Residential Property Disclosure and Disclaimer Statement

Residential Property Disclosure and Disclaimer Statement

Instructions to the Seller: Please complete the following form. Do not leave any spaces blank. If the question clearly does not apply to the property write "NA". If the answer to any items requires explanation, explain on attached sheets, if necessary.

Notice to the Buyer: The following disclosures are made by the seller(s), concerning the condition of the property located at ("the property"), or as legally described on attached Exhibit A.

Disclosures contained in this form are provided by the seller on the basis of seller's actual knowledge of the property at the time this disclosure form is completed by the seller.

Seller(s), , is / is not currently occupying the property.

Seller has owned the property for years.

I. Seller’s Disclosures

1. Title

A. Do you have legal authority to sell the property? Yes No Unknown

B. Is title to the property subject to any of the following?

(1) First right of refusal Yes No Unknown

If yes, explain:

(2) Option Yes No Unknown

If yes, explain:

(3) Lease or Rental Agreement Yes No Unknown

If yes, explain:

(4) Life Estate Yes No Unknown

If yes, explain:

C. Are there any encroachments, boundary disputes, or boundary agreements? Yes No Unknown

If yes, explain:

D. Are there any rights of way, easements, or access limitations that may affect the owner's use of the property? Yes No Unknown

If yes, explain:

E. Are there any written agreements for joint maintenance of an easement or right of way? Yes No Unknown

If yes, explain:

F. Is there any study, survey project, or notice that would adversely affect the property? Yes No Unknown

If yes, explain:

G. Are there any pending or existing assessments against the property? Yes No Unknown

If yes, explain:

H. Are there any zoning violations, nonconforming uses, or any unusual restrictions on the subject property that would affect future construction or remodeling? Yes No Unknown

If yes, explain:

I. Is there a boundary survey for the property? If yes, attach survey. Yes No Unknown

J. Are the property’s boundaries marked? Yes No Unknown

If yes, explain:

K. Are there fences on the property? Yes No Unknown

If yes, were the fences put up by the property owner? Yes No Unknown

L. Are any trees or other flora on the property diseased, dead or damaged? Yes No Unknown

If yes, explain:

M. Are there any covenants, conditions, or restrictions which affect the property? Yes No Unknown

If yes, explain:

N. Is the property accessed by public or private road? Public Private Unknown

If private, what yearly upkeep amount is paid by the property owner?

If private, explain road upkeep in detail:

2. Water

A. Household Water

(1) The source of the water is: Public Community Private Shared

(2) Water source information:

a. Are there any written agreements for shared water source? Yes No Unknown

If yes, explain:

b. Is there an easement (recorded or unrecorded) for access to and/or maintenance of the water source? Yes No Unknown

If yes, explain:

c. Are any known problems or repairs needed? Yes No Unknown

If yes, explain:

d. Does the source provide an adequate year round supply of potable water? Yes No Unknown

e. Are there any water treatment systems (softener, purifier, etc.) for the property? Yes No Unknown

If yes, explain, and state if the system(s) is/are leased or owned:

B. Irrigation

(1) Are there any water rights for the property? Yes No Unknown

If yes, explain:

(2) If they exist, to your knowledge, have the water rights been used during the last five-year period? Yes No Unknown

If yes, explain:

(3) If so, is the certificate available? Yes No Unknown

Explain:

C. Outdoor Sprinkler System

(1) Is there an outdoor sprinkler system for the property? Yes No Unknown

(2) Are there any defects in the outdoor sprinkler system? Yes No Unknown

If yes, explain:

3. Sewer/Septic System

A. The property is served by (circle one): Public Sewer Main Septic Tank System Other Disposal System

If other, describe:

B. If the property is served by a public or community sewer main, is the house connected to the main? Yes No Unknown

If no, explain:

C. Is the property currently subject to a sewer capacity charge? Yes No Unknown

If yes, explain:

D. If the property is connected to a septic system:

(1) Was a permit issued for its construction, and was it approved by the city or county following its construction? Yes No Unknown

(2) On what date was it last pumped:

(3) Are there any defects in the operation of the septic system? Yes No Unknown

If yes, explain:

(4) On what date was it last inspected:

By whom:

(5) How many bedrooms was the system approved for?

