HomeMy Public PortalAbout008-2023 - Temporary Easement to INDOT at Approximately 1200 East Main pr
BOARD OF PUBLIC WORKS & SAFETY
CITY OF RICHMOND, INDIANA
RESOLUTION NO. 8-2023
A RESOLUTION AUTHORIZING THE GRANT OF A
TEMPORARY RIGHT-OF-WAY EASEMENT
WHEREAS, The Board of Public Works and Safety (hereinafter "Board") is the disposing
agent for property owned and to be acquired or transferred by the City of
Richmond, Indiana (hereinafter "City"), pursuant to the provisions of Indiana
Code (IC) 36-1-11, et seq. and IC 5-22-22, et seq., and the Board has custody,
maintenance, and improvement powers of public ways in accordance with IC
36-9-6, et seq.; and
WHEREAS, The State of Indiana, by and through its Department of Transportation
("INDOT") is undertaking a road improvement project along State Road US
40 which impacts approximately eleven (11) intersection state traffic signals
within the City; and
WHEREAS, INDOT is seeking a temporary right-of-way easement upon Parcel 7 in the
City consisting of an approximate 41 square foot area located at the north-eas-t
corner of North 12th Street and East Main Street (State Parcel ID No. 89-16-33-
330-713,000-030) as further described on the submitted documents attached to
this Resolution; and
WHEREAS, The City wishes to grant INDOT said temporary right-of-way easement as
shown in the attached Exhibit A for the amount shown in the same.
NOW, THEREFORE, BE IT RESOLVED by the Board of Public Works and Safety of
Richmond, Indiana, that said Board hereby approves of the grant of the temporary right-of-
way easement outlined or contained in the documentation submitted by INDOT as
designated in Exhibit A to this Resolution.
NOW, THEREFORE, BE IT ALSO RESOLVED by the Board of Public Works and Safety
that David M. Snow as the Mayor of the City of Richmond, Indiana, and Vicki Robinson as
the President of the Board, shall be authorized to execute the final drafts of temporary
easement documents as previously examined by the Richmond Law Department and the
Page 1 of 2
Richmond Engineering Division, and all other appropriate documents as necessary in
connection with the same.
,
Passed and adopted this — day of11/E1P- 2023, by the Board of Public
Works & Safety.
Vicki Robinson, President
Em Palmer, ember
Matt Evans, Member
APPROVED:
, Mayor
avid M. Zfr 4/Z3
Page 2 of 2
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180Nu�hSena$ Avenue Eric Holcomb, Governor
OF TRO RoomN758-RE Michael Smith, Commissioner
Indianapolis,Indiana 462O �
August 18. 2O23
City nf Richmond, Indiana
[/o K4r. Grog EKieno, City Engineer �
5ON. 5mSt.
Richmond, |N47374
Re: US4O Improvement Project
QE8#21O1108
CodeTO2S
Parcel 7
Approx. 1200 E. Main Street, Richmond, IN 47374 _^
' Property Tax |D#88'1O'33'33O'713.O00-O3O '
Dear Property Owner;
The State of Indiana and Indiana Department of Transportation (INDOT) are planning a road improvement
project along US 40 through Richmond in Wayne County. As part of this project, 11 intersections will be
modernized with new traffic signals, including signal heads and wiring, new signal cabinets, controllers,
handholes, and conduit, and new pedestrian signal poles. The north leg of the roadway at the US 40
intersections with SW 18th Street and with SW 5th Street will be resurfaced, Signs and pavement markings
within the functional limits of the intersections will be replaced. Curb ramps within the project area that have
been found not to comply with the ADA standards will be reconstructed to meet those standards.
My company, Repp Real Estate Services, LLC, has been hired by the State to perform the land acquisition
services for this project. As the owner of record, you are being notified that the State of Indiana needs to
acquire a temporary easement over 41 square feet of land from the southwest corner of this property. The
temporary easement is a small, triangular shaped tract of land with dimensions of 11.05' x 12,73' x 7.5', This
easement is temporary in nature and will revert back to current ownership when construction is complete. This
area is better described in the enclosed documents.
The State of Indiana is prepared to offer you $1,000.00 for the temporary easement being acquired. In
accordance with Indiana Code 32-24-1, a value of $160.00 was arrived at by a real estate appraiser using
standard appraisal methods but it is INDOT's policy to compensate property owners a minimum of $1,000.00
when impacted by an acquisition like this, A full copy of the valuation report is enclosed in the back of the
packet on light green paper. Also, in accordance with Indiana Code 82-24-1, you have thirty (30) days from
date of receipt to accept or reject the offer.
