HomeMy WebLinkAboutRIGHT OF WAY DEED, PROPERTY OWNER'S AFFIDAVIT, IRS REPORTING FORM, SETTLEMENT & DISBURSEMENT STATEMENT FOR PROJECT NHOOO-0520-01 (017), RICHMOND COUNTY � � . . .
Book 01311:1915 Augusta - Richmond County
2011034479 08/17/2011 12:45:47.00
$0.00 RIGHT OF WAY DEED
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2011034479 Augusta - Richmond County
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GEORGIA DEPARTMENT OF TRANSPORTATION
RIGHT OF WAY DEED
$01 Highway 15 South, Tennille, GA 31089-0008
GEORGIA, RIGHMOND COUNTY PROJECT NO. NH000-0520-01 (017)
P.I.NO. 210700
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THIS CONVEYANCE made and executed the � day of ��� ,� + , 20 �.
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WITNESSETH that AUGUSTA GEORGIA, the undersigned, (hereinafter referred to as 'Grantor'), is the
owner of a tract of land in RICHMOND County through which I-520 WIDENING AND INTERSECTION
IMPROVEMENTS AT GORDON HIGHWAY AND DEANS BRIDGE ROAD, known as Project No. NH000-
0520-01 (017), has been laid out by the Department of Transportation being more particularly described
in a map and drawing of said road in the office of the Department of Transportation, 600 West Peachtree
Street, Atlanta, Georgia, to which reference is hereby made.
NOW, THEREFORE, in consideration of the benefit to said property by the construction and
maintenance of said road, and in consideration of ONE DOLLAR ($1.00), in hand paid, the receipt
whereof is hereby acknowledged, Grantor does hereby grant, sell and convey to said Department of
Transportation, and their successors in office so much land as to make a right of way for said road as
surveyed, being more particularly described as follows:
All that tract or parcel of land lying and being in Land Lot N/A of the N/A Land District and/or 89th
Georgia Militia District of Richmond County, Georgia, and being more particularly described on Exhibit "A"
attached hereto and made a part hereto by this reference.
Said right of way is hereby conveyed, consisting of 0.171 acres, more or less, as shown colored yellow
on the plat of the property prepared by the Department of Transportation, dated September 25, 2009;
revised June 17, 2011, said plat attached hereto and made a part of this deed as Exhibit "B".
For the same consideration Grantor hereby conveys and relinquishes to the Department of
Transportation all rights of access between the limited access highway and approaches thereto on the
above n,umbered highway project and Grantor's remaining real property from which said right of way is
taken except at such points as designated and shown on the attached plat prepared by the Department of
Transportation said right being 539.47 linear feet.
Parcel No. 9
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Book 01311:1916 Augusta - Richmond County
2011034479 08/17/2011 12:45:47.00
TO HAVE AND TO HOLD the said conveyed premises in fee simple and any rights Grantor has or may
have in and to existing public rights of way are hereby quitclaimed and conveyed unto the Department of
Transportation. Grantor hereby warrants that Grantor has the right to sell and convey said land and bind
himself, his heirs, executors and administrators forever to defend by virtue of these presents.
IN WITNESSETH WHEREOF, Grantor has hereunto set his hand and seal the day above written.
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Signed, Se led and Deli ered � �-.� R (L.S.)
