HomeMy WebLinkAbout2990Hennepin County, Minnesota
Mark Chapin
County Auditor and Treasurer
II II I I I
I I I
II I
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Doc No T05567260
Certified, filed and/or recorded on
Oct 9, 2018 2:01 PM
Office of the Registrar of Titles
Hennepin County, Minnesota
Martin McCormick, Registrar of Titles
Mark Chapin, County Auditor and Treasurer
Deputy 98 Pkg ID 1745383E
Document Recording Fee $46.00
Document Total $46.00
Transfer Entered
Oct 9, 2018 2:01 PM
PID(s)
06-116-21-44-0042
Existing Certs
1426890
This cover sheet is now a permanent part of the recorded document.
PIP: 06-116-21-44-0042
GRANT OF TEMPORARY AND PERMANENT EASEMENTS
THIS AGREEMENT made this 5 day of Ma , 2018, by BETTY J.
JOHNSON, TRUSTEE OF THE BETTY J. JOHNSON REVOCABLE TRUST DATED
JUNE 28, 2016, hereinafter referred to as "Grantor", to the CITY OF EDINA, a Minnesota
municipal corporation, the Grantee, hereinafter referred to as "City".
WITNESSETH:
TEMPORARY EASEMENT
The Grantor, in consideration of One Dollar ($1.00) and other good and valuable
consideration to it in hand paid by the City, the receipt and sufficiency of which is hereby
acknowledged, hereby grants unto the City, its successors and assigns a temporary construction
easement over, on, across, under, and through the land situated in the County of Hennepin, State of
Minnesota, as legally described in the attached Exhibit "A" and depicted on the attached Exhibit
"B"("Temporary Construction Easement ").
TO HAVE AND TO HOLD the same, unto the City, its contractors, agents, servants,
successors and assigns, commencing upon execution of this document and expiring October 31,
2019, together with the right of ingress to and egress from the Temporary Construction Easement,
for the purpose of constructing, reconstructing, inspecting, repairing, and maintaining the property
of the City, at the will of the City, its successors and assigns, it being the intention of the parties
hereto that the Grantor hereby grants the uses herein specified without divesting itself of the right to
use and enjoy the above described Temporary Construction Easement, subject only to the right of
the City to use the same for the purposes herein expressed; it being further intentioned by the parties
that if any of the City's activities cause any disruption of the surface of the Temporary Construction
Easement, the City shall cause such surface areas of the Temporary Construction Easement to be
put back in a condition as close as reasonably possible to the condition which existed prior to the
City's activities thereon, provided the City shall not be required to replace any shrubs, bushes, trees
or other vegetation.
197647v1
PERMANENT EASEMENT
FURTHER, the Grantor, in consideration of the additional sum of One Dollar ($1.00) and
other good and valuable consideration to it in hand paid by the City, the receipt and sufficiency of
which is hereby acknowledged, does hereby grant and convey unto the City, its successors and
assigns, forever, a permanent easement for public roadway, sidewalk, drainage and utility purposes
over, across, on, under, and through the land situated in the County of Hennepin, State of
Minnesota, as legally described in the attached Exhibit "A" and depicted on the attached Exhibit
"B" ("Permanent Easement Premises").
INCLUDING the rights of the City, its contractors, agents, servants, and assigns, to enter
upon the Permanent Easement Premises at all reasonable times to construct, reconstruct, inspect,
repair, and maintain said public roadway, sidewalk, drainage and utility systems over, across, on,
under, and through the Permanent Easement Premises, together with the right to grade, level, fill,
drain, pave and excavate the Permanent Easement Premises, and the further right to remove trees,
bushes, undergrowth, and other obstructions interfering with the location, construction, and
maintenance of said public roadway, sidewalk, drainage and utility easements.
The above named Grantor, for itself, its successors and assigns does covenant with the City,
its successors and assigns, that it is well seized in fee title of the above-described easement
premises; that it has the sole right to grant and convey the easements to the City; that there are no
unrecorded interests in the easement premises; and that it will indenmify and hold the City
harmless for any breach of the foregoing covenants.
(Remainder of the page intentionally left blank
Signature page follows)
197647v1 2
IN TESTIMONY WHEREOF, the Grantors hereto have signed this agreement the day
and year first above written.
