430 Stillwater Road LLC Realty Transfer CertREALTY TRANSFER CERTIFICATE
Confidential Tax Document The information contained
In this certificate is confidential by Montana law. unauthorized
disclosure of this Information Is a criminal offense,
15-7-308, MCA.
PART 1 - DATE OF TRANSFER (SALE)
12-20-2021 (MMIDDNYYY)
GEOCODE(S)
ASSESSMENT CODE:
The Department of Revenue will change the name on ownership records
used for the assessment and taxation of real property when this fort is fully
completed and signed by the preparer. (Please read the attached instructions
on page 1 for assistance �n completing and filing this form )
Montana law requires this form be completed and may Impose up to
a $600 penalty for failure to file a Really Transfer Certificate (15-7-304,
and , MCA)
IPART 2 - PARTIES Please complete this section in full; if additional space is required, please attach a separate page
Seller (Grantor) Enter the last 4 digits of the SSN or FIE
Name 430 Stillwater Road LLC Attn: Jason Evans SSN XXX XX -
Mailing Address 717 West Sprague, Suite 802 SSN XXX - _ )(X -
(Permanent) _ FEIN X_- X Dip 190
City Spokane ST WA Zip 98201 Daytime Phone (509) 475-8336
Seller Principal Residence _Yes if No Email Address i-4119-ft-tw—
Buyer(Grantee)
Name City of Kalispell Attn: Doug Russell
Mailing Address 201 1st Avenue East
(Permanent)
City Kalispell
Buyer Principal Residence ✓Yes No
Mailing Address
For Tax Notice
(If different) City
ST MT Zip 59901
ST_ Zip
SSN XXX - XX -
FEIN ) ( - XXX _
Daytime Phone (4061758-7703
Email Address dryneiltakalisneil.wm
T nsfer to Trustee, Custodian, or other
Representative:
Trust FEIN XX - XXX
Minor SSN )(XX--XXX -
I PART 3 - PROPERTY DESCRIPTION Please complete fully, if additional space is required, please attach a separate page. I
Legal Description See attached quit daim deed _ Attachment (d
Add/Sub
County_
Block Lot
Cityrrown Section Township Range
PART 4 - DESCRIPTION OF TRANSFER Please complete fully more than one may apply.
❑ Sa e ❑ Gift ❑ Barter 0 Nominal or no consideration ❑ Part of 1031 or 1033 exchange NepsRI P
❑ Transfer is subject to a reserved life estate O ti
bi ❑Transfer onOeathdeed
i
Distressed sales: ❑ Sheriffs deed ElTrustees deed ❑ Deed in lieu of foreclosure ❑ Shortsale OtherTO Cfr
Transfer by Operation of Law
Cl Termination of joint tenancy by ❑ Terminadon of life estate
by ❑ Court order or decree ❑ Merger, consolidation, or other
death death
(except sheriffs sale) business entity reorganization
PART 5 - EXCEPTIONS FROM PROVIDING SALES PRICE INFORMATION Please complete fully, more than one may apply
❑ Transfer between husbandWfe or parent/chfld for nominal consideration
❑ Transfer made in contemplation of death without consideration
❑ Termination of Joint tenancy by death
❑ Transfer of property of a decedent's estate
❑ Transfer to a revocable living trust
❑ Transfer pursuant to court decree (except shedfrs sale)
❑ Gift
❑ Termination of life estate by death
❑ Correction, modification, or supplement of previously recorded
la Transfer by government agency
instrument, no additional consideration
❑ Tax deed
❑ Merger, consolidation or reorganization of business entity
❑ Land currently classified as forestland and for contnued use for
❑ Land currently classified as agricultural land and for continued use for
producing Umber (15 7 307. MCA)
agricultural purposes ( )
PART 6 - SALE PRICE INFORMATION Please complete fully more than one may apply.
