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MINNESOTA Department of Revenue <br /> Certificate of Real Estate Value <br /> <br />Buyers' last namels), first, middle initial <br />Kincanon, Richard F. <br />Chuba, Dennis G. <br /> <br /> Address <br />317 Main st. <br />Elk River, Mn 55303 <br /> <br />Daytime phone <br /> <br />Daytime phone <br /> <br />Sellers' last name(s), first, middle initial New address <br /> One Edge Way <br />Shay, Timothy D. and Jennifer Northboro, Ma 01532 <br />Street address or rural route of properly purchased City or township County <br />xxx Highway 10 ElK River Sherburne <br />~'~] Dote of deed or controcl Legal descriplion of property purchased (lot, block and phi, or attach 3 copies of the legal description} <br />11/22/95 see attached <br /> <br />Financial arrangements Wa, p, ersona properly such as furniture inventory or equipment included in the pu[~chase, pr, ice? If yes, [] yes ~ no <br />~ Joia[ purchase price describe below and list current (not rep ocement value.(Ose the back of th s page iT neeaea. <br /> <br /> 45,000.00 $ $ <br />~'] Down payment <br /> 15,00Q.00 $ $ <br />~t, Points or prepaid interesl paid by seller <br /> $ $ <br /> <br />Type of acquisition (check all that apply) <br />Buyer and seller a~e relalives or hansaclion involved the trade of <br />rela,ed bust ....... [ I propa,,y <br /> <br />Property is a gift or inherilance ~] Buyer is a religious or charitable <br /> organization <br /> <br />~ Type of property transferred (check all that apply) <br />[] Land only [] Land and buildings <br /> <br />Total personal property <br />current value: <br /> <br />~S <br /> <br />Buyer is a unit of government <br /> <br />Condemnation or Ioredosure <br />lransaclion <br /> <br />Payotf or resale of contract <br /> <br />] Construction of a new building <br /> afle,' Jonuae/1 of year of sole <br /> <br />[ZI N .... tided ~o or cc-owner' ...... <br /> removed from deed (not o sole) <br />] Buyer purchased parlial interest only <br />[] Purchase a~,reement si~ned over two <br /> years ago.lear sJgnea: <br /> <br /> ~ Planned use of property (check one) <br />] Residential single family If you check one of lhe four boxes be(ow, you must complele schedule PE-20A and altach it 1o this certificate. <br /> <br />[-~ Residential duplex, lriplex [~J Agricultural Itype o~ bust ..... <br /> (number of acres:) ~ ___ J~J Commercia~-induslrial <br />] Cabin or recreational <br /> ( .......... iai) [] Apartment building [] Olher (describe:) <br /> (number of units:) <br /> <br />Will Ibis properly be Ihe buyer's principal residence?[~j yes J._~] no <br /> <br /> Method of financing (complete only if seller-financed, including a contract for deed or assumed mortgage) <br /> <br /> Check: Me,gage or conlract for deed Monthl~ paymenl for Inlerest role Total number Dale of any lump sum <br /> Assumed Conlracl amount at purchase pdncipalandinteresl now in effect ofpoymenls (balloon) payments <br /> Morlgoge for Deed <br /> <br /> I declare thai lhe information on Ibis form is true, cor~ectJand complete lo the best gf my'~nowledge and belief. _ <br /> <br /> A .... I ~ii!~]e ICER I~RP RIM I Use I Deed tYr ]Land ' (Bid9 <br /> ~-.__L__ ~- [ ~ ~ [ ..... J -__ .... ~ Secondary parcel idenlificalion # <br /> <br /> Good for study ~.] yes~ no I~ no, give reason/code b <br /> <br /> x H~ §f I A,Ji~ jAdi; ....... US,, Tillable EMV Api-- -- ['FM--c <br /> d <br /> <br /> Are there more porc.ls~ y.s [] no [] <br /> S~ock No 6000~00 <br /> Irev' 7/951 DEPARTMENT OF REVENUE COPY 0 0 3 8 8 5 <br /> <br /> ~ Buyers' 50¢i~1Se¢urit~ numbers (or ~irmesok= or federal I.D. numbers) [] Seller*' ~xial Sec~rily numbers (or Minnesota er federal I.D. n~mbers) <br /> 3 <br /> <br /> 3 <br /> <br />Stock No. 6000400 <br />Jrev. 7/95) <br /> <br />DEPARTMENT OF REVENUE COPY <br /> <br />003885 <br /> <br /> <br />