GRANTOR: BETTY J. JOHNSON,
TRUSTEE OF THE BETTY J.
JOHNSON REVOCABLE TRUST
DATED JUNE 28,2016
By ,c6(ii
Betty J. o on, stee
STATE OF MINNESOTA )
)ss.
COUNTY OF HENNEPIN )
The foregoing instrument was acknowledged before me this r day of in , G
2018, by Betty J. Johnson, Trustee of the Betty J. Johnson Revocable Trust Dated Junk28,
2016, on behalf of the trust.
ELIZABETH A. MOORE
NOTARYPUBLIC•MINNESOTA
My Commission Expires
January 31, 2022
Notary Public
DRAFTED BY:
CAMPBELL KNUTSON
Professional Association
Grand Oak Office Center I
860 Blue Gentian Road, Suite 290
Eagan, MN 55121
Telephone (651) 452-5000
RNK
197647v1
EXHIBIT "A"
TO
GRANT OF TEMPORARY AND PERMANENT EASEMENTS
Legal description of subject property:
Lot 1, Block 1, Braemar Hills Sixth Addition, Hennepin County, Minnesota,
[Property address: 6805 Valley View Road, Edina, Minnesota.]
Legal description of Temporary Construction Easement:
A temporary construction easement over, under, and across that part of the above described
property which lies northwesterly of Line A described as follows:
Line A: Commencing at the northeast corner of said Lot I; thence South 00 degrees 37
minutes 20 seconds East, assumed bearing along the east line thereof, 11.14 feet to the
point of beginning of said line to be hereinafter described; thence South 61 degrees 05
minutes 45 seconds West, 10,96 feet; thence South 09 degrees 21 minutes 39 seconds
East, 28.76 feet; thence South 56 degrees 33 minutes 31 seconds West, 26.08 feet; thence
North 52 degrees 16 minutes 20 seconds West, 29.54 feet; thence South 45 degrees 06
minutes 03 seconds West, 67.23 feet to the west line of said Lot I, and said line there
terminating.
EXCEPT
That part designated for a permanent easement for roadway purposes over, under, and across
that part of the above described property which lies northerly and westerly of the following
described line:
Commencing at the northeast corner of said Lot 1; thence South 00 degrees 37 minutes
20 seconds East, assumed bearing along the east line thereof, 733 feet to the point of
beginning of said line to be hereinafter described; thence South 61 degrees 05 minutes 45
seconds West, 60,44 feet to the northwesterly line of said Lot 1, and said line there
terminating.
Legal description for Permanent Easement:
A permanent easement for public roadway, sidewalk, drainage and utility purposes over,
across, on, under, and through that part of the above described property which lies northerly
and westerly of the following described line:
Commencing at the northeast corner of said Lot 1; thence South 00 degrees 37 minutes
20 seconds East, assumed bearing along the east line thereof, 7.73 feet to the point of
beginning of said line to be hereinafter described; thence South 61 degrees 05 minutes 45
seconds West, 60.44 feet to the northwesterly line of said Lot 1, and said line there
terminating.
197647v1 4
5 1976e17v1
/ CT) , _600'3770-E
I 1.73 , <e- NE CORNER OF SBCF3T2IYE --------%"----....., S.k. LOT 1 [POKE OF A / fIj,41...„,` ......," 'I et 4 COMMENCEMENT) 1 r / 4.- - -'...
£3
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LIJ
CD
/
I ry-r Ltd I
I !VT Al L-V I '+
a 1=1
OWNER: LINDA MAGMA
mess: 6817 VALLEY VIEW RD
PIO: 06-116-21d1-0W3
MIMS:45W
sfi /
r I- nsInt ism"' s V 60.44. 1
k. V
A :C.' . ' NWIX IJNE ,
(-•
N52'1620-W , 2154 e6seq9
akce's4,4
IV LINE _,:ty
94,0,41 OF LOT 1 qr
$1/4 .05111V k'
r
Ykgc`CD\ \ 1/4
0 r. \ CL)
k- ,
_rj \
v (e‘
PONT OF — BEGINNING
°ELMER
I OWNER: Tac soma:moo( I ACORESS: 6E05VALLEY VIEW RD
06-116-21-44-116.43
vI 5I192119-E I n-r- L-L./ I
I I
rt; tc\cir — n
2S55.06-83‘321V
ILAJeThml
111 ‘,_ E LINE
OF LOT 1
J
PERMANENT ROADWAY FAGAMENT Maio. 425 St FT.