Actual Sale Price $ 0.00
Value of good wig included In sale $ 0.00
Prancing: _Cash _FHA _VA _Contract _Other
Was an SID payoff Included in the sale price? _Yes Of No
Terms: _Now loan OR Assumption of existing loan
Did the buyer assume an SID? _ Yes ✓ No
Value of personal property included in sale S 0.00
Amount of SID paid or assumed: $ 0.00
Value of inventory Included In sale S 0 00
Was a mobile home Included in the sale? _Yes ✓ No
Value of licenses included In sale $ 0.00
PART 7 - WATER RIGHT DISCLOSURE Disclosure is on?y applicable to the property identified in PART 3 above
❑ A. Property is served by a public water ❑ S. Seller has no water
0 C. Seger is transferring All O D. Seller is dividing or exampling
supply, I a., city, Irrigation district, or rights on record with
water rights on record (reserving) water rights. Salter
water district provides water. DNNRCC to transfer.
with DNRC to the Buyer mist Ille Water Right Update form
X Seiler (Grantor) Signature
Date /1/7 A/
I PART 8 - PWARER IMORMATION Preparer's signature is required. I
X
Mailing Address 431 1st Avenue West
Namelfitle Mike Brodfie� _ City Kalispell _State MT Zip 59901
(please prim, &(0O - 6Qg — S 3 s
Daytime Phone
Clerk and Recorder Use Only ®.
Recording Information: Document No Book Page Date
Department of Revenue Copy Page 3
REALTY TRANSFER CERTIFICATE
Confidential Tax Document: The information contained
In this certificate is confidential by Montana law Unauthorized
disclosure of this information is a criminal offense,
15-7-308 MCA.
PART 1 — DATE OF TRANSFER (SALE)
12-20-2021 _,(MM/DDA YYY)
GEOCODE(S)
ASSESSMENT CODE:
The Department of Revenue will change the name on ownership records
used for the assessment and taxation of real property when this form is fully
completed and signed by the preparer. (Please read the attached instructions
on page 1 for assistance in completing and filing this form )
Montana law requires this form be completed and may Impose up to
a $500 penalty for falrure to Ole a Realry Transfer Cartiffcata (15-7-304,
15-7-305 and 15-7-310, MCA)
[PART 2 - PARTIES _ Please complete this section in full; if additional space is required, please attach a separate page
Seller (Grantor)
Name 430 Stillwater Road LLC Attn: Jason Evans
Mailing Address 717 West SWIgue, Suite 802
(Permanent)
City Spq4ne _ ST WA zip 98201
Seller Principal Residence _Yes ✓ No
Buyer (Grantee)
Name City of Kalispell Ann: Keith Haskins
Mailing Address 201 1st Avenue East _
(Permanent)
City Kalispell
Buyer Principal Residence ✓Yes _No
Mailing Address
For Tax Notice
(If different) City
sTMT zip 59901
ST_ zip
PART 3 — PROPERTY DESCRIPTION Please complete fully if additional space is required, please attach a separate page.
Legal Description See attached quit claim deed
Add/Sub Block
County Clty/Town
Attachment 0
Lot _
_ Section Township Range
PART 4 — DESCRIPTION OF TRANSFER Please complete fully, more than one may apply.
❑ Sale ❑ Gift ❑ Barter 0 Nominal or no consideration ❑ Part of 1031 or 1033 exchange rAovs p tt t1 Kdw�w erscN tP
❑ Transfer is subject to a reserved life estate ?a C' dt P 'KMrS IOE«
bI ❑ Transfer on Death deed
Distressed sales: ❑ Sherifrs deed ❑ Trustee's deed ❑ Deed in lieu of foreclosure ❑ Short sale <Mer
Transfer by Operation of Law
❑ Termination of joint tenancy by ❑ Termination of life estate by Cl Court order or decree ❑ Merger, consolidation, or other
death death (except sherifrs sale) business entity reorganization
PART 5 — EXCEPTIONS FROM PROVIDING SALES PRICE INFORMATION Please complete fully, more than one may apply.