Enclosed for your review and ultimate execution, and to assist with your questions, are the following items
(*indicates documents that need to be signed and returned, °° indicates documents that need to be signed.
notarized, and retunned):
1, Signing Instructions;
2, "Uniform Property or Easement Acquisition Offer letter;
1 "Temporary Easement, exhibit;
4. *Claim Voucher;
5� ~VV-9 Request for Taxpayer Identification Number;
6. °ACH Direct Deposit Form;
7. Title VI Survey (please complete);
Or_/
8Owner's Private Appraisal Letter;
!
Owner's
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S. Statement of Basis for Just Compensation;
1O. Copy of Valuation Report; �
11. Plan sheet highlighting area of acquisition;
12. Land Acquisition Brochure,
If you decide to accept the offer and need notary assistance, please contact me and I will be happy to set a
meeting to help sign documents, If you do not require my help signing documents, please make sure to sign
the enclosed forms where marked, exactly as your name appears, and in front of a notary where required.
Once executed, all documents can be returned to me in the self-addressed envelope provided in the back of
the packet, Please include a copy of the meeting minutes I appropriate resolution confirming, the
Signor's authority to act on behalf of the property owner.
Payment will be issued within approximately 90 days of the date that clear title to the property and legal
approval is obtained. Please note that all property taxes must be paid current prior to the State issuing
payment, If any delinquent taxes are owed, payment will be delayed.
If you disagree with the amount offered, you have the right to obtain and submit an appraisal or other
supporting evidence at your own expense for consideration by |NO[)T. Please note that while all appraisals
and supporting information will be considered, there is no guarantee that there will be an increase in your offer.
The Owner's Private Appraisal Letter enclosed near the back of this packet discusses various forms of
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acceptable evidence that will beconsidered.
Once you have a chance to review the enclosed items, please contact me at317-331'U832orbyemail at
katie.repp@outlook.com. Thank you for your cooperation and I look forward to speaking with you. �
Sincerely,
KaUeRepp
Agent for the Indiana Department ofTransportation �
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and State cfIndiana
Enclosures
X11113iT PAGE
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b + INDIANA DEPARTMENT OF TRANSPORTATION
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100 North Senate Avenue Eric Holcomb, Governor
•T
Op TO- Room N758-RE Michael Smith, Commissioner
Indianapolis,Indiana 46204
The enclosed documents must be signed, notarized if applicable, and
returned in the self-addressed envelope included within 30 days of
receipt. All other documents are yours to keep.
SIGNING INSTRUCTIONS FOR PROMPT PAYMENT
I. TO AVOID DELAY OF PAYMENT, PLEASE PROVIDE A COPY OF THE
APPROPRIATE RESOLUTION/ MEETING MINUTES CONFIRMING SIGNOR'S
AUTHORITY TO ACT ON BEHALF OF THE PROPERTY OWNER.
2. PLEASE SIGN YOUR NAME EXACTLY AS IT APPEARS IN THE RESOLUTION /
MINUTES.
3. THE NOTARY ACKNOWLEDGMENT MUST ACKNOWLEDGE YOUR NAME
EXACTLY AS IT APPEARS IN THE SIGNATURE BLOCK AND RESOLUTION /
MINUTES.
4, COMPLETE ALL AREAS REQUIRING YOUR SIGNATURE, DATE AND ALL
HIGHLIGHTED AREAS;
5. DATES MUST MATCH ON ALL DOCUMENTS. NO DOCUMENT CAN BE DATED
BEFORE THE ACCEPTANCE OF OFFER;
6. PLEASE DO NOT USE WHITE OUT ON ANY OF THE DOCUMENTS.
7. THE FOLLOWING DOCUMENTS ARE REQUIRED:
Acceptance of Offer: Sign and date in front of a Notary;
Temporary Easement: Sign and date in front of a Notary;
Real Estate Claim Voucher: Sign and date;
W-9: Complete Sect. 3, TIN, sign and date;
ACH Direct Deposit Form: Complete, sign and date;
Title VI Survey(optional): Complete.
Payment will be made within ninety (90) days after all documents are received provided there is
no liens found at the time of the final review. All property taxes must be paid current.