this _���day of � > FOR: AUGUSTA GEORGIA
20 /r , in the pres e of: ���
�/�/�r
.-�� ( L. S. )
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Notary � � _ � �
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�I C��.�+ ��� ti o A a �,� Parcel No. 9
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1 G y �uly 1
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DOT118
Revised 1/00
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Book 01311:1917 Augusta - Richmond County
2011034479 08/17/2011 12:45:47.00
EXHIBIT "A"
PROJECT NO.: NH000-0520-01 (017) Richmond County
P. I. NO.: 210700
PARCEL NO.: 9
DATE OF RNV PLANS: September 25, 2009
REVISION DATE: June 17, 2011 Page 1 of 1
All that tract or parcel of land lying and being in Land Lot N/A of the N/A Land District and/or 89TH
Georgia Militia District of Richmond County, Georgia, being more particularly described as follows:
Beginning at a point 82.00 feet left of and opposite Station 2046+64.41 on the construction centerline of
Deans Bridge Road on Georgia Highway Project No. NH000-0520-01 (017); running thence N 62°46'47"
E a distance of 25.59 feet to a point 82.00 feet left of and opposite station 2046+90.00 on said
construction centerline laid out for Deans Bridge Road; thence S 27°13'13" E a distance of 8.70 feet to a
point 73.30 feet left of and opposite station 2046+90.00 on said construction centerline laid out for Deans
Bridge Road; thence northeasterly 63.88 feet along the arc of a curve (said curve having a radius of
618.51 feet and a chord distance of 63.85 feet on a bearing of N 65°44'18" E) to the point 70.00 feet left
of and opposite station 2047+53.77 on said construction centerline laid out for Deans Bridge Road;
thence N 62°46'47" E a distance of 146.23 feet to a point 70.00 feet feft of and opposite station
2049+00.00 on said construction centerline laid out for Deans Bridge Road; thence S 27°13'13" E a
distance of 4.00 feet to a point 66.00 feet left of and opposite station 204�J+00.00 on said construction
centerline laid out for Deans Bridge Road; thence N 62°46'47" E a distance of 245.00 feet to a point 66.00
feet left of and opposite station 2051+45.00 on said construction centerline laid out for Deans Bridge
Road; thence N 15°13'11" E a distance of 46.07 feet to a point 100.00 feet left of and opposite station
2051+76.09 on said construction centerline laid out for Deans Bridge Road; thence S 27°41'11" E a
distance of 12.06 feet to a point 87.94 feet left of and opposite station 2051+76.19 on said construction
centerline laid out for Deans Bridge Road; thence S 8°54'47" W a distance of 50.37 feet to a point 47.26
feet left of and opposite station 2051+46.49 on said construction centerline laid out for Deans Bridge
Road; thence S 62°50'30" W a distance of 326.33 feet to a point 47.61 feet left of and opposite station
2048+20.16 on said construction centerline laid out for Deans Bridge Road; thence N 27°09'30" W a
distance of 20.00 feet to a point 67.61 feet left of and opposite station 2048+20.18 on said construction
centerline laid out for Deans Bridge Road; thence S 62°50'30" W a distance of 135.81 feet to a point
67.76 feet left of and opposite station 2046+84.37 on said construction centerline laid out for Deans
Bridge Road; thence N 81°42'17" W a distance of 24.52 feet back to the point of beginning. Containing
0.171 acres more or less.
ALSO, granted is the right to construct and maintain any required slopes and utilities within the easement
area shown colored orange on the attached plat.
ALSO, said described access rights being shown colored red on the attached plat.
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CLOSING STATEMENT
Purchaser: Georgia Department of Transportation
Seller: Augusta, Georgia
Property: Parcel9 of the I-520 widening and interchange improvements at Gordon
Highway and Deans Bridge Road consisting of 0.171 acres in fee and 7,455.68 sq.
ft. of easement, and 539.47 feet of access rights on Georgia Highway Project No.
NH000-0520-01 (017). Property Location — 3125 Deans Bridge Road.
Purchase Price: $350,622.40
Balance to Seller: $350,622.40
Conveyance of Right of Way is delivered herewith this _�day of !.7 ��, 2011.