TEMPORARYCONSTRUCTION EActFmENT gum. 1,55050 Fr,
•IsniommTm PARCEL UNE
Prepared by
WSJ
Valley View Road
Easement Exhibit
Address: 6805 Valley View Rd
PID: 06-116-21-44-0042
City of Edina, Minnesota
WS8 Prtfed Na. 010516420O Dale.:57118
EXHIBIT "B"
TO
GRANT OF TEMPORARY AND PERMANENT EASEMENTS
PID: 06416-21-44-0042
GRANT OF TEMPORARY AND PERMANENT EASEMENTS
THIS AGREEMENT made this 5 day of Md. , 2018, by BETTY J.
JOHNSON, TRUSTEE OF THE BETTY J. JOHNSON REVOCABLE TRUST DATED
JUNE 28, 2016, hereinafter referred to as "Grantor", to the CITY OF EDINA, a Minnesota
municipal corporation, the Grantee, hereinafter referred to as "City".
WITNESSETH:
TEMPORARY EASEMENT
The Grantor, in consideration of One Dollar ($1.00) and other good and valuable
consideration to it in hand paid by the City, the receipt and sufficiency of which is hereby
acknowledged, hereby grants unto the City, its successors and assigns a temporary construction
easement over, on, across, under, and through the land situated in the County of Hennepin, State of
Minnesota, as legally described in the attached Exhibit "A" and depicted on the attached Exhibit
"B"("Temporary Construction Easement ").
TO HAVE AND TO HOLD the same, unto the City, its contractors, agents, servants,
successors and assigns, commencing upon execution of this document and expiring October 31,
2019, together with the right of ingress to and egress from the Temporary Construction Easement,
for the purpose of constructing, reconstructing, inspecting, repairing, and maintaining the property
of the City, at the will of the City, its successors and assigns, it being the intention of the parties
hereto that the Grantor hereby grants the uses herein specified without divesting itself of the right to
use and enjoy the above described Temporary Construction Easement, subject only to the right of
the City to use the same for the purposes herein expressed; it being further intentioned by the parties
that if any of the City's activities cause any disruption of the surface of the Temporary Construction
Easement, the City shall cause such surface areas of the Temporary Construction Easement to be
put back in a condition as close as reasonably possible to the condition which existed prior to the
City's activities thereon, provided the City shall not be required to replace any shrubs, bushes, trees
or other vegetation.
197647v1
PERMANENT EASEMENT
FURTHER, the Grantor, in consideration of the additional sum of One Dollar ($1.00) and
other good and valuable consideration to it in hand paid by the City, the receipt and sufficiency of
which is hereby acknowledged, does hereby grant and convey unto the City, its successors and
assigns, forever, a permanent easement for public roadway, sidewalk, drainage and utility purposes
over, across, on, under, and through the land situated in the County of Hennepin, State of
Minnesota, as legally described in the attached Exhibit "A" and depicted on the attached Exhibit
"B" ("Permanent Easement Premises").
INCLUDING the rights of the City, its contractors, agents, servants, and assigns, to enter
upon the Permanent Easement Premises at all reasonable times to construct, reconstruct, inspect,
repair, and maintain said public roadway, sidewalk, drainage and utility systems over, across, on,
under, and through the Permanent Easement Premises, together with the right to grade, level, fill,
drain, pave and excavate the Permanent Easement Premises, and the further right to remove trees,
bushes, undergrowth, and other obstructions interfering with the location, construction, and
maintenance of said public roadway, sidewalk, drainage and utility easements.
The above named Grantor, for itself, its successors and assigns does covenant with the City,
its successors and assigns, that it is well seized in fee title of the above-described easement
premises; that it has the sole right to grant and convey the easements to the City; that there are no
unrecorded interests in the easement premises; and that it will indemnify and hold the City
harmless for any breach of the foregoing covenants.
(Remainder of the page intentionally left blank
Signature page follows.)
197647v1 2
IN TESTIMONY WHEREOF, the Grantors hereto have signed this agreement the day
and year first above written.