Return to: Katie Repp
Email: katie.repp@outlook.com
Repp Real Estate Services, LLC
Agent for the State of Indiana
PO Box 1941
Noblesville, IN 46061
Telephone: 317-331-0832
IF YOU HAVE QUESTIONS OR WISH TO SCHEDULE AN IN-PERSON MEETING, PLEASE
DO NOT HESITATE TO CONTACT ME. THANK YOU.
I INDOT Indiana
-
A Sm.the WorkA
PAGE 3 oF 1-11
6s'1)1Alvi INDIANA DEPARTMENT OF TRANSPORTATION
et, 0
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mgJO
100 North Senate Avenue Eric Holcomb, Governor
P Room N758-RE Michael Smith, Commissioner
Indianapolis,Indiana 46204
UNIFORM LAND OR EASEMENT ACQUISITION OFFER
Date: August 14, 2023
PROJECT: 2101108
CODE: 7629
PARCEL: 7
ROAD: US 40
COUNTY: Wayne
Offer Delivery Method (Check one)
In Person: Certified Mail: X
TO: The City of Richmond, Indiana
50 N. 51h St,
Richmond, IN 47374
The State of Indiana, acting by and through the Indiana Department of Transportation is authorized
by Indiana law to obtain your property or an easement across your property, for certain public purposes.
The Indiana Department of Transportation needs an easement across your property for a public highway
improvement known as US 40 and needs to take the easement as described on the attached legal
description.
It is our opinion that the fair market value of the easement we want to acquire from you is 51,000.0.0,
and, therefore, the Indiana Department of Transportation offers you $1,000.00 for the above described
easement. You have thirty (30) days from this date to accept or reject this offer. If you accept this offer,
you may expect payment in full within ninety (90) days after signing the documents accepting this offer
and executing the deed, grant or easement, and provided there are no difficulties in clearing liens or other
problems with title to the land. Possession will be required thirty (30) days after you have received your
payment in full.
FETXHIBIT PAGE ‘:-1 OF711
INDOT rJi NextLevel
Uniform Offer rwa INDIANA
REVISED 03/2022
Page 2
Project: 2101108 Parcel: 7
HERE IS A BRIEF SUMMARY OF YOUR OPTIONS AND LEGALLY PROTECTED RIGHTS:
1. By law, the Indiana Department of Transportation is required to make a good faith effort to
purchase an easement across your property.
2. You do not have to accept this offer and the Indiana Department of Transportation is not
required to agree to your demands.
3. However, if you do not accept this offer, and we cannot come to an agreement on the
acquisition of an easement across your property, the Indiana Department of Transportation has
the right to file suit to condemn, and acquire the easement in the county in which the real
estate is located.
4. You have the right to seek advice of an attorney, real estate appraiser or any other person
of your choice on this matter.
5. You may object to the public purpose and necessity of this project.
6. If the Indiana Department of Transportation files a suit to condemn and acquire an easement
across your property and the court grants its request to condemn, the court will then appoint
three appraisers who will make an independent appraisal of the to be acquired.
7. If we both agree with the court appraisers' report, then the matter is settled. However, if
either of us disagrees with the appraisers' report to the court, either of us has the right to
ask for a trial to decide what should be paid to you for the condemned.
8. If the court appraisers' report is not accepted by either of us, then the Indiana Department
of Transportation has the legal option of depositing the amount of the court appraisers'
evaluation with the court. And if such a deposit is made with the court,the Indiana
Department of Transportation is legally entitled to immediate possession of the easement .
You may, subject to the approval of the court, make withdrawals from the amount deposited
with the court. Your withdrawal will in no way affect the proceedings of your case in court,
except that, if the inal judgment awarded you is less than the withdrawal you have made
from the amount deposited, you will be required to pay back to the court the amount of the
withdrawal in excess of the amount of the final judgment.
Uniform Offer
REVISED 3/2022 FCHIBIT A PAGE_S___OF1.111
Page 3
Project: 2101108 Parcel: 7
9. The trial will decide the full amount of damages you are to receive. Both of us will be entitled
to present legal evidence supporting our opinions of the fair market value of the property or
easement. The court's decision may be more or less than this offer. You may employ, at
your cost, appraisers and attorneys to represent you at this time or at any time during the
course of the proceeding described in the notice.
