency, Inc., may charge a fee to record documents. This fee has been included on the settlement statement. In some cases this charge is combined with another, such as the recording fee, as recording may be done in several steps, by different people, at different times. �-�-.�- -�� ��� SS# �Fl - � �744�� / Signature Signature Phone: (Home) S$# (work)1� 3— 5?Z-359 % ' ��. � :�. rthwest Title ' Correction Agreement - Limited Power Of Attorney Borrower: Settlement Date: Property Address: Order Number: HOUSING AND REDEVELOPMENT ATHORIT1( IN AND FOR THE CITY OF FRIDLEY December 2, 2011 561 IRONTON ST NE, FRIDLEY, MN 55432-1634 20-00155869 The undersigned Borrower for and/in consideration for the Lender funding the loan and Northwest Title Agency, Inc. (hereinafter called "Closing Agent") closing the loan, agree that if requested by the Lender and/or assigns, the parties hereto will fully cooperate and adjust all errors involving typographical or clerical matters discovered on any or all of the closing documentation in regard to the loan. The undersigned appoints an officer of Northwest Title Agency, Inc, as their Attorney-In-Fact to correct any such errors and/or sign their initials on documents where changes are made, and/or sign their names to any document or form and may cause this Power of Attorney to be recorded among the land records. In the event that this procedure is utilized, the parties involved shall be notified and receive a corrective copy of the corrected/changed documents from the Lender or the Closing Agent. �� Effective this day of , 20�. ,�..,,� ,� , �,�. Borrower: HOUSING AND REDEVELOPMENT ATHORITY IN AND FOR THE CITY OF FRIDLEY State of MINNESOT�j� County of � I�T �s�� I, the undersigned, a Notary Public, and for the jurisdiction do hereby certify all of the parties who have executed the foregoing instrument bearing the above date, personally appeared before me in my said jurisdiction and produced a Driver's License as proof of identity and acknowl ed the said instrument to be their act and deed, and that they executed the said instrument for the pur o e c tai rein. , . o4T�'�;��; ALLAN F WERLING Notary Public ;�'j NOTARY PUBLIC �� MINNESOTA �''�f„*„f�e�e±;;;:�'� My Commiesion Expires Jan.31, 2015 ���.. �� rthwest Title #��: Certificate of Visual Verification of Identification FHA #: 271-879685 Notary's Verification of Identification Instructions: Use this form when facilities to capture and return an ima�e of a photo ID are not available during the closing. Return with other signed closing documents. I hereby certify that I, the undersigned notary, am conducting a loan signing for Northwest Title Agency, Inc. and that I have seen two different forms of identification from the borrowers and that the information contained herein is correct. Address of property to be purchased: 561 IRONTON ST NE, FRIDLEY, MN 55432-1634 Copy the following information from each borrower's license or government ID: Driver's License #: �� �b�� e3 ���i� Issue Date: �°(�� ( Social Security #: - - �� "' �� �1' ' "' Expire Date: i� (�( c�%� Borrower Signature .,.�-� A 13•��== Date: / 2/z 1/1 HOUSING AND REDEVELOPMENT ATHORITY IN AND FOR THE CITY OF FRIDLEY Driver's License #: Social Security #: Borrower Signature Driver's License #: Social Security #: Borrower Signature Driver's License #: Social Security #: � Borrower Signature e Notary Signature Issue Date: Expire Date: Date: Issue Date: Expire Date: Date: Issue Date: Expire Date: Date: r '. �,(L N� I Z�� \ rinted Name Date Northwest Title Agency, Inc. mall�titlemaster.com Z125 2"d St, Ste 200, White Bear Lake, MN 55110-3509 P:651-490-9056 Fax:651•490-9002 � State of County o MINNESOTA ss. Affidavit Regarding Corporation f k� ���'��' File #: 20-00155869 HOUSING St REDEVELOPMENT AUTHORITY IN &t FOR THE CITY OF FRIDELYbeing first duly sworn, on oath say(s) that: 1. (They are)(_he is) the and the respectively of a MINNESOTA corporation, the corporation named as grantee in the document dated and filed for record on as Document No. (or in the Book Page ) in the Office of (County Recorder) (Registrar of Titles) of ANOKA County, MINNESOTA. 2. Said corporation's principal place(s) of business during the last ten years hav been at: Years Address N`� � j� �'1,� ��i F 2►�C,Cr_ �Vyj�..� SS ��Z �� � r � � 3. There has been no: a. Bankruptcy or dissolution proceedings involving said corporation during the time period in which said corporation had any interes i the premises described above in the document ("Premises"); b �, b. Unsatisfied judgments of record against said corporation, nor to your Affiant(s) knowledge, any actions pending in any courts, which affect the Premises; c. Ta�c l9ens against said corporation; � J�� except as herein stated: 4. Any bankruptcy or dissolution proceedings of record against corporation with the same or similar names, during the time period in which the above named corporation had any interest in the Premises, are not against the above named corporation. 5. Any judgments, or tax liens of record against parties with the same or similar names are not against the above named corporation . 6. Said corporation has not ordered or arranged for any labor or mat�rials to be furnished to the Premises for which payment has not been made. �y}��..-� 7. There are no unrecorded contracts, leases, easements�r other agreements or interests relating to the Premises, except as state herein: �U �. 8. There are no persons in possession of any portion of the Premises of which the Affiant(s) (has) (have) knowledge, other than pursuant to a recorded document, except as stated herein: �Udr�.�Q/ 9. There are no encroachments or boundary line questions affecting the Premises of which Afficant(s) (has) (have) knowledge. 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. On this date � I �� � subscribed and sworn before me: � S9gnature of notary pu lic or other official Notorial stamp or seal (or other title rank): p4���T�, ALLAN F WERLING :�(� ��: NOTARY PUBLIC n,, MINNESOTA "'9f.�;eee►,.�••''�`My Commisslon Expiras Jen.31, 2015 This instrument was drafted by: Northwest Title Agency, Inc., 0 � HOUSING & REDEVELOPMENT AUTHORITY IN & FOR THE CITY OF FRIDLEY FHA/Case#: 271-879685 .