AUGUSTA, GEORGIA
� �,��� �
���' BY: QX vL� /
� � � �S
£ �S3 4 �.d9��� � ��-� Mayor
ATT T: . `�� ' a�� ��4 ��q� �l
� .�a
�,
t �
(L.S.)
erk of Co 'ssion " �
,�
Mailing Address:
530 Greene Street ��--.��
Augusta, Georgia 30901
ames unkett
Cl�i g Attorney
SETTLEMENT & DISBURSEMENT STATEMENT
OWNER(S) NAME: AUGUSTA GEORGIA
ADDRESS or LOCAT[ON OF PROPERTY: 3125 DEANS BRIDGE ROAD, AUGUSTA GEORGIA
(1) GROSS PROCEEDS TO SELLER: $ 350,622.40
(2) CURRENT COUNTY TAXES: $
(3) CURRENT CITY TAXES: $
(4) MORTGAGE PREPAYMENT PENALTY: $
(5) RELEASE OF MORTGAGE FEE: $
(6) RETENTION VALUE OF IMPROVEMENTS: $
(7) PERFORMANCE BOND: $
(8) PAYMENT(S) TO OTHER PARTIES:
a. $
b. $
c. $
d. $
TOTAL (Line 8) $
(9) TOTAL DISBURSEMENTS (LINES 2 THROUGH 8): $ 0.00
(10) SUB-TOTAL (LINE 1 LESS LINE 9): $ 350,622.40
(l l) REIMBURSEABLE EXPENSES FOR TRANSFERRING TITLE:
a. PRO-RATA SHARE TAXES (LINES 2& 3): $
b. MORTGACE PREPAYMENT/RELEASE FEE (LINES 4& 5): $
c. OTHER APPLICABLE EXPENSES (LINE 8): $
(12) TOTAL REIMBURSABLE EXPEIYSES (LIIVES 11 a, b,& c): $
(13)NET PROCEEDS TO SELLER (LINE 10 PLUS LINE 12): $ 350,622.40
***:��*�xX�x*�*�*x*�**�**���,����**:�*��**����*�**���*x**,�*x�*x��x*:��:�x*�*�**�*x�***�****
THE ABOVE [S THE COMPLETE, TRUE AND CORRECT AMOUNT OF FUNDS RECEIVED AND DISBURSED IN
CONNECTION WITH THE ABOVE TRANSACTION. THE SELLER IS HEREBY NOTIFIED BY THIS DOCUMENT TO
PROCEED WITH THE REMOVAL OF ALL ON SITE TRADE FIXTURES A1vD/OR RETAINED IMPROVEMENTS AS
PREVIOUSLY IDENTIFIED AND APROVED BY THE DEPARTMENT. IN THE EVENT THAT THESE ITEMS HAVE
NOT BEEN REMOVED WITHIN 30 CALENDAR DAYS FROM THE DATE OF THIS NOTICE THEY WILL BE
CONSIDERED ABANDONED AND SHALL BE REMOVED AND/OR DEMOLISHED BY THE DEPARTMENT. ( THIS
NOTICE DOES NOT APPLY IF THE SELLER AND/OR OTHER INTERESTS IN POSSESSION ARE CL,ASSIF[ED BY THE
DEPARTMENT AS RELOCATION DISPLACEMENTS. THE REMOVAL OF AND/OR DAMAGE TO ANY PORTION OF
THE PROPERTY NOT RETAINED BY THE SELLER IS UNLAWFUL AND SUCH ACTION WILL BE SUBJECT TO
PROSECUTION BY THE STATE..
