SELLER'S RESIDENTIAL REAL ESTATE SALES DISCLOSUREState Form 46234 (N1293\

Date (month, day, year)Nc'<rnYxr I l ,Z{x. ,c '

Sellet states lhat the information contained in this Disclosure is correct to the best of Seller's CURRENT ACTUAL KNOWLEDGF as of the above dale. The prospedve buyerand lhe owner may wish 1o obtain professional advice or inspections of the property and provide for appropriate provisions in a contracl between lhem concerning any advice,inspections, defects, or wananties obtained on the property. The represenlations in this form are the represenlations of the owner and are not the representat nsany. This information is for disclosure only and is not intended to be a part of any contract between lhe buyer and the owner. Indiana law (lC 32-21-51 generally requires sellersof 1-4 unit resideniial property to complele this form regarding the known physical condilion of the property. An owner must complete and sign the disclosure fofm and submitthe form to a prospective buyer before an offer is accepted for the sale of lhe real estale.

Propertyaddress {number and street, city,state, ZP cade) 77Cli., t ta\- Pl , ;,i\L{\af icl?cr\ra ,'1Tu LiLz O5

1. The are in the conditions indica{ed:

NOTE: "Defect'means a condition tha!would have a signfcant adverse effect on the value ofthe property thatwould signifcantly impair the health or safety offuture occupantsof the property or that, if not repaired, temoved, or replaoed, r,lrould significan{y shorten or adversely atfbct the expected normal life of the premises.

C. WATER & SEWER SYSTEM

Are tlte imorovements connecled to a oubfic sewerAre there any additions that may require improvements to

lf yes, have the improvements treen compleled on the

Are the improvements connecled to a privale/community

Are the improvements crnnected to a privaley'community

D. HEATING & COOLING

The information contained in this Disclosure has been fumished by the Seller, who certifies to tt€ truth thereof, based on the Selle/s CURRENT ACTUALKNOWLEDGE- A dtsclos:re form is not a walranty by lie owner or the owner's agent if any, and lhe disclosure form may not be used as a substitute for anyinspections or warranties that the prospective bulBr or owner may later obtain. At or before *{tlemenl the owner is reguir€d to disclose any material change in thephysical condition ol the properly or certiry to the purchaser at settlement that the condition of the property is substantially the same as it was when tlp disclosure

hereby acknowledge receipt of this Disclosure by signang beloBr:

of the properly is substantially the same as itwas when ltre,Seller's Di$closure form was originally provided to th€

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Pro'ertv Addfess {numb€r and stfeet' citv' state' zrP code) lavl c}ret ie* Fl , Jtlr,ft'artn pn)r-a. r-n-r ,i bzo>

ls there present damage to the raoP

codes, or restric$ve covenants?ls there more lhan one mof on the house?lf so, how many layers? ls the present use a nonmnforming use? Explain:

ls the access to your ploperty via a private road?Have lhere been or are there any hazardo.tsconditions on the property, such as methanegas, lead paint, radon gas in house or well,radioaclive maledal. landfi ll. mineshaft"exoansive soil, toxic materials, mold, otherbiologicat Glntaminants, asbestos insulation,or PCB's?

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ls the access to you. properly via a public road?ls acc€ss to vour gropetty via an easement?Have llau received any notices by anygovemmental ot quasi-govmmental agencies

Have any substantial additions or alleraticnsbeen made without a required building permit?

Are lhere mcisture and/or water probiems in thebasement, crawl space area, or any othet arca?

Have any improvemenls been treated for wooddestroying insects?

ls lire properly in a flood

Does the property contain underground sioragetank{s)?ls the flomeowner a licensed real estatesalesperson or broker?ls there any threalened or existing li{igationregarding the property?ls the property subject 1o covenants, conditions,and/or testrictions o{ a homeowner's association?

E. ADDITIONAL COMMENTS AND/OR EXPL,ANATIONS: {Use additional pages if necessary},

The information conljained in this Disclssure has been furr*shed by the Seller, who certifies lo the truth thereof, based on the Selleis CURRENT ACTUAL KNOWLEDGE' Adisclosure form is not a warranty by the owner or the owner's

"gunr, if

"ny, and the disciosu,e form may not be used as a substitute ior any insFections or mnanties that the

prospective buyer or own*. ."y bLr obtain. At or before settte-ment, the'owner is required io disclose any rnalerial ehange in ths physical conditon of ihe ptopetiy or ce ifto the purchaser at setilemenl-that the condition of the property as substantially the same as it rvas when the disclosure iorm was provided- Sellet and Purchaser hereby

same as it w€s when the Selle/s

(lndiana Real Estate Commission; 8?6 IAC 1-4-2: fled June 1, 1994,5:00 p-mll

Form #03. IAR 2009

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LEAD.BASED PAI NT CERTI F]CATION AN D ACKNOWLE DGM E NTDisclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards

(SALES)COMMERCIAL-INDUSTRIAL REAL ESTATE

I PROPERTYADDRESS:a

3 LEAD WARNING STATEMENT4 Every buyer of any interest in residential reat property on which a residential dwelling was built prior to 1978 is notified that5 such propefty may present exposure to lead from lead-basedparnf lhat may ptace young children af n'sk of developing6 lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning'l disabilities, reduced intelligence quotient, behavioral prablems, and impaired memary. Lead poisoning also poses a8 particular risk ta pregnant women. The seller of any interest in residential real propefty is required to provide the buyer9 with any information on lead-based paint hazards from isk assessff]enls or inspections in the se//er's possessbn and

10 notify the buyer of any known lead-based paint hazards. A risk assessmenf or inspectionfor possibte lead-based paint11 hazards is recommended prior to purchase.l213 SELLER'S DISCLOSURE14 (a.) Presence of lead-based paint and/or lead-based paint hazards: (check (i) or {ii) below)15

3+C 5 Ctl,v icT ?L ,-11*Di\'. r}rt-riS , JL '11,2 [ 5

(i) Known lead-based paint and/or lead-based paint hazards are present in the housing (exptain):

$n ,/- Seller has no knowledge of lead-based paint andlor lead-based paint hazards in the housing

Records and reports available to the seller: (check (i) or (ii) below){i} LZ- Seller has provided the buyer with all available records and reports including Seller's Residential Real Eslafe

Sa/es Drsclosure form, if applicable, pertaining to lead-based paint and/or

16t718t92A2122 (b.)23242526)'7

2829

housing (list and aftach documents below):paint hazards in the-U I ft,{-,{)

(ii) -_ Seller has no reporis or records pertaining to lead-based paint andlor lead-based paint hazards in the housing.

30

32

BUYER'S ACKNOWLEDGMENT (initiat)(c.)-Buyerhasreceivedcopiesofal l informat ionl istedabove.(d.) *.- Buyer has received the pamphlet Protect Your Familv From Lead In Your Home.(e.) - Buyer has (eheck (i) or (ii) below):

(i) received a 10-day opportunity (or mutually agreed upon period) to conduct a dsk assessment or inspection forthe presence of lead-based paint andlor lead-based paint hazards;

OR(ii) - waived lhe opportunity to conduct a risk assessment or inspection for the presence of lead-based paint andior

Iea*based paint hazards.BROKER'S ACKNOWLEDGMENT (initial)( r ) -Brokerhasinformedthesel |erofse| |er 'sobl igat ionsundertheResident ia|Lead-BasedPaintHazard

Reduction Act of 1592 (42 U.S.C. 4852d) and is aware of Broker's responsibility to ensure compliance.(NOTE: where the word "Broker" appears, it shall mean "Licensee" as provided in l.C. 25-34.1-10-6.8.)

CERTIFICATION OF ACCURACYThe following parties have reviewed the information above and certify, to the best of their knowledge, that the information theyhave provided is true and accurate.

This Cerlifibation and Acknowledgmenf may be executed simultaneously or in two or more counterparts, each of which shatl bedeemed an original, but all of which together shall consfltute one and the same instrument. The parties agree that thisCertification and Acknowledgment may be transmitted between them by facsimile machine. The parties intend that faxed

(office use only)Page 1 of2

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signatures constifute original signatures and are binding on the parties. The original document shall be promptly executedandlor delivered, if requesled.

BUYER'S SIGNATURE DATE BUYER'S SIGNATURE DATE

PRINTED PRINTED

IAREA CODE} TELEPHONE NUMB=RYFAX NUMBER (AREA CODE} TELEPHONE NUMBERIFAX NUMBER

5253545556575859606l62636465666768697A7l72t)

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78'74

8081828i

BUYER'S CE PURPOSES

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'3\1- 5Lt9 -OD+i(AREA CODE) TELEPHONE NUMBERYFAX NUMBER

DATE SELLER

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PRINTED

(AREA CODE) TELEPHONE NUMBERYFAX NUMBER

SELLER'S ADDRESS FOR NOTICE PURPOSES

SELLING BROKER

,t Afv l f t_ *LISTING BROKER DATE

Approved by and restricted to use by members of the Indiana Association of REALTORS@, Inc.This is a legatly binding documeni, seek legal advice if not understood. Form # F45- Copydght IAR 2009-

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