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<br />JUL 22 '98
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<br />03:16PM PET, BELL,CONV,JENSE
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<br />P.6/8
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<br />~orm No. aSiA.WEll ......._........OIodG8IJ'.IIIII_nl'.;1IQI
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<br />YJ."IhIJ' 'S D~Cn ..".,
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<br />MINNESOTA WELL DISCLOSURE STATEMENT
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<br />MInMSOIIII Law requires Il>al h",tnrq 0;I9nl119 on ogreemen( lu ~fllI or trarllller reol pro~rly ant!! ,June 30. 1\190, the
<br />serler m~.I disclose 101111 rn~tlon in wrili"9 to '''e buve' RhOllllh!!o !!itatur. {lnd IOalliol1..1 ..II known w9l1~ on It,e proper IV.
<br />1hl9 r~auirE!"''''''( I!; SatiQhcd by deliveri..,... (0 1M b'JYf!r gllhcr n 3Ialemenl I'Y "'I? !agller Ihallhe s""er cJu~s riot know 01
<br />"'''y -~ on Ihe property, (II a dl!lr.I,,~url? slalemonl inriicClII"\J 1111;1 legal cler.oription <,nd ~J\/f1ly ;In" a """'F" BhowinQ
<br />(he locoUon or each wP.lI In the disclocure sl",,,,,!!:! ,I HIP. ~Ier mll!:1 indic,,'e, lot HHr:h wl!'ll. ""h9lher tho well is i" ,,~~,
<br />001 In lr.re or ~aled,
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<br />^ seller.....1 II' rail!; 10 disclooo Ihe axislellCe 01 ~ we"~' Ihe lima or ~l'Ile 8rll' kn_ of, or had reason 10 "'IlJW 01, Ihq
<br />ex~1H'lCe Of;, well iI liable 10 IIItI bUyAr lor cosle relntin(J 10 Ih~ ~..~IIr1Q Or Iho woll find re1\SIJI1Holp. Allomay Ieee: for
<br />eolfeel/o" of costs 'rum 'h., !:eJlgr. if the E'lclion is f;r.1I","~lc9d wilh;n sil( VPoI)I::; aller Ihe dllle the buyer closed IIIF,!
<br />purc;' rClse of ,hi? r_1 property w"cre 1/ 1M welllelocalod.
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<br />Inslruel/on for completion ofthls form are on Ihe reverso side.
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<br />I. PROPERTY DESCRIPTION
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<br />SIreel addr...~: ..
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<br />'''''v
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<br />ec.",..
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<br />,. LEGAL DESCRJPTION
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<br />3. WELL DI9ClOSURE S r A TEMENT
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<br />(Check Ih(,! R""rt)pri;llg box,)
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<br />o The sell~!I ':f:'JII/les that Ihe 3eller does flU! know ot any wolls on Ihe ab,,,,,,,, ,.IIi!~cr't)9d real properly.
<br />II 'h~ "plion is chec!<ed. then !:kip to Ihe laSI hnc snd sign <!lull (fI:!lplhis sIQI91'1'1~1.
<br />o The r.e"er cerlifies t"ClllhFl fOllowing wcllsl!'!re l~alel'l on lhe IIbova d~erib",d real VIDf1P.rty
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<br /> MN, Unioue Well Year 01 Well IN 11SF. NOT IN S'=^lED
<br /> WP.lfNo, CJcplh Con!:! TYf)e us!:
<br />Well 1 --- -- (J U 0
<br />wen 2 '-.-- 0 rl CJ
<br />Well 3 -.----. ~_._- D 0 0
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<br />.... SEALED WELllNFORMA TION
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<br />For eael. well ~Signatgd so 3COfed abov,"" r:r.1mpl$tQ 111ie: ~f:tion.
<br />WllfU' wag the wE!IIsct:lled?
<br />Who sealod the well?
<br />Wes I') Sealell WAil Reporl riled wit~ Ihe Mint,,",sr1(a Department of Hea""? Ytffl ..__ No__
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<br />5. MAP
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<br />Compler" """ .macheCl ml1p 9nowinQ IIItI fll~IIOn 01 oRCh well on Ihf: renl f"'-'Pli'rry.
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<br />6. CERTIFICATION BY SELLER
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<br />, carllly Ihal IhA Information p~evld8d ebOvt'l 1111 <!Ic~urClle IInd oornplela 10 the be!;1 /'If mv knQwledge,
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<br />S~ (" O.,'O...n."d p~..,~nl""
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<br />::teft.f'(JtIJt'>s'""'J....'"'""'OIJt'..,~
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<br />0""
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