E. Do all plumbing fixtures, including laundry drain, go to the septic/sewer system? Yes No Unknown

If no, explain:

F. Are you aware of any changes or repairs to the septic system? Yes No Unknown

If yes, explain:

G. Is the septic system, including drainage field, located entirely within the property’s boundaries? Yes No Unknown

If no, explain:

4. Structural

A. How old is the current roof? years. Unknown

Roof is constructed of: Asphalt Shingle Wood Shingle Slate Metal Tile Asbestos Unknown Other

Other:

B. Has the roof leaked during your ownership? Yes No Unknown

If yes, has it been repaired? Yes No

Explain any roof repairs of which you are aware:

C. Has the house undergone any conversions, additions, or remodeling? Yes No Unknown

1. If yes, were all building permits obtained? Yes No Unknown

2. If yes, were all final inspections obtained? Yes No Unknown

Explain any conversions/additions/remodeling:

D. Do you know the age of the house? Yes No

If yes, give year of original construction:

E. Are you aware of:

(1) Any movement, shifting, deterioration or other problems with walls, foundation, crawl space or slab? Yes No

(2) Any cracks or flaws in the walls, ceilings, foundations, concrete slab, crawl space, basement, floors or garage? Yes No

(3) Any water leakage or dampness in the crawl space or basement? Yes No

(4) Any dry rot on the property? Yes No

(5) Any repairs or other attempts to control the cause or effect of any problem described above? Yes No

Explain any “Yes” answer(s) to 1-5 above:

F. If you know of any defect(s) regarding the following items, mark the defective item with a check:

Foundation Deck Exterior walls Chimneys Interior walls

Fire Alarm Doors Door locks Patio Ceilings

Slab Floors Driveways Attic Stairs Windows Window locks

Sidewalks Outbuildings Fireplaces Garage Floors Walkways

Balconies Wood Stoves

If you checked any of the above items, explain the defect(s):

G. In the last 4 years, was a pest, dry rot, structural or "whole house" inspection done? Yes No Unknown

If yes, which test(s), when, and by whom was the inspection done?

H. Has the property had a problem with pest control, infestations, or vermin? Yes No Unknown

If yes, explain:

I. Are you aware of:

(1) Any termites, wood destroying insects or pests on or affecting the property? Yes No

(2) Property damage by termites, wood destroying insects or pests? Yes No

(3) Any termite/pest control treatments on the property in the last 4 years? Yes No

If yes, list company and where treated:

(4) Current warranty or other coverage by a licensed pest control company on the property? Yes No

If yes, explain warranty and attach documentation:

J. Have you made a homeowner’s insurance claim(s) regarding the property in the last 4 years? Yes No

If yes, explain when and why:

5. Systems and Fixtures

If the following systems or fixtures are included with the transfer, do they have any existing defects: Yes No Unknown

A. Electrical system, including wiring, all switches, all outlets, and service

If yes, explain:

What type of wiring comprises the electrical system? Copper Aluminum Unknown

B. Plumbing system, including pipes, faucets, fixtures, and toilets

If yes, explain:

C. Hot water heater (mark one): Electric Natural Gas Other Age: years

If yes, explain:

D. Oven/stove: Electric Natural Gas Other Age: years

If yes, explain:

E. List ANY OTHER APPLIANCES TO REMAIN:

1. Age: years Yes No Unknown

If yes, explain:

2. Age: years

If yes, explain:

3. Age: years

If yes, explain:

F. Cooling and Heating systems

Air Conditioning (mark one): Central Electric Central Gas Heat Pump Window Unit(s) included in sale Other

Other (describe):

Age of cooling system: years. Zoned cooling? Yes No

Air Conditioning defects? No Unknown Yes

If yes, explain:

Heating system (mark one): Electric Natural Gas Fuel Oil Heat Pump Propane Other

Age of heating system: years. Zoned heating? Yes No

Heating system defects? No Unknown Yes

If yes, explain:

Last date of servicing: Heating: Cooling: By whom:

Are there rooms without heating/air conditioning vents? Yes No

If yes, which rooms:

G. Security system (Circle One): Owned Leased Any defects? Yes No Unknown

Describe security system:

If defects are indicated, explain:

H. Other: Any defects? Yes No Unknown

If defects are indicated, explain:

6. Common Interest

A. Is there a Home Owners' Association? Yes No Unknown

If yes, what is the name of the association?

B. Are there regular periodic assessments? Yes No Unknown

If yes, give amount per: Month: Year: Other:

If other, explain:

C. Are there any pending special assessments? Yes No Unknown

D. Are there any shared “common areas” or any joint maintenance agreements? Yes No Unknown

If any such areas exist, explain:

7. Appliances, Heating, Plumbing, Electrical and Other Mechanical Systems

Instructions: Mark INCL if the item is included in the sale. If item is included in sale, mark Yes or No to indicate whether item is in working order. Indicate the item’s approximate age in the age space, if provided.

