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<br />Audilor \Tse only
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<br />MINNESOTA Department of Revenue I
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<br />Certifi~~te ofR';al Estate Value----'-------'- PE-~.
<br />B~y;~s' la~t:;~~;;:;;(sl. finr, middle initiol .---Aid~~~----~-'--- Daytime phone - --(~f2.)----
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<br />-CrTY.-.oLA...lCJ2~lbb-5__ L'150 [.jfST 1-I/6:rjvJl'iL'31z.MIlNJJ",I,S,I'>1N..,SSJ,Z G"'~-5r.,7(c,
<br />Sellers' last nome(sl, first, middle initial I < lra::r; New address -r:: Daytime phone I
<br />''-'7 NOr.." OIu t"-'l-t'-... Colt.-
<br />-.Sb~.WRT<ON ~ /-J.....V,:>,('1N SSlL-z,., 033-'1'ctJ__
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<br />Stc"'Od&e;;oz:;~:;;pro7!;;'~;A-.A/ 621-)(5', (]~/U?r ~_,--.A~~~sE~t-\s~'f I
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<br />,11 Date of deed or controd Legal description of property pur:hased [lot, block and plat, or Q~ach 3 copies of the legal de5crip~ion)
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<br />. . Lor.s- ~l..t:JLK.2. ..z:~/f)1..4j/ 0)9-/(,5 (JoaRT I
<br />Financial arrangements Was Renanol property such as flJrniture, inventory or equipment included lI'l the purchase price? jf yes, ! yes K'" no
<br />2- : T I h . describe below and list current (not reolacement) value. (Use the back of this page if needed_) - L-.c
<br />. : ota purc ase price .
<br />3 ~:-:::::,'- $ $ I
<br />$._~__ :l_._ Total personal properry
<br />4 Po;'" or prepa;d ;"."" pa;d by ,ellee '."''''' ,oloe, I
<br />__ $ ...,~ $ r5$~(),()L)O
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<br />.6' Type of ocquisition (check all thot apply)
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<br />:1. Buyer and seller are relatives or Ii Transadon involved the trade of D' B ' 't f ~ ;~ Name added to or cc;..owner's name I
<br />_.__J related businesses L property i uyer IS a unl 0 govern mer. '~ removed from deed (not a sale)
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<br />V Properry is a gift or inheritance D Buyer is a religious or charitob:e =:J Conden:nation or foreclosure Buyer purchased partial interest only
<br />h ' organizatiot1 transaction
<br />i Payoff or resale of contract ;1 Purchase agreem":nt signed over tw"
<br />~ ~ years ogo_ Year signed:
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<br />il Type of property transferred (check all thaI apply)
<br />."\7; land only u: ! land and buildings ~ Cons~ruction of a new building I
<br />t:'V __ after January 1 of year of sale
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<br />8 Planned use of property (check one)
<br />. Residential single family If you check one of the four boxes below, you must complete schedule PE-20A and attach it 10 this certificate. I
<br />i Residen~ial duplex tri lex Agricultural -I Commercial.-industrial
<br />, P (number of acres: I L-J (type of bUSiness:)
<br />- Cobin or recr~otioncl r--I Apartment buildin -----:v L?
<br />- (norH:ommerclol)___: (number of units:1 9 __ ~........ Other (describe:) L"[lL1J2_l:~<2_Z __ ____
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<br />VIii! this property be the buyer's principal residence?Lj yes [J no I
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<br />Method of finoncing (complete only if seller.finonced, including a contract for deed or assumed mortgage) I
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<br />Check: MOrtgage or centract for deed Man~hly paymen~ for Interest rate Total nurr.ber Dote of any lump sum
<br />A,sumed Controcl amount at purchase principal and interest now in effect of payments (balloon) pcymen~s
<br />Mortgage for Deed
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<br />9; 0 ::::::: I
<br />10:..J D __'_
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<br />~9e<:lare Ihat the information on this form is tru,e, carred, and co~plete 10 the best of my knowledge and belief.. .
<br />Name (pnntor typel Signature Phone Dote
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<br />Co!~ C i Yr Bit [SO Yr 'lend ! Bldg ITor i Primary proper:y idenlification #
<br />OT I 1 I I
<br />Acre~ I Tllloble jTE=r U,. ,D.od lYe la"d J Bldg ,To' '- .
<br />I I '. 1.1, ' Seoo"docy,oeo.l;d",,",o"'", ..
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<br />Good for .tudy 0 yes 0 no If MO, g;"e reo,on/code .. b
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<br />~A:- I c,~ I .MV 12-~ IID---~d I
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