7.4 HRSR 11-06-2017 - Laserfiche WebLink

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DISCLOSURE STATEMENT:WELL 44. Page 2 45. Property located at 3 trirt N LA2', 46, OTHER WELL INFORMATION: 47. Date well water last tested for contaminants: Test results attached? Li Yes ri No 48. Contaminated Well:Is there a well on the property containing contaminated water? Li Yes 1-1 No 49. Comments: .T Re. SELISA IstrtiFJES. -Ti4AT 1146 sELLEa DOes 1601- k.tiotAl F 50. 143 y rl'41, OC4Pa 12 L, P o 51. 52. 53, 54, 55, 56. SEALED WELL INFORMATION:For each well designated as sealed above,complete this section. 57. When was the well sealed? 58. Who sealed the well? 59. Was a Sealed Well Report filed with the Minnesota Department of Health? Yes Ej No 60. MAP:Complete the attached Location Map showing the location of each well on the real property. 61. This disclosure is not a warranty of any kind by Seller(s)or any licensee(s)representing or assisting any part(hes)in 62. this transaction and is not a substitute for any inspections or warranties the party(ies)may wish to obtain. 63. SELLER'S STATEMENT: (To be signed at time of listing.) 64. Seller(s)hereby states that the facts as stated above are true and accurate and authorizes any licensee(s)representing 65. or assisting any party(ies)in this transaction to provide a copy of this Disclosure Statement to any person or entity 66. in connection with any actual or anticipated sale of the property.A seller may provide this Disclosure Statement to 67. a real estate licensee representing or assisting a prospective buyer.The Disclosure Statement provided to the real 68. estate licensee representing or assisting a prospective buyer is considered to have been provided to the prospective 69. buyer.If thiS Disclosure Statement is provided to the real estate licensee representing or assisting the prospective 70, buyer,the real estate licensee must provide a copy to the prospective buyer. 71. Seller is obligated to continue to notify Buyer in writing of any facts that differ from the facts disclosed here 72. (new or changed)of which Seller is aware that could adversely and significantly affect the Buyer's use or 73. enjoyment of the property or any intended use of the property that occur up to the time of closing.To disclose 74, new or changed facts,please use the Amendment to Disclosure Statement form. 75. ' -4Z' 44 t //)/./.4 (Sea (Date) ,se.,er) 76. BUYER'S ACKNOWLEDGEMENT:(To be signed at time of purchase agreement.) 77. Attie,the Buyer(s) of the property, acknowledge receipt of this Disclosure Statement:Well and Location Map and 78. agree that no representations regarding facts have been made other than those made above. 70. -- - iDater 80. LISTING BROKER AND LICENSEES MAKE NO REPRESENTATIONS HERE AND ARE 81. NOT RESPONSIBLE FOR ANY CONDITIONS EXISTING ON THE PROPERTY. MN-DSV-2 '7)