Please complete and return the following questionnaire to Gary C. Dahle, Attorney at Law, at

_____________________ and I will be able to prepare a purchase agreement ready for your

signature.

1. SELLER(S)_____________________________________________________

   ADDRESS______________________________________________________

   Marital Status____________________________________________________

   BUYER(S)______________________________________________________

   ADDRESS______________________________________________________

   Buyers to take title as joint tenants with rights of survivorship?_____________

2. LEGAL DESCRIPTION___________________________________________

   (The best source for the legal description is a copy of the deed by which the

   Sellers received title to the property. Fax me a copy of the deed if available.)

   PROPERTY ADDRESS____________________________________________

   CITY________________, COUNTY__________________________________

   SINGLE FAMILY?_____ CONDOMINIUM?______ TOWNHOUSE?______

3. PERSONAL PROPERTY AND FIXTURES INCLUDED IN SALE.

   (Cross-out if not included)

   1. Storm doors, windows, inserts, screens;
   2. Awnings, window shades, blinds, curtain-traverse-drapery rods;
   3. Attached lighting fixtures with bulbs’
      
   4. Plumbing fixtures, sump pumps, water heaters, water softeners;
   5. Heating systems, stoves, fireplace inserts, doors and screens;
   6. Built-in humidifiers, air conditioners, electronic air filters, dishwashers, garbage
      disposals, trash compactors; ovens and cooking stoves, hood fans, intercoms;
   7. Automatic garage door openers with controls;
   8. Television antennas, installed carpeting, work benches, security systems, and the
      Following: (insert additional personal property items to be included in sale).
      

      ______________________________________________________________

4. SALE PRICE_______________________________________________________

   Earnest Money______________________________________________________

   Who will hold the earnest money? Seller__________ Broker_____________

   Gary C. Dahle – Attorney at Law_____________ Other Attorney______________

   Balance of Cash Downpayment __________________________________________

   Closing date _________________________________________________________

   Location of Closing __________________________________________________

5. FINANCING

   Existing C/D or mortgage $_____________________ To be Assumed?_________

   New Mortgage $______________________Maximum interest rate ___________%

   Type of loan to be obtained: FHA__________ VA_________ Conventional___

   Mortgage points: number?_______________ who pays _________________

   Seller Financed Contract for Deed $______________ Interest rate ____________%

   Monthly Payments $_______________ Balloon Date________________________

6. REAL ESTATE TAXES AND SPECIAL ASSESSMENTS.
   1. Real estate taxes due and payable in and for the year of closing shall be (Circle one)
      1. prorated between Seller and Buyer on a calendar year basis to the actual date of
         closing, or
      2. Paid by Seller, or
      3. Paid by Buyer.
   
   
   2. All installments of special assessments certified for payment with the real estate taxes due
      And payable in the year of closing shall be (Circle one)
      1. prorated between Seller and Buyer on a calendar year basis to the actual date of
         closing, or
      2. Paid by Seller, or
      3. Paid by Buyer.
   3. All other special assessments levied as of the date of this Agreement shall be(Circle one)
      1. Assumed by Buyer, or
      2. paid by Seller.
   4. All special assessments pending as of the date of this agreement for improvements that
      Have been ordered by the City Council or other government assessing aythorities shall be
      (Circle one)
      1. assumed by Buyer, or
      2. paid by Seller.
   5. Taxes due and payable in the years _____________________ will be (Circle one)
      1. HOMESTEAD
      2. Non-Homestead
7. CONDITION OF THE PROPERTY.
   1. All appliances, fixtures, heating and air conditioning equipment, wiring, and plumbing
      Used and located on the property will be: (Circle one)
      1. Sold in As-is condition, or
      2. In working order on the date of closing.
   2. Seller [HAS\HAS NOT] had a wet basement or water in the basement. (Circle one)
   3. The property is connected to (Circle one)

      • city sewer [YES\NO]

      • city water [YES\NO]
      • cable TV [YES\NO]
   4. Seller [HAS\HAS NOT] received notice from any governmental authority as to the
      Existence of any Dutch elm, oak wilt, or other disease of any trees on the property.
   
   
   5. The roof [HAS\HAS NOT] leaked.
   6. Approximate year the home was built ____________________________
8. WELLS AND SEWER SYSTEM

   How many wells are located on the property?___________

   Is a private sewer system located on the property?__________

9. POSSESSION. Seller shall deliver possession of the property

   Not later than ___________________________________________

10. LEAD BASED PAINT

    In what year was the house constructed?___________

11. OTHER TERMS

    List any other terms and conditions you would like to make a part of the purchase

    agreement.

    _____________________________________________________________

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