Attic Fan Air Conditioner (central) age: Air Conditioner (wall/window) age:

Air Cleaner/Purifier age: Ceiling Fan(s), # included Clothes Washer age:

Convection Oven age: Dishwasher age:

Door Bells Drain Tile System Dryer age:

Exhaust Fans (bathroom) Fireplace Fireplace Mechanisms Furnace age:

Furnace Mechanisms Freezer age: Garbage Compactor Garbage Disposal

Garage Door Opener (GDO) GDO Auto-reverse Safety Mechanism GDO Remote Opener(s), # included:

Gas Grill Gas Logs Heating System (central) age:

Heating System (supplemental) age: Humidifier age:

Incinerator Intercom Lawn Sprinkler System Lawn Sprinkler Auto-timer

Lawn Sprinkler Backflow Valve Microwave Oven age: Plumbing

Pool age: Pool Equipment/mechanisms age:

Range/Oven Range Timer Range Vent-hood Refrigerator age:

Security System Smoke Detectors (battery) Smoke Detectors (hardwired) Solar Collectors

Sump Pump Toilet Mechanisms TV Antenna/receiver/dish TV Cable wiring

Water Heater age: Window Treatments Whirlpool/Hot-tub age:

Wood Burning Stove Yard Lights

Other:

Explanations: if any item above is NOT in working order, list the item and explain the defect in the space below.

8. General

A. Is there any settling, soil, standing water, or drainage problems on the property? Yes No Unknown

If yes, explain:

B. Does the property contain fill material? Yes No Unknown

C. Is there any material damage to the property or any of the structure from fire, wind, floods, beach movements, earthquake, expansive soils, or landslides? Yes No Unknown

If yes, explain:

D. Is the property in a designated flood plain? Yes No Unknown

E. Are there any substances, materials, or products that may be an environmental hazard such as, but not limited to, asbestos, formaldehyde, radon gas, lead-based paint, fuel or chemical storage tanks and contaminated soil or water on the subject property? Yes No Unknown

If yes, explain:

F. Are there any tanks or underground storage tanks (e.g., chemical, fuel, etc.) on the property? Yes No Unknown

If yes, explain, and give approx. position (attach map):

G. Has the property ever been used as an illegal drug-manufacturing site? Yes No Unknown

If yes, explain:

H. If the property contains a wood-burning stove or fireplace, when was/were the chimney(ies) last cleaned?

I. Are you aware of any of the following regarding the property?

Existing or threatened legal action Violation of any law or regulation General stains or pet stains to carpet or floor

Transferable warranties Any locks without keys Unrecorded interests affecting the property

Fire Damage at any time Appraiser or Mechanic’s Lien Landfills or underground problems

If any of the above are marked, explain:

J. If any tests to detect radon gas have been done on the property, provide documentation. If radon gas has been detected on the property, explain when, where, by whom, and all other details:

9. Full Disclosure by Sellers

A. Other conditions or defects: Does the Seller know of any other material defects affecting this property or its value that a prospective buyer should know about? Yes No

If yes, explain:

B. Verification: The foregoing answers and attached explanations (if any) are complete and correct to the best of my/our knowledge and I/we have received a copy hereof. I/we authorize all of my/our real estate licensees, if any, to deliver a copy of this disclosure statement to other real estate licensees and all prospective buyers of the property.

II. Buyer’s Acknowledgment

A. As buyer(s), I/we acknowledge the duty to pay diligent attention to any material defects which are known to me/us or can be known to me/us by utilizing diligent attention and observation.

B. Each buyer acknowledges and understands that the disclosures set forth in this statement and in any amendments to this statement are made only by the seller.

C. Buyer acknowledges receipt of a copy of this disclosure statement (including attachments, if any) bearing seller's signature.

Radon Disclosure

This document concerns the real property located at and legally described as .

Seller’s Disclosure of Radon

Seller has knowledge of radon concentrations in the dwelling. Yes No Unknown

One or more radon tests have been conducted in the dwelling. Yes No Unknown

Seller has records or reports pertaining to radon concentrations within the dwelling. Yes No Unknown

If Seller has answered “yes,” then the most current records and reports pertaining to radon concentrations within the dwelling are attached. Yes No Unknown

Has a mitigation system been installed? Yes No Unknown

If Seller has answered “yes,” then information regarding the radon mitigation system, including system description and documentation, is attached. Yes No Unknown

Radon concentrations at or above the U.S. Environmental Protection Agency Radon Action Level are known to be present within the dwelling. Yes No Unknown

Radon concentrations have been mitigated to below the U.S. Environmental Protection Agency Radon Action Level. Yes No Unknown

Well Disclosure Statement

Date:

Property street address: City: County:

Legal description:

Check the appropriate box:

The Seller certifies that the Seller does not know of any wells on the above described real property.

The Seller certifies that the following wells are located on the above described real property.

Well 1: MN Unique Well No. Well Depth Year of Const. Well Type In Use Not In Use Sealed

Well 2: MN Unique Well No. Well Depth Year of Const. Well Type In Use Not In Use Sealed

Well 3: MN Unique Well No. Well Depth Year of Const. Well Type In Use Not In Use Sealed

Sealed Well Information

When was the well sealed?

Who sealed the well?

Was a Sealed Well Report filed with the Minn. Dept. of Health? Yes No Unknown

Map: Complete the attached map showing the location of each well on the real property.

This disclosure is not a warranty of any kind by the Seller(s) or any Agent(s) representing any Party(s) in this transaction, and is not a substitute for any inspections or warranties the Party(s) may wish to obtain.