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SELLER'S PROPERTY DISCLOSURE STATEMENT This ronn applO\llld by tha Minnesota Associ8tlon of REALTOR$"', wt1ich disclaims any liability ari5ing o)ut of use or misuse 01 this form. 1. Date _ 2. Page 1 of Peges 3. NOTICE: This dlsc/QSure Is nol a warranty or a guarunly of any Idnd by the SeIIer(I) or Agent(1) representing 4. my party(a) In thll tnlnNe1lon. The Information dlllCloaed I. given to the best of the &eller', knowledge. 6. INSTRUCTIONS TO BUYER: Buy&ru Ire enC:OUl1lgld 10 thoroughly IlUIpeet the property personally or have it & Inspeeted by a third party, and 10 Inquire about any specltte areas of coneem. jo; 7. INSTRUCTIONS TO THE SELLER: (1) Complete Ihls form yoursel', (2) Consult prlor dlscloBure Itatement(s) 8. andJor Inspection report(s) when completing this form. (3) Describe conditions afleetlng the property 10 the best 9. of your knO\Itledge. (4) Attaeh addlllonal pages wllh your algnature If addlllonal spac:e Is requIred. (5) Answer 10. all que.tlons. (6) " any Items do ~01 apply, wrtht uNA;:;t appllcsble). .~. 11. Property l~atB9 at ).."'''2 ~(to/b'1r;v A...... . , 12. City 01 ~o..J...r COunty ot Lr>;o;.,j~Y 13. A, GENERAL INFORMATION: 104. ( 1 ) When did you purchase or build the home? 15. (2) 'TYPe of TItle Evidence: 16. Location 01 AbsIracI or Owner's DupUcale Certificale of Title: 17. Is there an exl$tlng Owner's Title Insurance policy? 1 B. (3) Haw you o<<:upled this home continuously for the past 12 months? 19. If no, explaJn: 20. ( 4 ) Is the homa suitable !of year round use? 21. (5) Is the property locaIlId in a designated flood plain? 22. (6) Are you In possession of prior seller's disclosure SUltamenl(s)? (1f yes. plesse attach) 23. Are Ihere: 24. (7) Encroachments? Yes 0 No D Unknown 0 25. (B 1 Covenants. Restrictions or Reservations (non.gOYernmental) affecting the use of the property?Yes g No 0 Unknown D 2& (9) Easements,OIh Ih nullity or drainage ea meal,,? Yes D Non UnknowrJ 0 'Zl. (10) Comments: A c:S'd Q'A-"O"\.iN\"'" ~ !Ul...d~ ~ v~~ 28. t:.. Nb It.. ~ I _ _---2- 29. B. GENERAL CONDITION:ro your knowledgo ha'I'8 any of tha Iollowlll!l eondltlons prevlou,1y allsted or do they currently ollsl? 30. ( 1 ) Has there been any damage by wind, fire, flood or other dlsasler(&) t1. YeJl'~ No n .. 31. It yes. give details 01 w.hal happened and when: ft'ltLr iI~""" I 0"''' rl-. r r- -7]"( 'h4/U 32. 1.1 tiT'" .A. vA I UIfc...iT, 33. . 34. (2) Has the slruClura(S) been altered? (i.e. addiUons, a!tered roollinss, changes 10 load bearing walls.) Yes 0 No ~- 35. If yes. please specify what was done, when and by whom (owner or contractor): ~--_._-- 36. 'ST. 38. (3) Soil Problems? Yes 0 No 0 39. ( ~ ) Diseased 1t88S? Yes 6?J No [] ~ 4C. ( 5) Animal Infe$tation? Yes 0 No 0 41. (6) Insect/PBst Infestation? Yes 0 No 0 42. ( 7) Do you 1t1\'1I or have you p~evIOUSIY had any ePts? Yes ~ No 0 If ye~. indicate type 43. (8) Comme~ ~ UAII,"" grr~~CI~'~'o".) ':Qh;; p~~r. .NC? 44. #' '1 w__ {'<JI pltOtT. - - ' 45. C. STRUCTURAL SYSTEMS:To your knowledgl hII/o any 01 the following condltlona pmvlOl.lsly exlslld or do they currently exist? 46. (Answers apply to ell structures, such as garage and out.buildings.) 47. (1) THE BASEMENT. CRAWLSPACE, SLAB 48. (a) Found8l1on problem Yes 0 No 1!!9. (e) Drain tile problem Yes 0 No jgI 49. (b) Aooding Yes i No rlSJ (I) Cracl<ed floorslwalls Yea 129- No 0 50. te) Wet ftoorSIwaJls Yes No 0 (91 Sewer backup Yes 0 No 0 51. tel) Leakage1seepage Yes No 0 (hi Other Yes 0 No 0 52. Give details to any question answared "yas": -.B::!ot>l,V'- 'fJI14:J...{,.tf 1l.I\NDiMJ f 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. , State ol~. /99-3 ::c "T1-I VV):::... A.bstract 6!'1" RegistereQ.fl"orrens) 0 Unknown 0 ~.AJt.:r ''[1;1,...9. Yea ~ No 0 Unknown 0 Yes~ No 0 Yas~ No 0 Yes 0 No 0 UnknoWn ~ Yes 0 No Ig), -.-----.-.----------..--- ---.--------------.....-- ~--........-......--_-----...-....... l:b6 J' and number ~. k!..AJr)'ow...<<l' cr " ....... (2) THE ROOF (e) Whal is Ihe age of .he roofing material? Ai c...{1o. IT (b) Has Ihere besn interior damage from ice build.up? (c) Has there been any leakage? (eI) Have \here been any rspalrs or replacemen made to the roof? Glw datan8 to any question an_red "yes": rs- "ff"A~ 63. D. PRIVATE SEWER SYSTEM DISCLOSURE: (A Private Sewer System Disclosure is required by Minn. Statutes) 64. ShlGI-; app'opriate box . 65. The sellar does not know of a prtvate sewer system on or serving Ihe abOYe described real property. 66. There i8 a private sewer system on or 81rving lhe abow desCribed real property. See Privata Sewef System DisclosLlre. ffl. E. PRIVATE WEll. DISCLOSURE: (A Wen Disclosuru StBlllment and Ceniflce.te are nlGuirad by Minn. Statutes) Ct1dC~ ~ppropllace bo. 68. fB. The seller certifies that Ihe saller does not knOw 01 any wells Of! the above described r88I property. 69. D The setler certifies lhere are one or more wells localed on 'he above described real prtIpVrty. Sea Well Disclosure Statement. 70. A.re Ihere any wens 8ervlng Ihe eboW described property 'hal are no! located on the property? Yes D No D Unkr'lown IlS 71. Dale well waler last l8ated lor contaminants: Test reaults attached Yes 0 No 0 12. Comments: 73. Is this property In a Special Well Con8lruClion Area? Ye, 0 No 0 Unknown bZI 74. Contarnina!8d Well: la there a well on or solVIng 111& property conlBlning contaminated waler? Yes 0 No 0 Unknown ~ 7'">. <A!"~.'D~.I (IJ':.'} C~h'3lN.\I. NIP':' TO ...IS~I'I(t 8Jo1::::~ 01: COPIf::9. TO 3td I:n, BuYER. 3(...lI~ dHuKE;:~. I I I I i I ! ! I j I I I I I I I