HomeMy WebLinkAbout19133 Mitchell Short Plat ROW Deed of Dedication_2022-08-05/DEEDofDEDICATION.doc\ SMT Page 1 of 4 FORM 04 0001/bh
Return Address:
City Clerkâs Office
City of Renton
1055 South Grady Way
Renton, WA 98057
DEED OF DEDICATION Property Tax Parcel Number:
Project File #: Street Intersection:
Reference Number(s) of Documents assigned or released: Additional reference numbers are on page _____.
Grantor(s): Grantee:
1.
2. City of Renton, a Washington Municipal Corporation
LEGAL DESCRIPTION: (Abbreviated or full legal must go here. Additional legal on page_______)
The Grantor, _________________________, for and in consideration of mutual benefits conveys, quit claims,
and dedicates to the Grantee, the City of Renton, the above described real estate situated in the County of
King, State of Washington.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year as written below.
Grantor(s):
Dated:
INDIVIDUAL FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
/DEEDofDEDICATION.doc\ SMT Page 2 of 4 FORM 04 0001/bh
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
CORPORTATE FORM OF ACKNOWLEDGMENT
STATE OF WASHINGTON ) SS COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
Notary Seal must be within box ________________________________________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and
purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
Accepted by the City of Renton:
By: ________________________________
Mayor
Attest:
By: ______________________________
City Clerk