10. If you have any questions concerning this matter, you may contact us at:
ATTN: Katie Repp
Repp Real Estate Services, LLC
Agent for the State of Indiana
PO Box 1941
Noblesville, IN 46061
Phone: 317-331-0832
Email: katie.repp@outlook.com
This offer was made to the owner(s):
City of Richmond, Indiana of Wayne County, IN on (Date)
of on (Date)
of on (Date)
of on (Date)
BY:
Katie Repp
Repp Real Estate Services, LLC
Agent for the State of Indiana
Uniform Offer
REVISED 3/2022
IBIT E-XH— '—k_PAGE
Page 4
Project: 2101108 Parcel: 7
If you decide to accept the offer of $1,000.00 made by the Indiana Department of Transportation,
sign your name below and mail this form to the address indicated above. An additional copy of
this offer has been provided for your file.
ACCEPTANCE OF OFFER
I (We), the City of Richmond, Indiana, an incorporated second class city, owner(s) of the above
described property or interest in property, hereby accept the offer of $1,000.00 made by the Indiana
Department of Transportation on this day of , 20
City of Richmond, Indiana,
an incorporated second class city
Original Offer $1,000,00
By:
David Snow, Mayor
Total Amount $1,000.00
NOTARY'S CERTIFICATE
STATE OF:
SS:
COUNTY OF:
Subscribed and sworn to before me this day of , 20
Signature
Printed Name
My Commission No.
My Commission expires
I am a resident of County.
..„—
Uniform Offer
R_EVISED 3/2022 EXHIBIT PA--GE 71-0—F.1.11
TEMPORARY HIGHWAY EASEMENT GRANT
(GENERAL)
Form T-3 Project: 2101108
Revised 08/2022 Code: 7629
Parcel: 7
Page: 1 of 4
THIS INDENTURE WITNESSETH, That the Cit of Richmond Indiana, an incorporated second class city, the
Grantor(s) of Wayne County, State of Indiana Grant(s) to the STATE OF INDIANA, the Grantee, for and in consideration of
the sum of One Thousand and 00/100 Dollars ($1,000.00)(of which said sum$0.00 represents land improvements acquired and
$1,000.00 represents land temporarily encumbered and damages) and other valuable consideration, the receipt of which is
hereby acknowledged, a temporary easement to enter upon and have possession of the Real Estate of the Grantor(s) for the
purpose of signal construction,which said work is incidental to the construction of the highway facility known as US 40 and as
Project 2101108, which said Real Estate situated in the County of Wayne, State of Indiana, and which is more particularly
described in the legal description(s) attached hereto as Exhibit "A" which is incorporated herein by reference, which said
temporary easement shall be extinguished, become void and revert to the Grantor(s) and/or the Grantor(s) successor(s) in title
upon completion of the said Project, Said extinguishment shall be evidenced by a release document, which shall he executed
and recorded by the Grantee,at no cost to the Grantor(s).
Interests in land acquired by the Indiana
Department of Transportation
Grantee mailinz address:
100 North Senate Avenue N758-RE
Indianapolis,Indiana 46204-2219
LC.8-23-7-31
1:6(171CCIT_ OF n I
•
Form T-3 Project: 2101108
Revised 08/2022 Code: 7629
Parcel: 7
Page: 2 of 4
The undersigned represent and warrants that he is the Mayor of the Grantor, that pursuant to resolution of the City
Council he has full authority to rnanage the affairs of said City and sign and execute documents on its behalf and that said
authority has not been revoked, and that he is therefore, fully authorized and empowered to convey to the STATE OF
INDIANA real estate of the City, and that on the date of execution of said conveyance instruments he has full authority to so
act,
Any and all timber, shrubbery, fences, buildings and any other improvements situated within the area of the temporary
easement granted herein shall become the property of the State of Indiana except:
No Exceptions
The said Grantor(s) acknowledge(s) that all provisions of this grant of temporary easement are as stated and set forth
herein and that no verbal agreements or promises exist with respect thereto.
This temporary conveyance is subject to any and all easements, conditions and restrictions of record. However, the
said Grantor(s), for the purpose of inducing the State of Indiana to accept this grant and to pay the hereinbefore referenced
consideration, represent(s) that the Grantor(s) is the owner(s) in fee simple of the Real Estate and that there exist no
encumbrances, conditions, restrictions, leases, liens (except current real estate taxes and assessments) of any kind or character
which would be inconsistent with the temporary rights granted herein.
lEXL-1181T=A PAGE_1__PF I-) 1
Forrn T-3 Project: 2101108
Revised 08/2022 Code: 7629
Parcel: 7
Page: 3 of 4
IN WITNESS WHEREOF,the said Grantor has executed this instrument this day of
City of Richmond,Indiana,an incorporated second class city
By:
David Snow, Mayor
STATE OF: •
SS:
COUNTY OF
Before me, a Notary Public in and for said State and County,personally appeared David Snow,Mayor of the City of Richmond,
Indiana, an incorporated second class city, the Grantor in the above conveyance, and acknowledged the execution of the same
on the date aforesaid to be a voluntary act and deed and who, being duly sworn, stated that any representations contained therein
are true.
