CM-2017-1313 - 2/10/2017DocuSign Envelope ID: 972DDA2E-OFFD-461C-936F-E235B8C93010
Form ROW -R-110
(Rev 07111)
Page 1 of 1
PROPERTY OWNER'S CLAIM FOR PAYMENT
INCIDENTAL EXPENSES OF PURCHASE OF REPLACEMENT DWELLING
I. Name ofClaimant(s)
Parcel No.: 12 County: Williamson
Billy & Beverly Ketchum
ROW CSJ: 0683-01-092 Project No.:
2. Occupancy of State-Acquircd Property:
3. Controlling Dates
Mo.
DaX
Yr.
09
09
2016
From (Date): 1993 To (Date): 1210612016
it, Gust Offer in Negotiations
b Property Acquired by State
4. Address of Replacement Property:
I I
01
2016
1206 High Chaparral Dr.
12
02
2016
Leander, TX 78641
L. Replacement Property Acquired
d CkcupungofRepluccmcnt
12
06
2016
Property
5. Expenses (I ist below each item included in claim - attach
receipts or closing documents to support each cost.)
Item
Amount
Title Policy
$187.20
Agent Fee - Escrow Agent
5300.00
Recording Fees
525.00
Home Inspection (POC)
5465.00
5
5
5
$
3
5
5
S
l'Olal $977.20
6. Payment of this claim in the amount shown in Block 5 above is requested. I certify these incidental expenses were necessary in the
purchase of my replacement dwelling and that I have not and will not accept reimbursement or payment from any other source for these
expenses. I further certify that all information shown above is true and correct, and that the replacement dwelling I now occupy meets the
standards of decent, safe and sanitary housing to the best of my know e d belief.Qwuao�-
Z4- /o n
Claimant
Datcoirdlaim
Claimant
Spaces Below to be Com leted by State
7. The dwelling at the address under Block 4 above has been inspected and in my opinion meets the standards for decent, safe and sanitary housing.
June 27, 2016
Date oflns ectron
1'' InspecledBy-5i ature
I certify that I have examined this claim and found it to conform to
certify the cer�9u T2dflt)e payment and the information shown
Date: By:
��Ajq%g§:and regulations governing n:location assistance payments, I further
ere is co a Ihis c�plm is mcnmmended for payment.
=f l'IAVYGLIA
jti ht orway Manager
1
Laurie HarLle�J—r'tt�t�arr�ger
d�i�IIIB�
DocuSign Envelope ID: 972DDA2E-OFFD-461C-936F-E235B8C93010
American Land Title Association ALTA Settlement Statement - Borrower/Buyer
Adopted 05-01-2015
File Number:
Print Date & Time:
Escrow Officer:
Settlement Location:
01247-64966
11/30/20161:03 PM
Kristl Dobrinskl
1903 Cypress Creek
Road, Suite 102
Cedar Park, TX 78613
Stewart Title of Austin, LLC
1903 Cypress Creek Road, Suite
102
Cedar Park, TX 78613
Property Address: 1206 High Chaparral Drive Leander, Texas 78641
Lot 4, Block 2, High Chaparral, Book B, Page 77, Williamson County, Texas
R035469
Buyer: Billy Ketchum - 406 Briarwood St., Round Rock, TX 78681
Beverly Ketchum, TX
Seller: Joe Eric Stevens -1206 High Chaparral Drive, Leander, TX 78641
Lender: Cash, TX
Settlement Date: 12/02/2016
Disbursement Date: 12/02/2.016
Additional dates per state reclidrements: 12/02/2016
description
Borrower/Buyer
-
Debit
Credit
Financial
Sales Price of Property
$280,000.00
{Deposit
$2,500.00
Proration s/Adjustments
County Taxes 12/2/2016 to 1/1/2017
$402.97
Option Fee
$100.00
Payment from City of RR from City of Round Rock
S /?,398.00
Seller Credit
$500.00
Title Charges & Escrow/Settlement Charges
Title - Owner's Policy (optional) $280,000,00 Premium - $1,872.00 to Stewart Title of
Austin, LLC
A B OTP RESIDENTIAL 593.60
T19 1 r 1 14OTP Reduced Rate STG $93.60
S 101.20
Signing Agent Fee to StewarlTitle o`Austin, LLC
$300.00
Government Recording and Transfer Charges
Recording Fees Deed: $25.00 Mortgage: to Stewart Title of Austin, LLC
$25.00
Debit
Credit
Subtotals
$280,915.17
$75,498.00
Due From Borrower
$205,417.17
Totals
$280,915.17
$280,915.17
Copyriot 2715 Amnion Land 711le Assoclallan F'leff 01247-64966
Xi arhu reacrved. Page 1 of 2 Printed on November 30, 2016 at 1:03 PM
DocuSign Envelope ID: 972DDA2E-OFFD-461C-936F-E235B8C93010
Inspection Support Network
(512) 906-9872
'TEXAS PROFESSIONAL
HOME INSPECTORS
T"rexasanny L Churchly _
Professional Horne t . for
Texas Professional Rome Inspectors
333 Country Aire Dr, Round Rock, TX 7
Payor
Billy Ketchum
1206 High Chaparral Dr
leander, TX 78641
Client / Subject
Billy Ketchum
1206 High Chaparral Dr, Leandt
DESCRIPTION
Inspection Fee
Cando/Townhouse Discount
Crawl Space
Trip Fee
Mother In -Law Apartment
Outbuildmg
Termite Inspection
Total:
PAID
rope" .
Cr4t Card $465.00 (##4477) on 10/14/2016
78641
Thank you P your busirwm i fyou have onyquestiors please coil us at (512)506 9872
AMOUNT
S365.00
50.00
50.00
$15.00
$0.00
$0.00
$85.00
5465.00
Page 1 of 1
Invoice 101416DC
Invoice Date: 10/14/2016
Due
due on receipt
http://go isn.netltexaspro fessionallviewinvoicelviewextemal?pq=eJwtiV EKgCAQBe-yJ8g... 10/20/2016
f� City of Round Rock
ROUND ROCK
TEXAS Agenda Item Summary
Agenda Number:
Title: Consider approval of a Claim for Payment of Incidental Expenses on the
Purchase of Replacement Housing for Ketchum -Parcel 12 on the RM 620
project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 2/10/2017
Dept Director: Gary Hudder
Cost: $977.20
Indexes: RR Transportation and Economic Development Corporation (Type B)
Attachments: 00371746. PDF
Department: Transportation Department
Text of Legislative File CM -2017-1313
Consider approval of a Claim for Payment of Incidental Expenses on the Purchase of
Replacement Housing for Ketchum -Parcel 12 on the RM 620 project.
The City has purchased the residence on Parcel 12 and landowners have purchased a
replacement home. The Uniform Relocation act allows for actual moving expenses to
be recovered as a result of this displacement, and the requested amount is supported
by the rules and recommended by the relocation consultant for payment. Pursuant to
the project funding agreement, this payment is 100% reimbursable by TxDoT.
Cost: $977.20
Source of Funds: RM 620 ROW Project
City of Round Rock Page 1 Printed on 2/912017