GRANTOR: BETTY J. JOHNSON,
TRUSTEE OF THE BETTY J.
JOHNSON REVOCABLE TRUST
DATED JUNE 28, 2016
By
STATE OF MINNESOTA )
)ss.
COUNTY OF HENNEPIN )
The foregoing instrument was acknowledged before me this 5tin day of i , n G
2018, by Betty J. Johnson, Trustee of the Betty J. Johnson Revocable Trust Dated JunI 28,
2016, on behalf of the trust.
ELIZABETH A. MOORE
NOTARY PUBLIC •MINNESOTA
My Commission Expires
January 31, 2022
DRAFTED BY:
CAMPBELL ENUTSON
ProfessionalAssociation
Grand Oak Office Center I
860 Blue Gentian Road, Suite 290
Eagan, MN 55121
Telephone (651) 452-5000
RNK
197647v 3
tWirriL Notary Public
EXHIBIT "A"
TO
GRANT OF TEMPORARY AM) PERMANENT EASEMENTS
Legal description of subject property:
Lot 1, Block 1, Braemar Hills Sixth Addition, Hennepin County, Minnesota.
[Property address: 6805 Valley View Road, Edina, Minnesota.]
Legal description of Temporary Construction Easement:
A temporary construction easement over, under, and across that part of the above described
property which lies northwesterly of Line A described as follows:
Line A: Commencing at the northeast corner of said Lot 1; thence South 00 degrees 37
minutes 20 seconds East, assumed bearing along the east line thereof, 11.14 feet to the
point of beginning of said line to be hereinafter described; thence South 61 degrees 05
minutes 45 seconds West, 10.96 feet; thence South 09 degrees 21 minutes 39 seconds
East, 28.76 feet; thence South 56 degrees 33 minutes 31 seconds West, 26.08 feet; thence
North 52 degrees 16 minutes 20 seconds West, 29.54 feet; thence South 45 degrees 06
minutes 03 seconds West, 67.23 feet to the west line of said Lot 1, and said line there
terminating.
EXCEPT
That part designated for a permanent easement for roadway purposes over, under, and across
that part of the above described property which lies northerly and westerly of the following
described line:
Commencing at the northeast corner of said Lot 1; thence South 00 degrees 37 minutes
20 seconds East, assumed bearing along the east line thereof, 7.73 feet to the point of
beginning of said line to be hereinafter described; thence South 61 degrees 05 minutes 45
seconds West, 60.44 feet to the northwesterly line of said Lot 1, and said line there
terminating.
Legal description for Permanent Easement:
A permanent easement for public roadway, sidewalk, drainage and utility purposes over,
across, on, under, and through that part of the above described property which lies northerly
and westerly of the following described line:
Commencing at the northeast corner of said Lot 1; thence South 00 degrees 37 minutes
20 seconds East, assumed bearing along the east line thereof, 7.73 feet to the point of
beginning of said line to be hereinafter described; thence South 61 degrees 05 minutes 45
seconds West, 60.44 feet to the northwesterly line of said Lot 1, and said line there
terminating.
L97647v1 4
5 197647v1
/
.g..(:c.)NE CORNER OF
_1300•372ITE
7.73
,..ct‘l.„ LOT 1 (POINT OF
.1/4C, COMMENCEMENT) r r 141
651115'451V_
Cc S61'0515'W
66.41
NWLY LINE -k
4.1
n
Z)j
N52•1620VY. ,SFO
29.54
aa
0.4*
W UNE AO'
OF LOT 1 .jr 9..r$ (-I.
4'C' Cr ti 0' /
N
)
10.96 r `- POINT OF
- — REGINNING
OF LINEA
I OWNER: T B C SCHWARZROCK
ADDRESS: 6603 VALLEY VIEW RD
PIO: 06-116-21-44-0843
369'21'39'E i c1,-
128.75 LA2 I
I 44 - "▪ L.1 _J
• C 0.
S56'33'31'W
26.08
• L 0 T
E UNE
OF LOT 1
L
1
J
r I ITh-f-L.1-) I
I iM-L _Li I A •-i
LINDAMASICA
IDRESS: 6817 VALLEY VIEW RD
no: 06-116-21-44-OG03 C„)
A
8
=MN
15
//,/ PERMANENT ROADWAY EASEMENT AREA- 423 SO_ FT.