A GUSTA GEORGIA
r
�yyj > �� �,1� '�l
� � � �� (S (DATE) (CLOS ICIAL) (DATE)
.�II > > �
(SELLER) (DATE) (TITL )
1VOTE: If taxes are not withheld or were not due and payable at time of closing, seller must submit paid tax receipfs for
reimbursement of their Pro-Rata share to the Georgia Department of Transportation, Office of Right of Way, Relocation
Section, 600 West Peachtree Street, Atlanta, Georgia 30308
, �**x*x���**���:�:�x**:����**:���*�**�������**��*�**�*�:�x����*�**��*�**�:�*�***�*���x�**���,�
D.O.T. USE ONLY
PAYEE: > AUGUSTA GEORGIA $ 350,622.40
3125 DEANS BRIDGE ROAD $
AUCUSTA, GEORGIA 30906 $
$
TOTAL $ 350,622.40
PROJECT NO. NH000-0520-01 (017) RICHMOND COUNTY
PARCEL NO. 9
P.I. NO. 210700-
RO W-527
Rev. 08-01-2010
�PRGJECT NO.: HN000-0520-01 (017) RICHMOND COUNTY
P.I. NO.: 210700-
PARCEL NO.: 9
S.R. NO.: 4
State of Georgia
Department of Transportation
IRS REPORTING INFORMATION
1. Address and/or legal description of conveyed property:
3125 DEANS BRIDGE ROAD, AUGUSTA GEORGIA 30906
2. Residential Property (1 to 4 units): Yes No X
3. Contract Sales Price (Gross Proceeds): $ 350,622.40
4. TAXPAYER IDENTIFICATION NUMBER and Division of Interest:
(Social Security or Employer ldentification)
Seller(s) Name Tax ID Number Division of Interest
AUGUSTA GEORGIA 100%
5. Correct Mailing Address of Seller(s):
3125 DEANS BRIDGE ROAD, AUGUSTA GEORGIA 30906
6. ALLOCATION OF THE GROSS PROCEEDS:
(See Attached Settlement and Disbursement Statement)
or
(See Attached Appraiser's Affidavit — Page 13)
The undersigned acknowledge(s) that the Internal Revenue Service requires the above
transaction to be reported and requires an accurate disclosure of the above information.
The undersigned warrant(s) that the above information is true and correct and
acknowledge(s) that the above information will be submitted to the Internal Revenue
Service with other information required by the Internal Revenue Service concerning the
sale of the above property this date. Under penalties of perjury, I certify that the number
shown on this statement is my correct taxpayer identification number.
AUGUSTA, GEORGIA
fl ��, BY; ,
Date of Closing ��l l� (Seller's Signa ure)
t
Cl in O ia and Title (Seller's Signature)
ROW-572A
Rev. 08-01-2010
PROJECT NO. STP00-0090-02 (023)
P.I. NO.: 222190-
PARCEL NO. 47/48
RICHMOND PROPERTY OWNER'S AFFIDAVIT
GEORGIA, �����'�(X1�COUNTY
Personally appeared before the undersigned attesting officer, duly authorized to administer oaths in said State and County,
James T. Plunkett, who after being duly sworn, deposes and says upon oath:
That affiant is Au�usta Geor�ia of Richmond Countv, the owner in fee simple of the improvements shown on Attachment
"A" hereto.
Further, that the improvements situated on said real estate are within the limits of said described property and that there has
been no violation of any restrictions that may have been imposed on said lands nor has any interest in same been sold or conveyed or
any change made in the improvements thereon since said lands were inspected as aforesaid.
Further, that the owner or owners named above is in indisputable possession of said described lands and knows of no one
claiming under any unrecorded bond for title of any nature of claiming any interest in said lands whatsoever; except as may be set out
below;
Further, that there are no leases, either recorded of record, unrecorded, or otherwise, currently in effect or terminated in
contemplation of the acouisition or purchase by the Georgia Department of Transportation (hereinafter the "Department") of the real
estate shown on Attachment "A" hereto, except as may be set out below;
Further, that there are no suits, judgements, bankruptcies or executions pending against the owner or owners named above in
any court relating to the subject properiy or which could in any way affect the title to said lands or constitute a lien thereon, and that
the owner or owners named above is not surety on the bond of any county or county official or any other bond that through default of
the principal therein a lien would be created superior to the deed mentioned above, nor are there any loan deeds, trust deeds,
mortgages, or liens of any nature whatsoever unsatisfied against said lands except as set out below;
Further, that there are no unpaid bills of any nature either for labor or materials or for architects', surveyors', or other services
rendered or used on the improvement of said real estate, except as set out below, which constitute or might constitute any lien upon
said real estate.
The owner or owners named above for (his/its) part acknowledges that this Affidavit is made and given to the Department in
connection with and for purposes of inducing the Department in its acquisition or purchase of the real estate shown on Attachment
"A" thereto and, further, agrees to indemnify and hold harmless the Department from any and all claims for compensation or benefits
made by any party or individual claiming through or under any interest in the property or business now or formerly situated or
operating on said property, against the Department other than as may be set forth herein below.
