HomeMy WebLinkAbout2021 Certificate of Trust II II II I 11 II II
LAND TYPE Torrens (T)
DOC NUM 5888546
Certified, filed and/or recorded on
Oct 28, 2021 1:00 PM
Office of the Registrar of Titles
Hennepin County, Minnesota
Amber Bougie, Registrar of Titles
Mark Chapin, County Auditor and Treasurer
Deputy 55 Pkg ID 2341663C
Document Recording Fee $46.00
Document Total $46.00
Existing Certs
1532238
This cover sheet is now a permanent part of the recorded document.
(Top 3 inches reserved for recording data)
CERTIFICATE OF TRUST Minnesota Uniform Conveyancing Blanks
By Individual Form 90.1.1 (2016)
Minn.Stat.501C.1013
State of Minnesota,County of Hennepin
Trisha Blake ,being
first duly sworn on oath states,or affirms under penalties of perjury,that:
1. The name of the trust,if one is given,is: Irwin L.Jacobs 2018 Irrevocable Trust dated as of April 30,2018
2. The date of the trust instrument is: April 30,2018
3.The name and address of each trustee empowered to act under the trust Instrument at the time of execution of this Certificate of
Trust is:
Trisha Blake Mark Jacobs
8096 Excelsior Boulevard 8096 Excelsior Boulevard
Hopkins,MN 55343 Hopkins,MN 55343
4. The trustees are authorized by the trust instrument to sell,convey,pledge,mortgage,lease,or transfer title to any interest in real
or personal property,except as limited by the following: (if none,so indicate)
None
5. The number of trustees required to act is: two
6. The trust D has ❑O has not been terminated.
(check one box)
The trust instrument U has O has not been revoked.
(check one box)
Pursuant to Minn.Stat.501 C.1013 subd.2:
The name of each settlor of the trust is: Hossein Alibadi
The name of each original Trustee is: Irwin L.Jacobs
I �,
•
Check this box ID if an Affidavit of Trustee,consisting of two pages,is attached to this Certificate of Trust.
The statements contained in this Certificate of Trust are true and correct and there are no other provisions in the trust instrument,or
amendments to it,that limit(i)the powers of the trustee(s)to sell,convey,pledge,mortgage,lease,or transfer title to interest in real or
personal property,or(ii)the authority of the trustees to exercise any other power identified in this Certificate of Trust.
Trustee or Settlor
(signature) Trisha Blake i
Signed and sworn to(or affirmed)before me on October_t21 ,2021 ,by Trisha Blake,Trustee for the
(month/day/year)
Irwin L.Jacobs 2018 Irrevocable Trust Agreement dated April 30,2018
(insert name of Trustee or Settlor making statement)
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(Stamp) a./ /0.� 7.e/V/
(signature of n al officer)
' coo 0.14.0 AMY JO DIGMAN t/ �, >
o'Y�. ,� Notary Public Title(and Rank): 1VQ4 1y Pulll,r cS ,f.e. OP mg)
r State of Minnesota /
"Vii' ' My Commission Expires
� >�!!"� My commission expires: vI'3/-,1-aa5
January 31, 2025
........... (month/day/year)
THIS INSTRUMENT WAS DRAFTED BY:
(insert name and address)
MALKERSON GUNN MARTIN LLP(GDS)
5353 Gamble Drive,Suite 225
Minneapolis,MN 55416
612.344.1111
278980
J
•
(Top 3 inches reserved for recording data)
AFFIDAVIT OF TRUSTEE(inter vivos Trust) Minnesota Uniform Conveyancing Blanks
Minn.Stat.501C.1014 Form 90.1.3(2017)
State of Minnesota,County of Hennepin
Trisha Blake ,being first duly sworn on oath states,or
affirms under penalties of perjury,that:
1.Affiant is the trustee(one of the trustees)named in that certain Certificate of Trust(or trust instrument):
0 to which this Affidavit is attached.
(check one box)
❑ recorded as Document Number
(month/day/year)
(or in Book of Page ),in the
Office of the ❑ County Recorder ❑ Registrar of Titles of County,Minnesota.
(check the applicable boxes)
executed by Affiant or another trustee or the settlor of the trust described in the Certificate of Trust(or set forth in the trust Instrument),which
relates to real property in Hennepin _ _County,Minnesota,legally described as follows:
Outlot A and Lot 4, Block 1,Tanager Estates,Hennepin County,Minnesota.
(If more space is needed,continue on attachment.)
2.The name(s)and address(es)of the trustee(s)empowered by the trust instrument to act at the time of the execution of this
Affidavit are as follows:
Trisha Blake Mark Jacobs
8096 Excelsior Boulevard 8096 Excelsior Boulevard
Hopkins,MN 55343 Hopkins,MN 55343
3. The trustee(s)who have executed that certain instrument(deed,mortgage,or other conveyance),relating to the real property
described above,between Mark Jacobs and Trisha Blake ,as trustee(s),
and plat of Shoreline Estates ,
which instrument is dated October 1,2021 ,(a)are empowered by the provisions of the Trust to sell,convey,pledge,
(month/day/year)
mortgage,lease,transfer title to,or release,any interest in real property held in trust;and(b)are the requisite number of trustees required by
the trust instrument to execute and deliver such an instrument.
4.
O The trust has not terminated and the trust instrument has not been revoked.
(check one box)
❑ The trust has terminated(or the trust instrument has been revoked). The execution and delivery of the
instrument described in paragraph 3 has been made pursuant to the provisions of the trust.
5. There has been no amendment to the trust that limits the power of trustee(s)to execute and deliver the instrument described in
paragraph 3.
6.
I] The trust is not supervised by any court.
(check one box)
E The trust is supervised by the Court of
County, . All necessary approval has been obtained
from the court for the trustee(s)to execute and deliver the instrument described in paragraph 3.
7. Affiant does not have actual knowledge of any facts indicating the trust is invalid.
Affiant
(signatdire) Trisha e
Signed and sworn to(or affirmed)before me on October o2/ ,2021 ,by Trisha Blake,as
(month/day/year)
Trustee for the Irwin L.Jacobs 2018 Irrevocable Trust Agreement dated April 30,2018
(insert name of Affiant making statement)
•
Stamp) a")-71.- a
els'0.40 AMY JO DIGMAN (signature ofnotaralofficer)6
4,4,-.1.„,4 Notary Public
it?.. .',r Alt,) State of Minnesota Title and Rank): itici ir,py 2 h/
T„R My Commission Expires /
January 31,2025
My commission expires: 0/ ,?/ --(- 0
(month/day/year)
THIS INSTRUMENT WAS DRAFTED BY:
(insert name and address)
MALKERSON GUNN MARTIN LLP(GDS)
5353 Gamble Drive,Suite 225
Minneapolis,MN 55416
612.344.1111
278980