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Form too.262A-WELL-khnnesola hf!gr Vt&r,mu,e 5iai�+ens r199Q Z 7,-1.r .L.. <br /> MINNESOTA WELL DISCLOSURE STATEMENT <br /> Minnesota Law requires that before signing an agreemenI to sell or transler real properly after June 30, 1990.the <br /> seller mast disclose information in writing to the buyer about the status and location of all known wefts on the preper�y <br /> This requirement is satisfied by delivering to the buyer either a statement by the seller that the seller does not know of <br /> any wells on the property,or a disclosure statement indicating the legal description and county and a map show ire q <br /> the location of each well In the disclosure slatement the seller musli indicate.for each well,whether the well is in k1sr, <br /> not in use or sealed. <br /> A seller who fails to disclose the existence of a well at the time of sale and knew of.or had reason to know of,xhe <br /> existence of a well is liable to the buyer for costs relaling to the sealing of tha well and feasonable attorney fees for <br /> collection of costs from the seller, if the aclion is commenced within six years alter the dale Elie buyer closed I he <br /> purchase of the real property where the well is located. <br /> Instruction for completion of this form are on the reve roe side. <br /> 1. PROPERTY DESCRIPTION <br /> Street address: <br /> 2. ILEGAL DESCRIPTION <br /> „ <br /> 3. WELL DISCLOSURE STATEMENT <br /> (Check the appropriate box,) <br /> ❑ The seller certifies that the seller does not know of any wells on the above described real property- <br /> If this option is checked,then skip to the Iasi tine and sign and date this statement. <br /> ❑ The seller certifies that the following wells are located on the above described tea I property <br /> M N.Unique Well Year of Welt IN USE NOT IN SEALED <br /> Well No. Depth Const. Type USE <br /> 4. SEALED WELL INFORMATION <br /> For each well designated as sealed above,cornplele I is section <br /> When was the well sealed? <br /> Who styled the welt? <br /> Was a Sealed Well Report tiled with the Minnesota Department of Health? Yes No <br /> 5. MAP <br /> Complete the attached reap showing the location of each well on the real property. <br /> 6. CERTIFICATION 13Y SELLER <br /> I certify that the information provided above is accurate and compiele to the best of my knowledge- <br /> Solldror aesignaled ClavesenlRlnoe <br /> .'+pJIPPF�I QP.r�+"1�1�R�'R'r?RPI'+1AlIVp �lF, <br />