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DISCLOSURE STATEMENT: SELLER’S DISCLOSURE ALTERNATIVES 47. Page 2
1122 Laurel Ave
48. Property located at
OTHER REQUIRED DISCLOSURES:
49. 50. 51. 52. 53.
In addition to electing one of the above alternatives to the material fact disclosure, Minnesota law also requires sellers to provide other disclosures to prospective buyers, such as those disclosures listed below. Additionally, there may be other required disclosures by federal, state, local, or other governmental entities
that are not listed below.
54. A. SUBSURFACE SEWAGE TREATMENT SYSTEM DISCLOSURE: (A subsurface sewage treatment system 55. disclosure is required by MN Statute 115.55.) (Check appropriate box.)
DOES NOT know of a subsurface sewage treatment system on or serving
Seller certifies that Seller
--------------- (Check one. )--------------
57. the above-described real property. (If answer is DOES , and the system does not require a state permit, see 58. Disclosure Statement: Subsurface Sewage Treatment System .) 59. There is a subsurface sewage treatment system on or serving the above-described real property. 60. (See Disclosure Statement: Subsurface Sewage Treatment System . ) 61. There is an abandoned subsurface sewage treatment system on the above-described real property. 62. (See Disclosure Statement: Subsurface Sewage Treatment System . ) 63. B. PRIVATE WELL DISCLOSURE: (A well disclosure and Certificate are required by MN Statute 103I.235.) 64. (Check appropriate box.) 65. Seller certifies that Seller does not know of any wells on the above-described real property. 66. Seller certifies there are one or more wells located on the above-described real property. 67. (See Disclosure Statement: Well . ) 68. Are there any wells serving the above-described property that are not located on the property? Yes No 69. To your knowledge, is the property in a Special Well Construction Area? Yes No 8 8 8
72. C. VALUATION EXCLUSION DISCLOSURE: (Required by MN Statute 273.11, Subd. 18) 73. There IS 8
IS NOT an exclusion from market value for home improvements on this property. Any valuation
--------- (Check one. )--------
74. exclusion shall terminate upon sale of the property, and the property’s estimatedmarket value for property tax purposes 75. shall increase. If a valuation exclusion exists, Buyers are encouraged to look into the resulting tax 76. consequences.
79. D. FOREIGN INVESTMENT IN REAL PROPERTYTAX ACT (“FIRPTA”): Section 1445 of the Internal Revenue Code 80. provides that a transferee (“Buyer”) of a United States real property interest must be notified in writing and must 81. withhold tax if the transferor (“Seller”) is a foreign person and no exceptions from FIRPTA withholding apply. 82. Seller represents that Seller IS IS NOT a foreign person (i.e., a non-resident alien individual, foreign corporation, ------- (Check one. )------ 83. foreign partnership, foreign trust, or foreign estate) for purposes of income taxation. This representation shall 84. survive the closing of any transaction involving the property described here. 85. NOTE: If the above answer is “ IS ,” Buyer may be subject to income tax withholding in connection with the 86. transaction (unless the transaction is covered by an applicable exception to FIRPTA withholding). In 87. non-exempt transactions, Buyer may be liable for the tax if Buyer fails to withhold. 88. If the above answer is “ IS NOT ,” Buyer may wish to obtain specific documentation from Seller ensuring 89. Buyer is exempt from the withholding requirements as prescribed under Section 1445 of the Internal 90. Revenue Code. 91. Due to the complexity and potential risks of failing to comply with FIRPTA, including Buyer’s responsibility 92. for withholding the applicable tax, Buyer and Seller should seek appropriate legal and tax advice regarding 93. FIRPTA compliance, as the respective licensees representing or assisting either party will be unable to 94. assure either party whether the transaction is exempt from the FIRPTA withholding requirements. MN:DS:SDA-2 (8/16) 8 Page 15 of 32
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