❑ Transfer between husbandhWe or parentichild for nominal consideration ❑ Transfer made In contemplation of death without consideration
❑ Termination of joint tenancy by death ❑ Transfer of property of a decedent's estate
❑ Transfer to a revocable living trust ❑ Transfer pursuant to court decree (except sheriff's sale)
❑ Gift ❑ Termination of life estate by death
❑ Correction modification, or supplement of previously recorded Id Transfer by govemment agency
instrument, no additlonsi consideration ❑ Tax deed
❑ Merger, consolidation or reorganization of business entity ❑ Land currently classified as foresdand and for continued use for
❑ Land currently classified as agricultural land and for continued use for producing Umber (15-7-307 MCA)
agricultural purposes ( )
I PART 6 — SALE PRICE INFORMATION Please complete fully, more than one may apply.
Actual Sale Price $ 0.00
Value of good will Included in sale $ 0.00
Financing: _Cash _FHA _VA _Contract _Other
Was an SID payoff Included in the sale price? _Yes ✓ No
Terms: _New ban OR Assumption of existing ban
Did the buyer assume an SID? _ Yes ✓ No
Value of persona' property included in sale $ 0.00
Amount of SID paid or assumed: $ 0.00
Value of 'nventory Included In sale $ 0.00
Was a mobile home included in the sale? Yes ✓ No
Value of licenses included In sale $ 0.00
_
PART 7 - WATER RIGHT DISCLOSURE Disclosure is only applicable to the property identified In PART 3 above.
❑ A. Property is served by a public water ❑ B. Seller has no water
Id C. Seller is transferring ALL ❑ D. Seller is dividing or exempting
supply ..e., city. Irrigation district, or rights on record with
water rights on record (reserving) water rights. Seger
water d'stdot provides water DNRC to transfer
with DNRC to the Buyer. must file Water Right Update form
X Se::er (Gra-.tor) Signature
Date �2/ Z f
PART 8 - PROPAf)ER INE(,7RftnCM Preparer's signature is required
X Signature f-'� _ Vf j _ Mailing Address 431 1st Avenue West
NameMUe Mike Brodie, PE City Kalispell State MT Zip 59901
please pnrdj U(o - ro 51 -11S-� --
Daytime Phone
Clerk and Recorder Use Only
Recording Infwrnallon: Document No Book Page Date
Buyer/Seller Copy Page 4
Form 640 Revised 04/2012
Montana Department of Natural Resources and Conservation - k ___
1424 9th Avenue, PO Box 201601
Helena, MT 59620-1601
Phone: 444-6601, FAX: 444-0533
Certification of Water Right Ownership Update
The Realty Transfer Certificate submitted with the deed or other instrument indicates a water right is being divided or
exempted (reserved) from the property. The Clerk and Recorder may not record the deed or instrument unless this
certification is completed and signed by the buyer, seller and escrow agent (if applicable). See 85-2-424(6), MCA.
❑ The required DNRC Ownership Update Divided Interest, Form 641 or DNRC Ownership Update Exempt (Reserved) /
Severed Water Right, Form 642 and the required fee are held in escrow.
I certify under penalty of false swearing that the statement appearing here is to the best of my knowledge true and
correct.
Seller Signature
Buyer Signature
Escrow Agent Signature
Date
Date
Date
(,a There is no escrow. The required DNRC Ownership Update Divided Interest, Form 641, or DNRC Ownership Update
Exempt (Reserved) / Severed, Form 642, has been prepared and will be sent with the required fee to the Department
of Natural Resources and Conservation within five business days of recording. The transferee (buyer) acknowledges
that failure to file the appropriate form and fee may result in the department imposing up to a $75 penalty against the
buyer. See 85-2-431 and 85-2-424(6)(b), MCA.
