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SELLER'S PROPERTY DISCLOSURE STATEMENT This form spprovGO by Ihe Minll8SO!a Assoc<atlon 01 REALTOAS~. wt\i~h discJaitr>s any hsP,!ity ariSIng ~ul 01 ul8 or miU5e :>I this form 1. Date .' 2. Page 1 of Pages 3. NOTICE: Thla dllClosure I. not a warranty or a !lualilntv 0' any kind by the Seller(a) or Agent(a) representing 4. any partyte) In the tranNCllon. The In'oll1\lltlon dl8Clo1ed I, !liven to lhe befll of the 58l1er', knowledge. 5. INSTRUCTIONS TO BUVER: Buyef1l .re encountged to thoroughly 'napect Iha property P8f11onaJly Or hBYI! it 6. lnapocted by e ttllrd party, Itnd to Inq.,dre IIbout any' .paciflc Itreus of concern. 'jo; 7. INSTRUCTIONS TO THE SEllER: (1) COmplete thl. form you....lf. (2) COnlJUlt prior dlKlosunt 'Iatement(s) B. and/or IMpeCIkIn report(lt) when completing ttlls tonn. (3) D.,acnbe conclJl1oM affecllng lhe ptOperty 10 the best 9. of your knowledge. (4) Attac:h addltlonlt! peg.,e with your IlgnelUre If Iddltklnalepace Is required. (5) Answer 10. ell qunllon.. (8) If any Items do not apply, wrtte "NA",j' appllceble). ~. n. Property Jo<oa!8d 81 ~G.i ~'iJ"'b'1f)<..J ;<1...... 12. ory of _ A..D~.Lr" County 01 J..ji~,jvy 13. A. GENERAL INFORMATION: 14. ( ') When did you purchase ()( build Ihe home? 15. (2) lYPB of T1tIe Evidence: 16. t..oulion of AbIIracl or Owner's Duplicate Certificate of Title: 17. Is there an exla1lng OwrIer's Title Inauranee policy? 18. (3) Haw you occupied this home continuously for the past 12 ffiCnlhs? 19. II no. explaill: 20. ( 4 ) Is the home suitable lor year round use? 21. ( 5 ) Is the property loc.aIed ill a deaign3ted nood plaIn? 22. (6) Ale you in possession of prior seller'a discloaure Sllltemel'lt(s)? (II yes. please ..l1achj 23. Are Ihere: 24. (7) EncroaChments? Yes 0 No [] UI'IAl'Iown 0 25. (8) Covenants, Restrictions or Reservations (non-gowrl'lmentlll) affecting the use of the propeny7Ves ~ No 0 Unknown 0 26. (9) Easements, oth Ih n utlity or draifl8ge ea ment? Yes 0 No . Ullknow 0 'n. (10) Comments: '" ~ 28. <..tLlNb 29. B. GENERAL CONDITION:To your knoow~'" II'IV of tile following condIUons pnMOUl1y 111,ted or do Ihey I:unently erl,t? 30. ( 1 ) Has there been any damage by ....ind. fire, flood or other dlsaster(a) ", 'faJl'~ No 0 . 31. If yes, givll dtttails 01 W!1at happened and WIlen: rc-ltLr 1tcB.If.,.r I uo............, q--.1li.1)1It-J 32. ,,'OoT" A. vA I ~~q-. D : - 34. (21 Ha the str1.Idul8(8) been enerecI? (Le. additiona, altered rooIlill8S. cnanges 10 loaD b8IIf~ walls.) Yes [] No ~-- 35. If yea. please 8p11(:IIy what ....as done, when and by whom (OWner or contr8ctor):.~.___._n'__'__"___ 36. _.____ _.n_.___._.._...___. ---.-. ~ --- -------.-.-----------.---.