SELLER'S RESIDENTIAL REAL ESTATE SALES DISCLOSURESlate Form,{6234 (R6/ 6 14)

C.dn 2l s.hcru, {q9 t 9dn sr6r ldsrsrE tN /t62.t0

,om I ar 876 IAC 9.1.2 lo incfude oueslrons reoardino disclosure ol contarrnalron relaled lo cortrdl€di #llbe made lo 876lAC 9-l-rlo nclude lheEe changes ,n rhe

^ear luiure. howeve' the

PhE: I l7-509,/(DO Fd: llr-Jt!-5tt2

Oale (monlh, day, year)rpril. 2, 2015

IIJAL KN(.'WLEUGE iIS OI lhE ADCale provislons in a contracl belw€rtalims of lha olxn6r and aro not thrand tho ornsr. lndrana law (lC 32

Ah owner musl complele and slgh

1. Th6 ln th€ condilions indEaled:

C. WATER & SEWEF SYSTEII

Are lhe siruclures connected to a Dublic waler

Arc th6 slruclur6s conncclod to a Dob[c s€w6r

Are there any additions lhat may require impro/€.nents to

th€ imFovlmants b€6n compl6l6d on th6

A16 tha improv.monls con .ctsd lo a privaldcommurily

A16 lhe inprovenErls comocted to a privaldcommJ ty

NOTE: "Oclcct" m.rnt . conditior th.l would h.v. t Cgnaficrnt .dvfir.flccl on thc yrlu. of lhc propcrly, thlt would .ieniiic&lly inp.k th. hctlthq rtcly ot tutuac occupanl3 ol thc p.operty, or thrl It not rapakad, rcmorcdor rrplrccd rould Gbnmc. ly dron.n or rdv.iG.ly rttcci lhc .,Qoct.dhorhal lltc or lhe p.!rtl.6e.

Thc lnlonn lloh cont.lh.d lh lhl. Dl.closur. h.r b..h tun{.h6d b,y lh. S.Ior, rho c.rltll.3 lo lt!. ln,lh lhlrcol, b.iod oh rh. SolLdr CURREI{T ACTUALfiOWLEDGE. A discb.urc fo.m 15 nol r u.rl.nl! by thG own.r o. thr oun t's.ganl, il any, rnd th. discbsurc lorm mry nol b. used ra. subditutc fo. lnyinlpccliona or warr.ndGa fhil $r proapcclivc buycr or owrrr mry lalcr obtain. At or batora ratllclnc.rt, thc ownrr ia rcquircd to diaclo3c rny matarialchenlc in lha

fomr wl3 provld.d. S.lLr rhd Purch&.t h!7rby .cknoulcdg6 r.crlpt ol thL Dl.cbslr. by cl€nlng bdow.

hcieby c.ttifB thlt ihr condldon ol thc lhc 6rmc aa lt *ls uljcn lhG SalL/a D{scbsurc tofln r.3 o.iglnally p.ovid6d lo th.

Signalure of Seller (ai crosirv) Signaiur. of Sell6r (al cios,rg0

Page 'l ol 2

Produod ri'l rifdtraby rFl-q,ix 1807{) Fi,tan tl.lo R6d, fras.. itctig& a8026 m:i{dirte

Ptcp,dty add'c!6 (Nnfur atd st€eL dty, slale, ad ZP dc)12347 Tr!rc*.nh.r Driw., Fi.hor., a6037

2. ROOF YES NO DO t{OTKiiorv 4. OTHER DISCLOSURES YES NO DO NOT

KNOW

Ad€. il lmotYr: ' I Yeais. Oo stsucfures have abminum wiiinq?

Does the roo, leak? Ars il€lo any loundarim pnot 6nls wth tn€sln cturas?

ls there present darnaqe to the roo,? Are there any €ncroachments?b th6.a rr.E than dle hyor ot shimlB on0!€ hdrse?

Are thcre any vlolations ol zonir{, brrillrEcodes, or r6sfidir? covanams?