I certify under penalty of false swearing that the statement appearing here is to the best of my knowledge true and
correct. l
Seller Signature Date 11-L 2 f
Buyer Signature Date Z24
D g ussell, City Manager, City of Kalispell
If you have questions, contact your local water resources regional office.
BILLINGS
406-247-4415
Big Horn, Carbon, Carter, Custer, Fallon, Powder River,
Prairie, Rosebud, Stiliwater, Sweet Grass, Treasure and
Yellowstone Counties
BOZEMAN
406-586-3136
Gallatin, Madison and Park Counties
GLASGOW
406-228-2561
Daniels, Dawson, Garfield, McCone, Phillips, Richland,
Roosevelt, Sheridan, Valley and IMbaux Counties
HAVRE
406-265-5516
Blaine, Chouteau, Glacier, Hill, Liberty, Pondera, Teton and
Toole Counties
HELENA
406-444-6999
Beaverhead, Broadwater, Deer Lodge, Jefferson, Lewis
and Clark, Powell and Silver Bow Counties
KALISPELL
406-752-2288
Flathead, Lake, Lincoln and Sanders Counties
LEWISTOWN
406-538-7459
Cascade, Fergus, Golden Valley, Judith Basin, Meagher,
Musselshell, Petroleum and Wheatland Counties
MISSOULA
406-7214284
Granite, Mineral, Missoula and RavaN Counties
Page 5
Revised 10/19
REALTY TRANSFER CERTIFICATE
Confidential Tax Document
WHO MUST FILE —Any party transferring real property regardless of whether the transfer is or is not evidenced by deed or Instrument or
any party presenting an instrument or deed evidencing a transfer of real estate for recording. Real estate includes land, growing timber,
buildings, structures, fixtures, fences and improvements affixed to land.
YOU MAY OWE INCOME TAXES —Any gain on this transfer is Montana source income and should be reported to the Department of
Revenue on the appropriate income tax return.
WHEN AND WHERE TO FILE —The completed Realty Transfer Certificate must be filed with the County Clerk and Recorder when the
instrument or deed evidencing a transfer of real estate is presented for recording.
If the transfer is by operation of law, then a Realty Transfer Certificate with the required supporting documentation should be filed with the
local Department of Revenue office. See Part 4 for further information.
The Department of Revenue will change the ownership record when this form is fully completed and signed by the preparer.
PART 1— DATE OF TRANSFER (SALE)
This should be the date on which the instrument or deed was executed (the date the instrument or deed was signed by the Seller
(Grantor) and Buyer (Grantee) unless otherwise specified in the deed or date of decedent's death). Contracts for Deed and Notices of
Purchaser's Interest should use the date the contract or notice was initially effective.
PART 2 — PARTIES
Seller (Grantor)/ Buyer (Grantee): Enter the names of the Seller (Grantor) and Buyer (Grantee) exactly as they appear on the transferring
document. Business organizations, corporations, trusts, etc. should enter their name(s) exactly as it appears on the transferring document
Addresses: For the Seller (Grantor), enter the current mailing address. The Seller (Grantor) and the Buyer (Grantee) are requested to
mark Yes or No to indicate if the property subject to this transfer has been or will be the location of their principal residence. A principal
residence is a residential dwelling that was occupied, in the case of the Seller (Grantor), or will be occupied, in the case of the Buyer
(Grantee), for at least 7 months. The Buyer (Grantee) must enter the permanent mailing address. If the tax notice is to be sent to a
different mailing address, please complete the additional mailing information.
SSN or FEIN. For individuals, provide the last four digits of the social security number of all legal owners named in the transferring document
Business organizations, corporations, trusts, etc., provide the last four digits of the federal ID number(s) of the legal entity(ies) named in
the transferring document. See 15-1-201. MCA and 42 USC 405(c)(2)(C)Oxiv). The Department of Revenue uses personal identification
numbers to cross match Realty Transfer Certificates with income tax returns to verify taxpayer compliance on gains from real estate sales or
transfers and to identify delinquent taxpayers. Additional SSN or FEIN numbers (last four digits) may be provided on an attachment.