Witness my hand and Notarial Seal this day of
Signature
Printed Name
My Commission Number
My Commission expires
I am a resident of County.
EXHIBIT JA PAGE LO_OF
EXHIBIT"A"
Project: 2101108 Sheet 1 of 1
Code: 7629
Parcel: 7 Temporary Right of Way for Signal Construction
Form: T-3
A part of Lot 183 in CW Starr's 6'Addition to the city of Richmond, Indiana, the plat of which is recorded in Plat
Book 1,Pages 223 &224,in the Office of the Recorder of Wayne County,Indiana,,described as follows: Beginning
at the southwest corner of said lot;thence North 0 degrees 26 minutes 31 seconds East 11.05 feet along the west line
of said lot; thente South 35 degrees 27 minutes 08 seconds East 12.73 feet to the southern line of said lot; thence
South 84 degrees 47 minutes 09 seconds West 7.50 feet along said southern line to the point of beginning and
containing 41 square feet,more or less.
This description was prepared for the Indiana Department of Transportation,by Jason McCort,an Indiana Registered
Land Surveyor, License Number LS20300004, on the nth day of April , 2023.
/,,,
...
(7) 0
No.
20300004 ':(: •=7
7-13 0
STATE OF
10/11110,-\
'EXHIBIT F PAGE J 1 61: I-711
REAL ESTATE CLAIM-VOUCHER
lt,,,, Slate Form 9929(RID/4-18)
•,;;,,:n..,..,,, Approved by State Board°remounts,2018 Voucher number Received date(monlh,day,year)
ir Approved by Auditor of Siete,2018
INDIANA DEPARTMENT OF TRANSPORTATION
VENDOR INFORMATION
Name(s)of vendor Name(s)of vendor _
RAY FAMILY PROPERTIES,LLC
.------
Name(5)cif vendor — Name(s)of vendor
Address(number and street,city,state, and ZIP code)
4084 Hunt Rd.,Richmond,IN,47374
AGENCY INFORMATION . .
Agency Name Agency Number Project number Code
INDOT 800 800210110800ST3 7629
-----
Parcel PeopleSoft vendor Identification Vendor Location Description number
7 2101108
THIS SECTION TO BE COMPLETED BY THE AGENCY
Fund Department Locality Invoice Date Amount 1099 Code —
(month,day,year)
Gross Amount $1,000.00 _
INDOT ACCOUNTING LINE DISTRIBUTION
Line Invoice Number Account Program Profile Activity Percentage Amount
01
------"
02
03
04
CLAIMANTS
Pursuant to the provls>si-iandi-- nalties of Indiana Code 5.-.11-10:171 hereby certify that the foregoing account i; just and correct, thar the ;-T,;,7;Tc.ii aimed i; geily
,due after allowiniallAvesxedits, nd I et no part of the same hes been paid.I also authorize payment to be made as indicated above,
Signature,T,i-claimant' r-, Plinked narne Date(month day, oar)
---.
David Snow,Mayor,CiV of Richmond,Indiana
iSIgn!ture of c en Printed name Date(m nth,day, ear)
...____..,-...
S
1.9OaTU7;,,Tai7,1T—"-----""" Printed name Dale(month,day,year)
— .
Signature of claimant Printed name '---- '--- --- -------- 071W(rTo7fi-T,day,year) ---
.
Payment Type-message
_
Signature of originator Printed name Date(month,day,year)
Katie Repp,Agent for the State of Indiana
LIENHOLDER
IIiiOiZYSign this clalTccTucharas Ilenholder end only certify to the extent of my Interest therein end authorize payment to be made as Indicated above,
Signature of lienholder Printed name Date(month,day,year)
APPROVALS
Instrument approved ato form,pretiminery only,Except ng reel estate description end subject to title update.