TEMPORARY CONSTRUCTION EASEMENT AREA - 1.550 SO_ FT.
PARCEL UNE
Prepared or.
MY3
Valley View Road
Easement Exhibit
Address: 6B05 Valley View Rd
Pit): 06-116-21-44-0042
City of Edina, Minnesota
Ma Protect No. 010516 cm Oale: 5/7118
EXHIBIT "B"
TO
GRANT OF TEMPORARY AND PERMANENT EASEMENTS
II II
II I I I I I
II I
I I
I II
Doc No T05567261
Certified, filed and/or recorded on
Oct 9, 2018 2:01 PM
Office of the Registrar of Titles
Hennepin County, Minnesota
Martin McCormick, Registrar of Titles
Mark Chapin, County Auditor and Treasurer
Deputy 98 Pkg ID 1745383E
Document Recording Fee $46.00
Existing Certs
1426890
Document Total
Referenced Docs
5567260/Easement
$46.00
This cover sheet is now a permanent part of the recorded document.
(Top 3 inches reserved for recording data)
AFFIDAVIT OF TRUSTEE (inter vivos Trust) Minnesota Uniform Conveyancing Blanks
Minn. Stat. 501C,1014 Form 90.1.3 (2017)
State of Minnesota, County of Hennepin
Betty J. Johnson being first duly sworn on oath states, or
affirms under penalties of perjury, that:
1. Affiant is the trustee (one of the trustees) named in that certain Certificate of Trust (or trust instrument):
(chock ono box) 8.1 to which this Affidavit is attached.
q recorded as Document Number
(rnontWday/year)
(or in Book of Page 1 in the
Office of the m County Recorder Li Registrar of Titles of County, Minnesota,
(check the applicable boxes)
executed by Affiant or another trustee or the settlor of the (rust described in the Certificate of Trust (or set forth in the trust instrument), which
relates to real property in Hennepin County, Minnesota, legally described as follows:
Lot 1, BI ock 1, Braemar Hills Sixth Addition
PID No. 06-116-21-44-0042
(!(more space Is needed. mantle on an attachment.)
2. The name(s) and address(es) of the trustee(s) empowered by the trust Instrument to act at the time of the execution of this Affidavit are
as follows:
Betty J, Johnson
6805 Valley View Road
Edina, Minnesota 55439
Page 1 of 2
Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 90.1.3
3. The trustee(s) who have executed that certain Instrument (deed, mortgage, or other conveyance), relating to the real property
described above, between Betty J. Johnson as trustee(s),
and City of Edina, a Minnesota municipal corporation
which Instrument Is dated May 5, 2018 (a) are empowered by the provisions of the Trust to sell, convey, pledge,
(mon1Wday/yeal)
mortgage, lease, transfer title to, or release, any interest in real property held in trust; and (b) are the requisite number of trustees required by
the trust Instrument to execute and deliver such an Instrument.
4.
pack one box) GO The trust has not terminated and trust instrument has not been revoked.
0 The trust has terminated (or the trust instrument has been revoked). The execution and delivery of the instrument
described in paragraph 3 has been made pursuant to the provisions of the trust.
5. There has been no amendment to the trust that limits the power of trustee(s) to execute and deliver the instrument described in
paragraph 3.
6.
(check one box) 56 The trust is not supervised by any court.
0 The trust Is supervised by the Court of
County, . All necessary approval has been obtained
from the court for the trustee(s) to execute and deliver the instrument described In paragraph 3.
7. Affiant does not have actual knowledge of any facts indicating the trust Is invalid.
Signed and sworn to (or affirmed) before me on September 9R 2018 by Betty J. Johnson
(monliWaylyear)
VALE IE A EDERICK
Notary Public-Minnesota
My Commlaelon Expires an SI, 2020
THIS INSTRUMENT WAS DRAFTED BY:
(Wolf name end address)
Orlin Te Slaa
Walsten & Te Slaa, P.A.