Daytime Phone and Email Addrress: Enter phone numbers and email addresses for both the Seller (Grantor) and Buyer (Grantee).
PART 3 — PROPERTY DESCRIPTION
This section identifies the parcel that is being transferred by location and is the legal description found on the instrument or deed
conveying the real estate or the abstract to the real estate.
The property description may be provided on an attachment and can be identified by checking the applicable box.
PART 4 — DESCRIPTION OF TRANSFER (Please refer to When and Where to File above.)
Check the box(es) that describes the transfer for which an instrument is to be recorded with the County Clerk and Recorder.
Transfer by Operation of Law: Check the box(es) that apply to the type of transfer. A copy of the following applicable documentation
must be attached to the Realty Transfer Certificate:
• Termination of joint tenancy or life estate by death — copy of the certified death certificate.
• Court Decree — certified copy of the order or decree requiring the transfer.
• Merger, consolidation or other business reorganization — plan of reorganization filed with the Secretary of State.
• Name change only —documents filed with the Secretary of State to accomplish the name change.
PART 5 — EXCEPTION FROM PROVIDING SALES PRICE INFORMATION
If any of the exceptions listed apply to this transfer, check the appropriate box and do not complete Section 6. If you are unsure
whether this transaction should be defined as an exception or if you have any other questions concerning exception status, request a
determination from your local Department of Revenue field office. 15-7-307, MCA
PART 6 — SALE INFORMATION (If there Is no exception checked In Part 5, you must complete this section.)
Confidentiality: Sale Information is confidential and for official use by the Department of Revenue only.
Enter the total purchase price paid for the sale parcel. This should include cash, mortgages, property traded, liabilities assumed, leases,
easements and personal property.
Financing: If you paid cash for the entire sale parcel, check the box for Cash. If you financed the property by receiving a loan, check the
appropriate box: Federal Housing Administration (FHA) Loan, Veterans Administration (VA) Loan or Conventional. If this was a contract for
deed or trust Indenture, check the box for Contract. If there was some other type of financing used such as a Montana Board of Housing
Loan, trade of property, etc. check the box for Other. Also, indicate whether this was a new loan or an assumption of an existing loan.
Personal Property: Enter the dollar amount of any personal property included with the sale of this parcel. Personal property Includes
furniture and fixtures, business and farm equipment, livestock, recreational vehicles, leases and easements, and mobile homes. Anything
that is permanently attached to the real estate should not be included. Negligible personal property included in a residential sale need not
be reported.
SID (Special Improvement District— liens levied against the property for amenities like street paving, sewers, water systems, etc.): Answer
the questions by checking the appropriate boxes, and include the amount of the SID paid or assumed.
Value of Inventory: Provide the value of any business inventory that was included in the sales price.
Value of Licenses: Provide the value of any licenses included in the sales price, i.e , liquor licenses, gambling licenses, etc
Value of Good Will. Provide the value of Good Will included in the sale price. (Good Will is defined as "the economic advantage over
competitors that a business has acquired by virtue of habitual patronage of customers.')
PART 7 — WATER RIGHTS DISCLOSURE — This disclosure must be completed and signed by the Seller (Grantor) or the Seller's legally
appointed agent if box B, C or D is checked. Seller's (Grantor) signature is not required if box A is checked. If Box D has been checked,
the Certification of Water Right Ownership Update, Form 640 (page 5), must also be signed by the Seller (Grantor), the Buyer (Grantee),
and the escrow agent (if applicable) for the deed or instrument to be recorded by the County Clerk and Recorder. Refer to page 2 for
further information about the disclosure.