I v.6. ho* manv hv6rs? b tf|o F63€nt us6 a non-codomhe t[36?E)ghin:

3- HAZARDOUS CONOMONS YES NO DO NOTKXOW

Hav6lh6ro bacr d alo lhera eny hazardolxrcondltons on th€ pr@edy, such as methanega6, load painl. radon gas in house or w6ll,radoactive matcdal, landfili, min6Ehall,orpan6iva sril.loxc matedals, mdd, olhorUdoglcal cofitamihahts. asb€stos insulalioar,or PCB',s?

ls lh6r€ contamlnatioh caus€d by the

t/h tlre access to yourprope0 via a privale road?

prDsrty thal has nol bcen cGflified asdec.alaminaled by ah ihsp€cld approv€dund€r lC 13-1+r-15?

h lhe access to voor oroo€dY vra a olblic road?

ts lh€ acc€ss to vdlr Droorly via an oas€msfll?Havs yo! rocriv€d any nolic.s by any

Has lhere beeh manulaclure olhsfiarnphetamlne or dJllfxilg ol wasla lrcan

the manulacluG ol m6lhampholaming in erssirential sttucturE fi lhc prcpcrty?

govemmonld or quasFgov€rnm€nEl a9€nq6satl€ctiry dtis prQ€.ty?

Are lher6 any slructwal problorns wilh tha buiUinq?

Havs any sub6tantjal addilions d alleratidsb€€n mado wilhout a required bulbiho p€mit? \,,Explain:A16 fiere nbisturr andbr welEr p.obldns in &eba6am6nl, c'awl spaca araa, or any oth.l aroa?

h theE any datnage due to *ihd, fbod, lennites,

Htvt eny dn dt,as b6an trcalad for EoddcE oyirE inEccl6?

E. AODITIONAL COUIIENTS AND/OB EXPLANATIONS:(UEc ddttlonal pages, ll nec"sstl.!)

fua the fumsc.y'woodslovo/drimn€yrbe all inwo*ing oder?

E rcludesl1,nAi na alt(qa- ?Pa'kr

a"rd;d fl& !eeez<tUt +.rl?", 66;H res #;aqe-d.rsBr,vnt air hcck€.I +abh, Fol. fab'te , #'r'a- tllote'

b lh€ Droo€rtv an a food dain?Do v(r, cunentlv Dav llood rnsurance?

oo€s th€ p.ope7ty co.{ain undeEround sloragelar*(s)?

b tl|e homeowner a licens€d realeslalesal€speGon or troker?

h lh6ra ahy thrual.n.d oI.xisltro lliFridrrag6rfi9 th. prq..ty? t,

b tne p.ope(y subiect to covenants, cpndilionsan.Uor re8tnclaons of a homeowira/s alsociatioh?

b the proFrty localed wilhin ffle (1) mil. ot aniiEod?

Thc lr ormltlon contalnad ln hlyolaclo.lra h!. b.cn fuml.hcd by tha Scllrr, rho carllflaa to lhr lrulh lhcrcot, braad on tha Scllc''r CURREi{T ACTUALKNOWLEDGE, A dlsclo.uro loih lr hol a wlr.nty by thc oxhcr o. thc omcr'. .gG.rl, ll.ny, &d th! dLclo.ur. ,orm m.y not bc u.cd !r ! subdltutc lor ahylhlp.ctlma or warantlcs lhll lhc piolpcctlva t r.ry.r oi owh.r lrlry lncr obtaln. Ai or bclo.rtia Dhyalcrl condldoi of lhc Drolarty oa ccrlity lo lh! Durcha6ar at 3atuaa[ait that thc col

thc our.r la acqulaed to dl66losa rny naterlal chengc inti. phy.lcrl condldoi of lhc prolrrty o. ccrlity lo lh! purcha6ar at 3.tu..r.it th.t thc condliloh ol thc paoperly lB 6tib3t ntLlly thc a.m6 .6 it w.6 thcn thcdlsdosurc tonn was Drovk €d. Scllor and Purchraa. hdtby rcho*ledoe r.celpt ol thls Dlscbiul! by shhlho belou.

Wva /TJt.u,to Data_lmi,leu) Signawe#uyrr. ,az/44.w '//-4, 'TI/f|i:s,ii-n*"Ja s.r". ? Oata (ht{drW) Signalure ol Buyor D"t i^,r/kw)

Th. S.[.r h..!hy c.rnth. th.l thc cqrdllfi ot t r. Fop.rly ]. lbcLnd.ly lhc .{'l. .r ll r.. rhdr ltG Sclh/r DLcb.ur. ldlrl wa. orl0ln lly p.oyldrd to ttl.&ryaa.

Signaluro ol S6icr (al ck si4g) Dele (nill&W) S;ionature ot Seller (d clasi400 Dale (nnld/W)

Form #03.

Pag€ 2 ol 2Prcdrcod rith zipFo.noby zipLook 18070 Fft.Gn Mb noed, Fras6r, i/icH0En 4€026 B*w.zid-ftixrorn

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