AUGUSTA, GEORGIA
Sworn to and � ore me, BY = `-'`�- "' °' ' ( (S.E.A.L.)
this '� �; N� , 20 � �. j��W�
��
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Nota i�, � As � (�,�, - ,�,, . `• .�,� �
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��f; ptije! ::� �� '��'`��' F , �. � (S �.� � .)
r�, � �
t� A C� ..�`' r� ���.��� � � �
tlor`�a.�..'� �� � �
Exceptions: � `• 0 �' �
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,�
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Rev. 08-01-2010
� .` Y"'
��� DEPARTMENT OF TRANSPORTATION
�PTION FOR RIGHT OF WAY
GEORGIA, RICHMOND COUNTY P.I.#: 210700 PARCEL NO.: 9
Received of The Department of Transaortation, the sum of One ($1.00) Dollar, the receipt whereof is hereby acknowledged, and in
� consideration thereof, and in consideration of the benefits derived by me from the proposed project mentioned herein, I bind myself, my heirs,
executors and assigns as follows: �'i ��1���°�
If the said Deaartment of Transnortation, shall within 60 days after date hereof pay me the sum of � when the
undersigned agrees to execute and deliver to the Department of Transportation fee simple title and easements to the land owned by the undersigned,
which is shown reflected in color on the right of way map attached hereto and made a part hereof by reference, to be used for highway purposes
on the I-520 widenine and interchan�e imarovements at Gordon Hiehwav and Deans Brid�e Road being Parcel 9 consisting of 0.171 acres in
fee, and 7 ,455. 68 square feet of easement, and 539.47 feet of access rights on Georgia Highway Project Number NI3000-0520-01 (017).
It is agreed and understood that all TEMPORARY EASEMENTS are limited to the period required for the construction of said project and
upon completion and acceptance of same by the Department of Transportation from the contractor, said TEMPORARY EASEMENT will terminate.
It is agreed and understood that I, or any tenant now in possession or any other persons having a claim or interest in subject property, will
have not less than two (2) months from date of execution of a deed and easements or for residential properties three (3) months from the date
replacement housing is available, whichever is greater to vacate the premises and that on vacating of said premises, only items of personal property
wiil be removed, all items attached to the property and being classed as realty to remain. The above agreement to appiy uniess otherwise provided in
Special Provision. If the Department of Transportation agrees to allow the Grantor or tenant in possession to occupy the subject premises beyond the
two month period stated above, the person will be required to pay a rental fee of $ 0.00, payable each month in advance. Subsequent to the date of
transfer of title to the Department of Transportation and prior to vacation of subject premises, the person in possession will hold the Department
harmless as to any claim in connection with the occupancy of said premises. The above option price includes payment for the right of way above
described, together with all improvements wholly or partially situated thereon and the right to enter upon the adjacent lands not included in said
required Right of Way and Easements for the purpose of removing or demolishing such improvements.
The undersigned further agrees that the Department will be designated an authorized agent for the removal of underground storage tank
systems located wholly or partially in said right of way or easement.
***�**********************�*****�********************+*SPECIAL PROVISION**��***�a�*�*********�**��**********��*���*�*
Grantor may retain title to N/A for sum of $ 0.00 which shall be deducted from the option price at the time of closing; PROVIDED, he will
obligate and firmly bind himself and his successors in title to strictly and faithfully comply with each of the following conditions:
1. Grantor wilt demolish or remove the above described improvements from the right of way, easemenu and set back area and clear said
right of way, easements and set back area from the right of way sufFicient to comply with County Building Code requirements;
however, in the absence of County requirements, a minimum set back of 50 feet is required. All rubbish and debris must be removed
to the satisfactions of authorized personnel of the Department of Transportation within 30 calendar days after notice to proceed.