- 38. ( 3) Soil Problems? Yes 0 No 0 39. (4) Diseased ltees? Yes P!;I No CJ~ 40. ( 5) Animal Infestation? Ves 0 No 0 41. (6] InsectlP8st Infestation? Ves 0 No D f\... / .f ' 42. ( 7] Do yoI.I q~ or have yOU P!av,ouIIY had any ~? Yes 1)(1 No CJ If ye.:!. Indicate type ~_ and number ..:!-..... 43. (8) Commel)llC. ~ iL&Yf" tr~~ ~CI ",Y1r. oJ :D.u.- P-tSj. ft.(2 ~..,.-'lIH"'" (:.~ 44. A~ '1 l.__t-lI f~f1 ~- ' - 45. C. STRUCTURAL SYSTEMS:To your knowledge hive any of !!'Ie following condition. PfWlousty ulsted Of do they currently uiSl? 46. (AnSWllf1l apply to all 8UUCtures, SUCl1I18 garage and out.buildiIl9S.) 47. (1) THE BASEMENT, CRAWLSPACE. SLAB 48. (a) FoundatiorI problem Yes 0 No e (e) Drain tile problem Yes 0 No fBj 49. (b) Aoodlng Yes i No gJ (0 Cracked floors/wall !I Yea 5 No 0 SO. (C) wet f\oortIWIIls Yea No 0 (9) s-r backup Yes 0 No 0 51. (d) LBakage/SeeP8Q8 Yes No D (h) Other 'nIa 0 No 0 52. Giw details 10 any question answered "yes'" ~JY'" 'fHtlOoJ'-" tf U.J\~! 53. 54. 55. 56. 57. sa. 59. 61). 61. 62. ,Sta'a(]t~ /98'3 ~ WvV~ Abstract 6i1 RegistarecU10rrensf LJ Ullkllown 0 ~..A Jf.:r I!Ti-'" Yes ~ No 0 Unknowll 0 Yes~ No 0 Yes ~ No 0 ------ Yes 0 No CJ UnknoWII ~ Yes 0 No tKL (2) THE ROOF (a) WI1aI is the age of the roofing material? .Ai (b) H811 there been Interior damage from ice build-up? (e) Hal there been Itny leakage? (d) Haw ther8 been any repa!11 or repflll:e Give details 10 Itny question ~ "yet": c....... IT ~7~ Ves Jii:J No 0 "VSNoD Yes 0 No C5 made 10 the roof? AILV' U~&-...+- , ~"" t:r.M\ P.J1ttl\ll.b~ iiIJ~w ~h/1t..'d, 63. D. PRIVATE SeWER SYSTEM DISCLOSURE: (A Private Sewer system Disclosure is required by Monn. Slatuto}sl 64. _!;hecK app'~e 00. . 65. I2S The seller do8I no! know of II private sewer system on or 8IIMng !he abOVe described real property'. 86. 0 There i$ a prl....te _r system on or serving the above dcIICribed real property. See Privala S8wef 5yslom OisclosUfo. fIT. E. PRIVATE WELL DISCLOSURE: (A well DiscloS1,n'8 Swement and CoIrtitlcatel/lI required b)I MInn. $tsliJllISl Cr..'c' ~ppfO~(I.1(e M' 68. 69. 70. 71. 72. 73. r,g. TIte setl8( certlnn mal the seller does ncx know of any weUs on the abOve described real property. o The MIler C8I1ifill8 lhere are one or mO(e wvllslocal9d on the IIbO-o'8 d.scribed real propertY. See Well Disclosure Swemenl. Are there any wells servlno Ihe above described property that are nol located on the property? YII& 0 NOB Unlu10lvn ~ Dete well water IasI IBSIIId lor conuunlnanls: TIISI resufls attactled Yes 0 No COmments: Is this property In e S4:JeCJaJ Well Con8!l'1Jction Aree? Yas 0 No 0 Un~nown b(J _ . . ,.t_". I. ~....___ .... ......11 ....... ..... ~AM,.,n ,,.,~ ....rnrw:lrtv c..."')nfAln,no CQntemlnsred wafer? Yes rJ No 0 Unknown ~ ; I I ! i I i i I J I ,