PART 8 — PREPARER INFORMATION — All Realty Transfer Certificates must be signed and dated by the preparer. By his/her signature,
the preparer indicates the information provided is true and correct to the best of his/her knowledge, that the Seller (Grantor) and the Buyer
(Grantee) have examined the completed Realty Transfer Certificate and agree the information contained within is correct and accurate.
Paqe 1
WATER RIGHT DISCLOSURE INFORMATION
The Water Right Disclosure is required by Montana Law. The Legislature requires both the buyer
and seller of property to know what the water right situation is —whether any water rights exist and
whether they are being transferred with or withheld from the property.
A water right is a legally protected right to beneficially use water in priority that was obtained in
accordance with Montana law. Buyers should investigate whether water being used on a property
is allowed as a valid water right, or is merely an unauthorized and unprotectable use of water.
In Montana, all irrigation water rights must have a valid Department of Natural Resources and
Conservation (DNRC) water right number to be of record. However, existing water rights for livestock
and individual domestic use, as opposed to municipal use, based on an instream flow or groundwater
source before July 1, 1973, do not need a DNRC water right number. If a water right does not have a
DNRC number, and does not fall within the above narrow exception, there is no water right.
Once the water rights belonging to a property have been identified, the investigation of water rights
should not stop there. Although a water right may have a valid DNRC water right number, it may still
be subject to final adjudication in Montana's general stream adjudication. The Montana Water Court is
currently adjudicating all Statements of Claim for pre -July 1, 1973 water rights. A water right's validity
is dependent on the results of its adjudication, and how its priority compares to other water rights
on a source of supply. The buyer and seller of a property may need to consult an attorney or water
rights consultant for an opinion of the status of the property's water right. The Montana Water Court
can answer questions about the current status of Statements of Claim being adjudicated by calling
1-800-624-3270 (in state) or406-586-4364.
Important: If there are water rights that have been historically used on the property being transferred,
but are not going to be transferred in the sale of land, the deed must specifically exempt (reserve)
those water rights from the land sale. If the deed is silent, the water rights automatically pass with the
land by operation of law.
The following descriptions may be helpful to determine the appropriate box to mark in Part 7, Water
Rights Disclosure. If further assistance is needed, the buyer and seller of a property may want to seek
legal advice.
CHECK ONLY ONE BOX (on Part 7, Water Rights Disclosure on page 3)
To correctly complete the water right disclosure, the seller (grantor) needs to know if there are water
rights belonging to the subject property on record with the DNRC.
A. Property is served by a public water supply, i.e., city or water district provides water.
Check this box if the water you use on the land described in this document is provided by a city,
town, water users association or other entity. Seller's (grantor) signature is not required in Part 7
if box A is checked. The seller does not need to file a Water Right Ownership Update form.
B. Seller has no water rights on record with DNRC to transfer. Check this box if there are no
water rights appurtenant to the subject property on record with the DNRC. The seller does not
need to file a Water Right Ownership Update form.
If only filing a Transfer on Death Deed, water rights do not transfer at this time. Check this box.
C. Seller is transferring ALL water rights on record with DNRC to the Buyer. If all of the water
rights belonging to the subject property on record with the DNRC will be transferred to the buyer,
check this box. All of the water rights associated with the land described in Part 3 will have the
owner name updated once the fee is submitted. Submit the proper fee and DNRC Water Right
Ownership Update, Form 608 (pages 6-7), to your local water resources office.
D. Seller is dividing or exempting (reserving) water rights. If the seller (grantor) has divided the
property and water rights or has exempted (reserved) the water rights (not transferred with the
land sale), check this box and complete the Certification of Water Right Ownership Update, form
640 (page 5). The seller (grantor) must submit a DNRC Ownership Update Exempt (Reserve)
Severed Water Right, Form 642 and filing fee identifying which water right has been kept by the
seller. If a water right has been divided, the seller must file a DNRC Ownership Update Divided
Interest, Form 641 and filing fee explaining how and with whom the water right was divided.
Contact the DNRC for information if water is used on the property other than described above.
Page 2