2. Grantor wil( comply with all laws, ordinances, and regulations of building codes applicable to demolition or removal of buildings in
Georgia and hold the DeparGnent of Transportation and the CITY OF AUGUSTA AND THE CO[JNTY OF RICHMOND
harmless as to any claim in connection therewith.
3. It is understood and agreed that no utility connections shall be made or allowed to relocated structures across or from a limited access
right of way, and it is understood and agreed that grantor has agreed to bazgain, sell and convey to the Department of Transportation
all existing utility rights, and the Department will not be liable in any way for utility reconnections adjacent to acquired rights of way
or any subsequent loca6on of improvements.
4. Grantor will leave on deposit with the Department of Transportation the addi[ional sum of $ 0.00 which will be deducted from the
aforesaid option price at closing. This sum will be held as a cash performance bond co�ditioned on the strict and faithful performance
of the aforesaid obligations.
Time is expressly made of the essence of this Special Provision, and in the event grantor fails to comply with aforesaid obligations, all sums held •
by the Department of Transportation shail be retained as liquidated damages, a��d title to and the riglrt to remove said structure shall vest in the
Department of Transportatian
**�*�********************************�*:x�**�***�**�a�*OTHER PROVISIONS***�***a*�*�:**�**********�**�***********�*******
The above offer includes $I82.SOO.00as cost cure for ParkinF and Maneuverability.
Grantor may execute and deliver fee simple title to the Department of Transportation to the above referenced right of way and an additional 0.00
acres of land owned by the undersigned adjacent to and abutting on the above numbered highway for the total consideration of $ 0.00 which includes
payment for the above referenced right of way requirements, other rights and conditions described herein and additional lands. This additional land
being shown on the attached plat as Pazcel No. N/A.
Page 1 of 2 WT 663-A
Revised: 08-01-20i0
, .
-0 DEPARTMENT OF TRANSPOItTATION
OPTION FOR RIGHT OF WAY
GEORGIA, RICHMOND COUNTY P.I.#: 21070Q PARCEL NO.: 9
The undersigned herein agrees for the same consideration, to provide, without cost to the Department of Transportation, a quit claim deed
or such other releases as may be required by the closing attorney from any tenant now in possession of subject property and any other parties having
a claim or interest in subject property.
It is further agreed for said consideration to convey and relinyuish to the Department of Transportation all rights of access between the
Limited Access Highway and approaches thereto on the above numbered Highway and a11 of the remaining real property of the undersigned except at
such points as designated by the Department of Transportation, This paragraph is not applicable unless access rights are indicated on the attached
plat. s
The said parcel of land as above indicated is shown upon plans on file in the office of the Department of Transportation, Atlanta, Georgia,
said plans being identified as Project Number NHOOO -0520-01 (017).
I(We) do (do not) elect to retain improvements as set out in Special Provision.
,..� t ,��
rt-"`� �wej ao �aa,��x��� to execute and deliver deeds set out in Other Provisions.
,� � �. ; ,^ a<� �� n
b �T K
F� �.��tnessmyhan3�n���thisZ dayof_ "��N� ,20 �� Augusta, Georgia
� .� , � , � � �
�' c ; � o�i
� ' A�teste ��' � �� `�
afi E , f5 ' tf � / ^ 1
i e � V f �
�
Y�� �� C :� � �' .- � - D —
Y � l./� •
� � .
�-� `' � (L. S.) ,�J/� M a y o r
�e ,�/�9p�f
Le� J���`�o� �r�„�,�Clerk of Commission
Signed, Se��� ' � ����(
in the presence of:
_��r►1\wt •
�
�. � G fr'" Q � , .
�.. �`jr • � / � �"�.�G.1 -'�
i p""' = °�
, 0 0 s f � 8�` .�a � Q %
IP ��b z o t�� ACC EPARTMENT OF TRANSPORTATION
G �e�r ,a, �' ��.�> C� � �
r ����7�� °o �����'s BY: � • �'' � � � '� � �
4�� ` ����,�
(Date)
Page 2 Of 2 DOT 663-A
Revised: BS-81-2010