STATE OF MINNESOTA )
)ss. OWNER’S/DEVELOPER’S AFFIDAVIT (Individual)
COUNTY OF ________________ )
_______________________________________________________________________________, being first duly sworn, on oath says that:
1. (S)He is the person named as _______________________ in the document dated ______________, 20____, and filed for record ______________, 20____, as Document No. _____________, (in Book _______ of _______, page _______,) in the office of the (County Recorder or Registrar of Titles) of ________________ County, Minnesota.
2. Said person is of legal age and under no legal disability with place of business at:
and for the last ten (10) years has resided at:
3. There are no:
a. Bankruptcy, divorce or dissolution proceedings involving said person during the time period in which said person has had any interest in the premises described in the above document (“Premises”).
b. Unsatisfied judgments of record against said person, nor any actions pending in any courts which affect the Premises.
c. Tax liens filed against said person. (; except as herein stated:)
4. Any bankruptcy, divorce or dissolution proceedings of record against parties with the same or similar names, during the time period in which the above-named person has had any interest in the Premises, are not against the above-named person.
5. Any judgments or tax liens of record against parties with the same or similar names are not against the above-named person.
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 has knowledge.
10. There is a right of access to the real property from a public right-of-way.
11. Affiant hereby represents and warrants that the Property is free of Hazardous Substances and is not subject to any “Super Fund” type liens or claims by governmental regulatory agencies or other third parties arising from the release or threatened release of Hazardous Substances in, on or about the Property.
For purposes of this Affidavit, “Hazardous Substance” means hazardous waste, toxic substances, polychlorinated biphenyls, asbestos or related materials and also includes, but is not limited to substances defined as “hazardous substances” or “toxic substances” in the Comprehensive Environmental Response Compensation and Liability Act of 1980, 42 U.S.C. Sec. 9601, et. seq. (Federal Superfund Act) as amended by the Superfund Amendments and Re-Authorization Act of 1986 (SARA), Hazardous Materials Transportation Act, 49 U.S.C. Sec. 6901, et. seq., Resource Conservation and Recovery Act, 42 U.S.C. Sec. 6991, et. seq., or as “hazardous substance”, “hazardous waste” or “pollutant or contaminant” in the Environmental Response and Liability Act. MINN. STAT. Sec. 115B.01, et. seq., or the Petroleum Tank Release Cleanup Act, MINN. STAT. Sec. 115C.01, et. seq. The term does include petroleum, including crude oil or any fraction thereof, natural gas, natural gas liquids, liquified natural gas, synthetic gas usable for fuel or mixtures thereof.
12. Affiant has not received any notice from any governmental authority as to a violation of any law, ordinance or regulation. If the property is subject to restrictive covenants, Affiant has not received any notice from any person as to a breach of the covenants. Affiant has not received any notice from any governmental authority as to the existence of any dutch elm disease, oak wilt, or other disease of any trees on the property.
13. Affiant has not received any notice from any governmental authority or public utilities corporation as to a pending public improvement project, the costs of which may be assessed against the property, or as to a proposed taking of all or part of the subject property by exercise of eminent domain, or as to a proposed change in the zoning classification of the subject property.
14. This Affidavit is made contemporaneously with the execution of a Plat and development Contract for the plat of ___________________________________________, or contemporaneously with the execution of an easement deed for a minor subdivision for the following described property:
[Description of fee title dedications]
[Description of easement title dedications]
Affiant knows the matters herein stated are true and makes this Affidavit for the purpose of inducing the passing of title to the _________________.
Subscribed and sworn to before me this ____ day of __________, 20__.
Signature of Notary Public Other Official
THIS INSTRUMENT WAS DRAFTED BY:
City of Columbus
16319 Kettle River Blvd.
Forest Lake, MN 55025
(612) 464-3120