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<br />. <br /> <br />. <br /> <br />. <br /> <br />U;)/U~/UL <br /> <br />\,,111. U~ !Ill' <br /> <br />~UU~ <br /> <br />~L:~~ ~AA ~!~ 134 J~~~ <br /> <br />counselor <br />realty inc. <br /> <br />3. <br />4. <br />5, <br /> <br /> <br />1. <br />2. <br /> <br />6. INSTRUCTIONS TO BUYER: Buygrs are encouragecllD lhClnlughJy InspllCl the proPerty 13~i!llly Of' have it inspected by a <br />7, lhltd Party. and 10 Inquire about 8I'ly $pocilic areas of concern. <br /> <br />B. <br />9. <br />jO. <br />11, <br /> <br />1:!. <br />13. <br /> <br />INSTRuCTJONS TO THE Se;LL.E~: (1) Complete tNs rorm yowselr. (2) ConSUlt prIor disClosure SI3tement(s) andlor inspealon <br />rapor[(sl when completIng tills form. (~) Oescrltle 'condlti0l'l3 affecting l11C pt'Opsrty to the bE!Sl of YOIII' knowledge. If u/l5ure. <br />Check. unknown where eppllcable. (4) Atraeh addItional p:ilges with your slgnalUre If additions I space Is reQUired. (5) Answer <br />all questions.. (6) It any Items do nOl: apPlY. ~ "NA" (not appflcaOle). <br /> <br />~~~J~~(~tJ,,3-U?~tL ~~~~~ <br /> <br /> <br />A. .G.ENE~Al INFORMATIm/' . ",,0 ~ <br />0) Wnen dla ~u purchase Or build tile hOme? / :1'7"7 .. <br />(2) Type olli~e Evidence. AbsD'ac:t D ~ <br />Locaucn Of Abstract or Owners OupDCSle Cercllicete Of T1tIe: <l,oJu...., <br />Is tnere an exlsling Ownlll"s TItle Il'I$urance pOlicy? <br />(~) Have you OCCUpied Ihls nome contJnuCI.IS1y fer the p8$l 12 months? <br />If no. ox~: <br />(4) Is the nome SlJitablc I'or year round use? <br />(5) Is tIIa proDalt)' IOCilted in a de.;ignaleCllloOd plain? <br />(6) Are you In POssession of prlor SellerS disclosure Slatemenl(s)? Or yes. please OIllSeh) <br />Are there: <br />(7) Enc:roec:hmenlS? <br />(8) A3s0clauOIl. CovenanlS. Rcs!!Ml~ons or esulctions atr8Cl1ng 1118 we oflhe property? <br />(9) 1!ll'3ement:s. Ol1lar man utllllY or clralnag aasem~nts? <br />(10) Commen15; <br /> <br />. Stale of ~...-n.~ <br /> <br />-=. <br /> <br />14. <br />15. <br />16. <br />17. <br />la. <br />19. <br />20. <br />21. <br />22, <br />23. <br />24. <br />25. <br />26. <br />2'. <br />28. <br />.9. <br /> <br />~..:,C::~ (Torrens)~ UnlInown 0 <br />YesD No ~ Unknown 0 <br />'Ves[B-NOD <br />Ye$ CiiY" No D <br />YesC) No ~known CJ <br />YesCJ No Ll:I- <br />Vasa No ~knOwn D <br />YesD No [B'"Unkno\Nl'l c:J <br />YesD No cs--tJnknown c::::J <br /> <br />, <br />1 <br />.G~ERAI CONDmO]l: Have any of the following COtldltJon:; previously existed ot do they Cl.'f1"enU ~xi <br />el) H.es there baen any damage by wind. fire. tlOOd or DIller a"'aster..~J? Yesl..:::r <br />~Ir ~_givedelailsofwhOltllls~enet!and~ w~:"'!f ;./A?>..4/e. on ntLK.. <br />_'L7!t.t" ~se~.." /.7~~"'A~ <br />. <br /> <br />(2) Has lhe 5lI1JaIJre{s) been 8Iterecl7 O.e. aQdIlJons. aIlCrea rcor rIlleS. Cha~ ro Ioed llear1ng wells.)ves <br />"yes. please specIfy whal was'dona. when and by whom (owner or conll'llCtCr): ;; 9'- r- <br /> <br />~ ~nk~D <br />,... '/ <br /> <br />30, B. <br />31. <br />32. <br />33, <br />34. <br />35. <br />36. <br />37, <br />3a. <br />39. <br />40. <br />41- <br />42. <br />43. C. <br />44. <br />45. <br />46. <br />47. <br />~a. <br />49. <br />50. <br />51. <br />52, <br />53. <br />54. <br />55. <br />56. <br />57. <br />59. <br />59. <br />60. <br />S, . D. <br />62, <br />63. <br />64. <br />55. <br />66. E. <br />67. <br />68. <br />6S, <br />70, <br />71, ' <br />72. <br />73. <br />74. <br /> <br />No 0 Uhknown 0 <br />C./?