Laserfiche WebLink
' m MINNESOTA DEPARTMENT OF NEALTH <br /> ;� WELL DISCLOSURE CERTIFICATE <br /> u � PLEASE TYPE OR PR/NT ALL INFORMATION <br /> Person filing deed must attach$1D fee payab/e to county recorder. <br /> A. PROPERTY DESCRIPTION <br /> Attach a legal description of property if the property does not have a lot number, biock number, <br /> and adtlition name.• <br /> COUNTY LOT NUMBER BLOCK NUMBER ADDITION NAME <br /> Hennepin 5 & 6 3 Saga Hills revised <br /> STREET ADRESS <br /> 1295 Loma Linda Avenue <br /> CITY STATE ZIP CODE <br /> Orono MN 55364 <br /> B. PROPERTY BUYER MAILING ADDRESS AFTER CLOSING <br /> FIRST NAME MIDDLE INITIAL LAST NAME <br /> Ursula J. Platteter <br /> COMPANY NAME (IF APPLICABLE) <br /> ADDRESS " � <br /> ADDRESS <br /> 1295 Loma Linda Avenue <br /> CITY STATE ZIP CODE TELEPHONE NUMBER <br /> Orono lyN 55364 � � <br /> C. CERTIFICATION BY SELLER <br /> I ce�tify that the information provided on this certificate is accurate and complete to the best of my knowledge. <br /> J �__��� Y <br /> Signature of Seller or Designated Representative of Seller Date <br /> D. CERTIFICATION BY BUYER <br /> The buyer or person authorized to act on behalf of the buyer,must sign a Well Disclosure Certi(icate(or all deeds given in tultiltment of <br /> a contract tor deed if there is a well on the property. <br /> In the absence of a seller's signature,the buyer,or person authorized to act on behali ot the buyer may sign this well certificate. <br /> No signature is required by the buyer if the seller has signed above. <br /> Based on disclosure iniorrpation provided to me by the seller or other available iniormation,I certity that the in(ormation on Ihis certificate <br /> is accurate and complete to the best of my knowledge. <br /> Signature of 8uyer or Designated Representative o(Buyer Date <br /> (OVER) <br />