Reference MISSOI.|RIASSOCIATIONOF REALTORS@
Farmor VacantLand or Lot DisclosureStatement
This document has legal consequences. lf you do not understand it, consult your attorney. 1 2 3 4 5 6 R v
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The followingis a disclosure statementmade by Sellerconcerningthe followingProperty(the"Property").
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This disclosurestatementmay assista Buyer in evaluatingthe Property,but it is not a warrantvof any kind by for any inspectionor warrantiesa B-uyer and is not a substitute Selleror any brokeror license6in thistransaction, may wish toobtain.Realestatebrokersand licenseesinvolvedin the sale do not inspectthe Propertyfor defects or juarantee the accuracyof the informationprovidedin this form. TO THE SELLER: Pleasecomplete the following form, including past history or problems if known. Do not leave (or "Unknown")in Propeftv (or any sDaces vour Pqopefty br unknown), mark "N/A" (or-"Unknow.n") anv spaces btank. lf the condition is not applicable to your TFe6iank. TF;dtowing are representatidnsmade tiy the Seller and are not representations of any broker or licensee. Complete and truthful disclosureof the history and conditionof the Property gives you the best protection 'answers against future charges that you violated a legal disclosure obligation to a Buyer. Your answers or the you fal b provide, eiher way, may have legal consequences,even after the closing of the sale. This questioniaire should help you meet your disclosureobligations,but it may not cover a// aspects of the Properly. lf you know of or suspect some condition which may negativelyaffect the value of the Property or impair the health or safety of future occupants (e 9., environmentalhazards,physicalcondition or materialdefecls in the Property or title thereto),then you may use the space at the end of this form to further describe that conditionand/or attach additionalpages if additionalspace is required. TO THE BIJYER: Since fhese disclosures are based on the Se//er'sknowledge, you cannot be sure that there are, in fact, no problems with the Property simply because the Selleris not aware of them. The answersgiven by the Sellerare not warrantiesof the conditionof the ProperTy.Thus, you may want to conditionyour offer on a professionalinspection(s)of the Property. Conditionsof the Property that you can see on a reasonable inspection and/or that are disclosed herein should either be taken into account in the purchase price or you should make the correctionof these conditions by the Sellera requirementof the sale contract. lF YOU SrGN A SAIE CONTRACT TO PURCHASE THE PROPERTY,THAT CONTRACT, AND NOT THIS D'SCIOSURE STATEMENT,WILL PROVIDE FOR WHAT 'S TO BE INCLUDEDIN THE SALE. 'F YOU EXPECT CERTAIN I T E M S O R E Q U I P M E N T T O B E I N C L U D E DT H E Y M U S T B E S P E C I F I E DA S I N C L U D E DI N T H E S A L E CONTRACT. A. SURVEY,EASEMENTS,FLOODING eoo/ (1) When did you purchasethe land? - llnesI N o (21 Has the landbeensurveyed?. . .. :/DQilo;d ^) Year surveyed (3) What companyor personperformedthe survey? Phone Name Address I - .,.-.- ........ lVes 1'1ruo land, has a certificateof surveybeen compleieOT (4) lf this is_platted , , _ijp. When? rf "Yes," by whom? ,^ ....-...|J.ilK|10t - .-........ ((5)-lHas the ptatbeen recordedin the land records.r flYe.f lNo Page # lf "Yes," Plat Book # To the best of your knowledge: i lYestY/o or boundaryline disputes?.... ...... (6) Are thereany encroachments t lyes ["fl(o (7) Are thereany easementsotherthan utilityor drainageeasements? (8) ls the Propertyin a designated100 year flood plainor wetlandsarea? . . . \rtfes L ['lo ......... I lYes [d,lt6 (9) Has thereever beena floodor otherdisasterat the Property?..... (10) Have thereever been drainageproblemsaffectingthe Propertyor adjacentproperties?....... LlYutiJfto (11)Give the detailsif any of questions6 through9 qle answered"Yes." a
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To the best? rour?i**"** B. USERESTRTC-T|ONS.
(1) Do any of the followingtypes of covenants,conditions,or restrictionsaffectthe land a. Subdivisionor other recordedcovenants,conditions,or restrictions? b A rightof firstrefusalto purchase?............. specific specialuse permits,or otherzoningrestrictions c. Variances, to this Property?
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(2) lf any of the abovequestions(Bl) are answered"Yes,"do you have writtencopiesof thesecovenants,conditionsor restrictions? .......... p14, ;, *o lf "Yes," descnbe.' (3) Have you ever receivednoticefrom any personor authorityas to any breachof any of thesetovenants,conditionsorrestrictions? lf "Yes," describe: CONDITIONOF THE PROPERTY.To the best of your knowledge: -/ (1) Are there any structures, improvements, or personalpropertyincludedin the sale l tYes ffio lf "Yes," list all items: Are thereany problemsor defectswith any of theseitems? f lYes 1ffi lf 'Yes," describe all problems or defecfs: (21 Are there any operatingor abandonedoil wells,b uriedstoragetanks,or burieddebrisor _ -_ / wasteon the Property? Yes [Ul.l(o lf "Yes," give details: (3) ls there any hazardousor toxic substancein or on this Propertyor any adjacentproperty (includingbut not limitedto mold or lead in the soils)? lYes [Z{o lf "Yes," give details: ( 4 ) H a v e a n y s o i l t e s t sb e e n p e r f o r m e d ? t l Y e s t:vt{6lf "Yes." When? By Whom? Results: (5) Doesthe Propertyfraveany fittor uncompacted soils?...-..... Yes
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give details: lf (71 ls there a large-scaleinfeitation, iot oi Orseasein tfre trees on ihe Property? L lYes lpt6 lf "Yes," give details: UTILITIES.To the best of your knowledge: (1) Have any percolation testsbeen performed? [ ] Y e sl \ 1 4 6 lf "Yes," When? By Whom? Results: (21 Are any of the followingpresently.lxistingwithin the Property? Connectionto publicwater? d. Awaterwell?....... . . . f l Y e s lrff(-o Wye I I tto tVYa Connectionto public sewer? e. Septictanf