HomeMy WebLinkAboutAR Draft Renton ROW dedication form
Return Address:
City Clerkâs Office
City of Renton
1055 South Grady Way
Renton, WA 98055
DEED OF DEDICATION Property Tax Parcel Number: 292305-9009
Project File #: LUA15-XXX Street Intersection: SE 172nd Street & 106th Ave SE
Reference Number(s) of Documents assigned or released: Additional reference numbers are on page _____.
Grantor(s): Grantee(s):
Avana Ridge, LLC,
a Washington limited liability company
City of Renton, a Municipal Corporation
LEGAL DESCRIPTION: (Abbreviated or full legal must go here. Additional legal on page )
A PORTION OF LOT 1 OF CITY OF RENTON LOT LINE ADJUSTMENT NO. LUA-09-024-
LLA, LND-30-0349, RECORDED DECEMBER 16, 2011 UNDER RECORDING NO.
20111216900001, IN KING COUNTY, WASHINGTON.
The Grantor, for and in consideration of mutual benefits conveys, quit claims, dedicates and donates to the Grantee(s) as
named above, 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.
Approved and Accepted By: Grantor(s): Avana Ridge, LLC Grantee(s): City of Renton
Mayor
City Clerk
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: Page 1
IN WITNESS WHEREOF, I have hereunto set my hand the day and year as written below.
INDIVIDUAL FORM OF ACKNOWLEDGMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
___________________________________________ 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:
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING ) I certify that I know or have satisfactory evidence that ______________________
___________________________________________ signed this instrument, on oath
stated that he/she/they was/were authorized to execute the instrument and
acknowledged it as the _________________________ and ____________________
of ___________________________ to be the free and voluntary act of such
party/parties for the uses and purposes mentioned in the instrument.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
CORPORATE FORM OF ACKNOWLEDGMENT
Notary Seal must be within box STATE OF WASHINGTON ) SS
COUNTY OF KING ) On this _______ day of _____________, 19____, before me personally appeared
to me known to
be of the corporation that
executed the within instrument, and acknowledge the said instrument to be the free
and voluntary act and deed of said corporation, for the uses and purposes therein
mentioned, and each on oath stated that he/she was authorized to execute said
instrument and that the seal affixed is the corporate seal of said corporation.
Notary Public in and for the State of Washington
Notary (Print)_____________________________________
My appointment expires:____________________________
Dated:
Page 2
Exhibit A
Legal Description
Project:
WO#
PID
GRANTOR:
Street:
Page 3
Map Exhibit
Page 4