-9.4'" .n_..~ <br /> <br />(3) In:;ectlAnlmaVPe:st Inrestatlorl? _ ~ YesD No <br />(41 Do you have or haVe you previously had eny PElcs?Yes 0 Nol!:nf YP.$, IndICate !YPe- tlnd number <br />(:5l ComlT\QnlS: <br /> <br />Ul'l~l'lown D <br /> <br />STRUCTURAL ~. Heve 1Jny of lhe fOllOWIng condldcns prevlQU:l1y exISted or do they cunel1(/y exISl'1 <br />CANslflofoo:; III'l't..V TO AU. ~ SUCH AS C'4ACE....O CUT1UILllING:;.1 <br />(1) THE BASEMENT. CRAWLSPACE. SLAB ~ <br />(e) Foundation problem Yes W No E' known 0 (e) Drain tile prOblem <br />(b) FlOOding .' ~s 0 No 'NO 0 (0 CraCkea nOcrlwallS <br />(e) Wet floorslwsllS Ves c::; NO ~nl<nown 0 Co) Sewer backul=l <br />(d) Leakage/seepage Yes 0 No I:E"Unknown 0 (h) Other <br />Give dstalls 10 any questlons answered "yes,' <br /> <br />NO~kno\M'l 0 <br />NO~known 0 <br />No c::l UnknoWl'l ~_ <br />No c::J Unknown L~ <br /> <br />VesD <br />vasa <br />Yes <br />Yes c::J <br /> <br />121 T~E R~~ Is the 1.196 of t/'Io 100""11 materi~l? 9' A":A(.r <br />(Ill Hes there Dcen Intenor damage from Ice Dulld.up? <br />(e) Has there been any leakage? <br />(dl Mave tnere been lIIlY repairs or rllpla <br />G' e der.al~ to any q " <br />/2.., <br /> <br />Years Unknown Cl <br />Yes~ No ~ Unknown CJ <br />'res~.......... No CJ Un!<nown c:::J <br />AVe:;~ ~ L2, Unkllown CJ <br />e "'jP... L:'.... 7?J <br /> <br /> <br />~ATE SFwEJ;! SYSTFM DISCI OSUR~; (A Prtvate Sewer System Disclosure Is required by Minn. Statues 115.55) <br />CheclC appropriate box <br />(;31'ne Seiler does nO! know Of a privata sewer system en or serving [he above descrlbed raal property. <br />o There is e private sewer syStem on or serving the above described real property. See PrlVElle Sewer System DiSclosure. <br />o 'mere Is /In eb"ndoneo private .- system on the Stleve described r831 property. See Prlvece Sewer SY5lem Oisclosure. <br /> <br />PR!\IATF WEll DISC! rnUR!": (A WeD Dl'sclosurs Statement and Certl/lc3ls are required by Minn. StatuQS , OJl .2~SI <br />~ppropriate box , <br />seUer certifies !I'IOlt the seller does not know of any wells en the above descrlbetl real prOperty. , <br />'l11e :seiler cenIfIes !here 3re one or more well:; loceted on !he 1Jbcve dllSCl10e(l reel property. See Well lli..~, SllltElment. <br />Are there 8rry weHs serving me above described property that are not 'cealed on lI1e property? Yas 0 No l!.d'" Un'<ncwn D <br />Dilfe wCJI water !as rested for contamlnant:s: _ 'Test resuilS 3tladled Yea D No c:J CJ <br />OOl1'1ments: ' <br /> <br />Is ItIls property in a Special Well Con&ructlcJ1 Area? Yes D NO ~nkno"'n 0 <br />Contaminated Well;, is there a wen on or serving Ille property contalnlrlg cornaminated WlIter? Yes CJ No B""UIl~nown 0 <br /> <br />75.' ORIGINAL COPY TO Ll5nNG BROKER: COPIES TO SElliR.. BUYER, SELUNG BROKER <br />MN: SPO:;'1 (9tes) <br /> <br />" <br />