Signature of Deputy Attorney GtTii;iia1 Printed name --------Date(rnorith,Tay,year) ---
Approved by the Indiana(Department of Transportation
Signature of Director Printed name Date(month,day,year)
FXI'1 ii..31T __A PAGE 1 7,0Fia.
....,
--
- ....--...--„--_---,----
Real Estate Code Parcel
Request for Taxpayer Give Form to the
Form IN-9(Rev.October 2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service I►Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name(as shown on your Income tax return).Name is required on this line;do not leave.this line blank,
City of Richmond,Indiana
2 Business name/disregarded entity name,If different from above
ci
3 Check appropriate box for federal tax classification of theperson whose name Is entered on line 1.Check onlyone of the 4 Exemptions(codes apply only to
certain entities,not Individuals;see
co
following seven boxes,is. instructions on page 3):
p ❑ Individual/sole proprietor or ❑ C Corporation ❑S Corporation ❑. Partnership ❑Trust/estate
al
single member LLC Exempt payee code(if any)
❑ Limited lability company,Enter the tax classification(CaC corporation,SaS corporation,PaPartnership)►
gNote:Check the appropriate box in the line above for the tax classification of the single-member owner, Do not check Exemption from FATCA reportingLCis classifiedas a single-memberfromthe owner unlessthe owner of LLC If the L inglb LLC that Is disregarded the LLC is code(ff any)
•e- another LLC that Is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
O. o is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other(see Instructions)►
(App5es Ix Accounts meaEnined oxekle the U.S.)
co 5 Address(number,street,and apt,or suite no.)See Instructions. Requester's name and address(optional)
0, 50 N.5th St.
6 City,state,and ZIP code
Richmond,IN 47374
7 List account number(s)here(optional)
Part 1 Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social security number
backup withholding,For individuals,this is generally your social security number(SSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the Instructions for Part I,later.For other - -
entities,it Is your employer identification number(EN).If you do not have a number,see How to get a
TiN,later, or
Note:If the account is in more than one name,see the Instructions for line 1,Also see What Name and Employer Identification number
Number To Give the Requester for guidelines on whose number to enter.
Part li Certification
Under penalties of perjury,I certify that:
1.The number shown on this form Is my correct taxpayer Identification number(or I am waiting for a number to be Issued to me);and
2.I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that II am
no longer subject to backup withholding;and
3.I am a U.S.citizen or other U.S.person(defined below);and
4,The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all Interest and dividends on your tax return,For real estate transactions,Item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an Individual retirement arrangement(IRA),and generally,payments
other than Interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the Instructions for Part II,later,
Sign Signature of
Here u.s.person► Date►
General Instructions •Form 1099-DIV(dividends,Including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of Income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest Information about developments •Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its Instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9, •Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan Interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of Information alien),to provide your correct TIN.
returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(Interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10•2018)
PAGE 13_O ni
CAUTOMATED DIRECT DEPOSIT
---.; ) AUTHORIZATION AGREEMENT
- (
‘. 1 AstappteroF:eb4y7s5l5alte B(R07nlif8)Acco.t$,2ois
Prescribed by Auditor of State,2018
*This agency is requesting disclosure of your Federal Identification Number/Social Security Number in accordance with IC 4-1-8-1,
Disclosure is mandatory,and this record cannot be processed without it,
In accordance with IC 4-13-2-14.8, a person who has a contract with the State of Indiana or submits invoices to the
State of Indiana for payment shall authorize the direct deposit by electronic funds transfer of all payments by the
state to the person.
This form must be completed in order to receive payment from the State of Indiana and any time there is a change
in banking information. This form must be accompanied by a W9. If you are changing an e-mail address to
receive electronic notifications of EFT deposits,please contact vendorsc&auditor.in.gov.
El New Enrollment
Change of Existing Account Prior Routing Number:
Prior Account Number:
SECTION 1: AUTHORIZATION
According to Indiana law,your signature below authorizes the transfer of electronic funds under the following terms:
City of Richmond, Indiana
Name of Company or Individual(as shown on the account) Federal Identification Number/Social Security Number
50 N. 5th St. Richmond, IN 47374
Address(Number and Street and/or PO Dos Number) City,State,and ZIP Code(00000-0000)
SECTION 2: DIRECT DEPOSIT INFORMATION
Type of Account: I]Checking(Demand) 0 Savings
Please check this box if your direct deposit will be automatically forwarded to a bank account in another country.