79000 Xerxes Avenue S., Ste. 2000
Bloomington, Minnesota 55431
952-896-5100
(nosed name asMan( making stalemen0
;t0 1,4,14C(1%
(signature of notarial officer)
Title (and Rank): ilia+ a r>, A /13 I la
My commission expires: C;n. 3c -200)0
(month/day/year)
M
ggI
(Top 3 inches reserved for recording data)
CERTIFICATE OF TRUST Minnesota Uniform Conveyancing Blanks
by Individual Form 90.1.1 (2016)
Minn. Stat, 501C.1013
Slate of Minnesota, County of Hennepin
Betty J. Johnson being
first duly sworn on oath states, or affirms under penalties of perjury, that:
1. The name of the trust, if one is given, is: Betty J. Johnson Revocable Trust
2. The date of the trust Instrument is: June 28 2016
3. The name and address of each trustee empowered to act under the trust instrument at the time of execution of this Certificate of
Trust is:
Betty J. Johnson
6805 Valley View Road
Edina, Minnesota 55439
4. The trustees are authorized by the trust Instrument to sell, convey, pledge, mortgage, lease, or transfer title to any Interest In real
or personal property, except as limited by the following: (If none, so Indicate)
None
5. The number of trustees required to act is: one
6. The trust CI has El has not been terminated.
(check one box)
The trust instrument U has RI has not been revoked.
(check one box)
Pursuant to Minn. Stat. 5010,1013 subd. 2:
The name of each settlor of the trust Is: Betty J. Johnson
The name of each original Trustee is: Betty J. Johnson
Page 1 o12
Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 90.1.1
Check this box El if an Affidavit of Trustee, consisting of two pages, is attached to this Certificate of Trust,
The statements contained in this Certificate of Trust are true and correct and there are no other provisions in the trust instrument, or
amendments to it, that limit (I) the powers of the trustee(s) to sell, convey, pledge, mortgage, lease, or transfer title to interest in real or
personal property, or (II) the authority of the trustees to exercise any other power Identified In this Certificate of Trust.
Trus,eier Settler
SI /
(signature) Be
(denature)
Signed and sworn to (or affirmed) before me on September 28 2018 by Betty J. Johnson
(morfitiklaylyead
(nsert name of Trustee or Settler making statement)
I
(Sla p)
VALERIE A. FREDERICK
Notary Public-Minnesota
My Commission EvIres Jen 81,2020
id? IN, 0 `mi .
(signature of notodel officer)
TIllo (and Rank): AJO O ry IQ..
My commission expires' Q0 • 3 1/ r20 C.)
finonlh/daykear)
THIS INSTRUMENT WAS DRAFTED BY:
(Insert name end address)
Orlin Te Slaa
Walsten & Te Slaa, P.A.
7900 Xerxes Avenue S., Ste. 2000
Bloomington, Minnesota 55431
952-896-5100
(Top 3 inches reserved for recording data)
AFFIDAVIT OF TRUSTEE (inter vivos Trust) Minnesota Uniform Conveyancing Blanks
Minn. Stat. 501C.1014 Form 90.1.3 (2017)
State of Minnesota, County of Hennepin
Betty J. Johnson being first duly sworn on oath states, or
affirms under penalties of perjury, that:
1. Affiant is the trustee (one of the trustees) named in that certain Certificate of Trust (or trust instrument):
(check one box) to which this Affidavit is attached.
0 recorded as Document Number
(month/day/year)
(or in Book of Page ) in the
Office of the 0 County Recorder LJ Registrar of Titles of County, Minnesota,
(check the applicable boxes)
executed by Affiant or another trustee or the settlor of the trust described in the Certificate of Trust (or set forth in the trust instrument), which
relates to real property in Hennepin County, Minnesota, legally described as follows:
Lot 1, Block 1, Braemar Hills Sixth Addition
PD No. 06-116-21-44-0042
(Ilmore space is needed, continue on an attachment)
2. The name(s) and address(es) of the trustee(s) empowered by the trust Instrument to act at the time of the execution of this Affidavit are
as follows:
Betty J. Johnson
6805 Valley View Road
Edina, Minnesota 55439
Page 1 of 2
Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 90.13
3. The trustee(s) who have executed that certain instrument (deed, mortgage, or other conveyance), relating to the real property
described above, between Betty J. Johnson as trustee(s),
and City of Edina, a Minnesota municipal corporation
which instrument is dated May 5, 2018 (a) are empowered by the provisions of the Trust to sell, convey, pledge,
(month/day/year)
mortgage, lease, transfer title to, or release, any interest in real property held in trust; and (b) are the requisite number of trustees required by
the trust instrument to execute and deliver such an instrument.