Financial Institution:
Routing Number(9 digits):
Account Number(maximum 17 digits--include leading zeros):
SECTION 3: E-MAIL ADDRESS TO RECEIVE ELECTRONIC NOTIFICATION OF ELECTRONIC FUND
TRANSFER(EFT)DEPOSITS *Required
(Please contact Lendors@at6loriszo_y,to add more than four addresses.)
All future notices of EFT deposits to the bank account specified above will be sent to the following e-mail addresses:
0 By checking this box,I authorize the information provided on this form to be accurate and I agree with the provisions on
the reverse side of this form. I also authorize the State of Indiana to initiate credit entries and to initiate, if necessary, debit
entries and adjustments for any credit entries in error to my account indicated above. This authorization will remain in effect
until the state has received written notification of its termination and has adequate time to act upon the request.
NAME(type) TITLE TELEPHONE
AUTHORIZED SIGNATURE DATE(month,day,year)
"Under IC 26-2-8.106,your electronic signature on this form represents the same legal authority as your written signature.
TEXHIO IT A___ PAGE 7111
INDIANA DEPARTMENT OF TRANSPORTATION
Code 7629 Parcel 7
Dear Owner or Tenant,
As a recipient of federal finds, the Indiana Department of Transportation (INDOT) is required to develop a
procedure for gathering statistical data regarding participants and beneficiaries of its federal-aid highway
programs and activities (23 CFR 200.9(b)(4)).
You are not required to provide the requested information. Submittal of this information is voluntary. This form
is a public document that INDOT will use to monitor its programs and activities for compliance with Title VI of
the Civil Rights Act of 1964,as amended and its related statues and regulations. No person shall, on the grounds
of race, color or national origin, as provided by Title VI of the Civil Rights Act of 1964 be excluded from
participation in, be denied the benefits of, or be otherwise discriminated against under any of its programs and
activities.
If you have any questions regarding INDOT's responsibilities under Title VI of the Civil Rights Act of 1964 or
the Americans with Disabilities Act, please contact INDOT's Title VI/ADA Program at 100 N Senate Ave,
N758-LS, Indianapolis, Indiana 46204 or via e-mail: accessforall@indot.in.gov.
You may complete this form with the assistance of your assigned Right of Way Agent or you may complete the
form and return with a postage paid envelope to be provided by the Right of Way Agent upon request.
Date: Road: US 40
(please indicate number of individuals for each category)
Hispanic or Not Hispanic or
Gender: Male Female Ethnicity:
Latino Latino
Race: American Indian or Alaska Native
Asian
Black or African-American
Multiracial or other
Native Hawaiian or other Pacific Islander
White
----
Age(s): <21 22—40 41 --65 65 >
lease check one for each catego_yr )
Household
—I $0 - $12,000 E $12,001 - $24,000
Income:
$24,001 - $36,000 ri $36,001 - $48,000
$48,001 - $60,000 L $60,001 +
[ Limited English
Disability: Yes No I Yes E No
_
Proficiency:
I *2)(1-11131T j4 PAGE 1 OF 1:1
!HOOT lsiLNextLevel
IN
REVISED 06/2022
bS 1+ INDIANA DEPARTMENT OF TRANSPORTATION
1.!1 ,
NM 1. 14141 T
e100 tiocth Senate Avenue Eric Holcomb, Governor
OF rritP.- Room t1758-RE Michael Smith, Commissioner
Indianapolis,Indiana 46204
Date: August 14, 2023
TO City of Richmond, Indiana
50 N. 5th St.
Richmond,IN 47374 PROJECT: 2101108
CODE: 7629 PARCEL.: 7
ROAD: US 40
COUNTY: Wayne
Dear Property Owner:
It is the policy of the Indiana Department of Transportation, Real Estate Division, to accept for review any
evidence of value submitted by the property owner for the purpose of determining fair market value. Any costs
incurred from obtaining such evidence, however, is the responsibility of the owner. Acceptable forms of
evidence of value include, but are not limited to, appraisals, comparable sales, and cost estimates.
Evidence of value must he supported by factual data and items of damage must be fully documented.
Submitted evidence based on these facts is acceptable for review.
Sincerely,
Katie Repp
Repp Real Estate Services,1.1,C
Phone: 317-331-0832
Email: katie.repp@outlook.com
Agent of: The Indiana Department of Transportation
1tlX1111-ETITIIA— PAGE 1(1 OF 1.1
Owner's Appraisal Letter MOOT Indiana
REVISED 01/2017 A ' A State that Wed.
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