4.
(check one box) NI The trust has not terminated and trust instrument has not been revoked.
q The trust has terminated (or the trust instrument has been revoked). The execution and delivery of the instrument
described in paragraph 3 has been made pursuant to the provisions of the trust.
5. There has been no amendment to the trust that limits the power of trustee(s) to execute and deliver the instrument described in
paragraph 3.
6.
(check one box) qd The trust is not supervised by any court.
q The trust is supervised by the Court of
County . All necessary approval has been obtained
from the court for the trustee(s) to execute and deliver the instrument described in paragraph 3.
7. Affiant does not have actual knowledge of any facts indicating the trust is invalid.
Affiant
-"Cz7. 0<f)i17/-62-e7-*
(a knature) Bet. J &Johnsen
Signed and sworn to (or affirmed) before me on September 2R . 2018 by Betty J. Johnson
(month/day/year)
41. VALE IEA. EDERICK
Notary Publlo-M1nnesota
My CommIsston Expires Jan Slp 2020
THIS INSTRUMENT WAS DRAFTED BY:
(/nserf name and address)
Orlin Te Slaa
Walsten & Te Slaa, P.A.
79000 Xerxes Avenue S., Ste. 2000
Bloomington, Minnesota 55431
952-896-5100
(insert name or Affiant making statement)
7/Caette/
(signature of notarial officer)
Tulle (and Rank):
A.,14-a ry 449 I IC_
My commission expires: CrOt . (,/ 02000
(month/day/year)
(Top 3 inches reserved for recording data)
CERTIFICATE OF TRUST
Minnesota Uniform Conveyancing Blanks
by Individual Form 90.1,1 (2016)
Minn. Stat. 501C.1 013
State of Minnesota, County of Hennepin
Betty J. Johnson being
first duly sworn on oath states, or affirms under penalties of perjury, that:
1. The name of the trust, if one is given, is: Betty J. Johnson Revocable Trust
2. The date of the trust instrument is: June 28, 2016
3. The name and address of each trustee empowered to act under the trust instrument at the time of execution of this Certificate of
Trust is:
Betty J. Johnson
6805 Valley View Road
Edina, Minnesota 55439
4. The trustees are authorized by the trust instrument to sell, convey, pledge, mortgage, lease, or transfer title to any interest in real
or personal property, except as limited by the following: fir norm so indicate)
None
5. The number of trustees required to act is: one
6. The trust q has El has not been terminated.
(chock one box)
The trust instrument El has RI has not been revoked.
(chock one box)
Pursuant to Minn. Stat. 501C.1013 subd. 2:
The name of each settlor of the trust is: Betty J. Johnson
The name of each original Trustee is: Bet y J. Johnson
Page 1 of 2
Trusteepr Settlor
712
(signature) Be h1150
IG )z/32 (7 )2"
Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 90.1.1
Check this box RI if an Affidavit of Trustee, consisting of two pages, is attached to this Certificate of Trust.
The statements contained in this Certificate of Trust are true and correct and there are no other provisions in the trust instrument, or
amendments to it, that limit (i) the powers of the trustee(s) to sell, convey, pledge, mortgage, lease, or transfer title to interest in real or
personal property, or (ii) the authority of the trustees to exercise any other power identified in this Certificate of Trust.
(signature)
Signed and sworn to (or affirmed) before me on September 28 2018
by Betty J. Johnson
(montWday/year)
(insert name of Tmstee or Settler making statement)
(Stamp)
VALERIE A. FREDERICK
Notary Public-Minnesota
My Commission Emiros Jan 31,2020
1,i2L4 A-0(4444./
(signature of notarial officer)
Title (and Rank): A,)0 ty pi.) 6 f
My commission expires: SCC el 1/
(month/day/year)
THIS INSTRUMENT WAS DRAFTED BY:
(Insert name and address)
Orlin Te Slaa
Walsten & Te Slaa, P.A.
7900 Xerxes Avenue S., Ste. 2000
Bloomington, Minnesota 55431
952-896-5100