Form 17 @Copyright 2009

Seller Disclosure Statement Northwest Multiplelisting ServiG'"

Rev. 7/09 SELLER DISCLOSURE STATEMENT t ALL RIGHTS RESERVED
Page 1 of 5 IMPROVED PROPERTY
SELLER: Brian Bla~e __&_C_a_rG_l_B_l_A_k_e _ _. 1
+ To be used transfers of improved residential real property, including residential dwellings up to four unit" new construction, condominiuus 2
in
nol subject 10 a public offering statement, certain timcshares. and manufactured and mobile homes. See RCW Chapter 64.06 and Sccii..» 3
43.22.432 for further explanations. 4
!~S'fRUCHO~S TO niE SELLER 5
Please complete the following form. Do not leave any spaces blank. If the question clearly does not apply to the property write "NA" if i::~ 6
answer is "yes" to any asteriskcd (*) itenus), please explain on attached sheets. Please refer to the line nurnbcrts) of the qucstionts) when ,'·U 7
provide your cxplanatiorus). For your protection you must date and initial each page of this disclosure statement and each attachment. Deliver- X
or the disclosure statement must occur nol later than live (5) business days, unless otherwise agreed, after mutual acceptance of a wriu.:n 9
purchase and sale agreement between Buyer and Seller. 10
NOHO: TO THE BrYER II
THE FOLLOWIKG DISCLOSURES ARE MADE BY THE SELLER ABOUT THE CONDITION OF THE PROPERTY LOCATED.Y' 12
5929 Cherokee Loop SlE 13
CITY Lacey ,COUNTY Thurston ("THE PROPERTY" ,14
OR ASr.F.GAr-:LY DESCRIBED ON THE Al'T,<\CHED EXHIBIT A. SELLER MAKES THE FOLLOWlNG DISCLOS{JRES OF EXISTll'C 15
rvfATERTALFACTS OR MATERIAL DEFECTS TO BUYER BASED ON SELLER'S ACTUAL KNOWLEDGE OF THE PROPERTY \ r 16
TIlE TIME SELLER COMPLETES TIllS DISCLOSURE STATEMENT. UNLESS YOL: AND SELLER OTllERW:SE AGREE ['-I 17
WRITING, YOU HAVE THREE (3) BUSINESS DAYS FROM THE DAY SELLER OR SELLER'S AGENT DELIVERS "I'll'S 18
DISCLOSURE STATEMENT TO YOL: TO RESCL'ID THE AGRE;EMENT BY DELIVERING A SEPARATELY SIGNED WRITT1'\.' 19
STATEME1\~ OF RESCISSION ro SELLER OR SELLER'S AGENT. IF THE SELLER DOES NOT GIVE YOU A COl'v1PLETFD20
DISCLOSURE STATEMENT, THEN YOt: MAY \VAIVE THE RIGHT TO RESCIND PRIOR TO OR AFTER TIlE TIME YOU El\lT-:Z 21
INTO A PURCHASE AND SALE AGREEMENT. 22
THE FOLLOWING ARE DISCLOSURES MADE BY SELLER AND ARE NOT THE REPRESENT ATfONS OF Af'..'YREAL ESTAlE 23
LICENSEE OR OTHER PARTY. THIS INFORMATION rs FOR DISCLOSURE ONLY AND IS NOT INTENDED TO BE A PART (!;7 24
ANY WRITTEK AGREEM::NT BETIVEEN BUYER AND SELLER. 25
fOR A MORE COMPREHENSIVE EXAJlllINATIONOF THE SPECIHC CONDITION OF TIllS PROPERlY YOU ARE ADVISED TU 26
OBTAIN AND PAY FOR THE SERVICES OF QUALIFIED EXPERTS TO INSPECT 'mE PROPERTY, WHICH MAY INCLUDE, WITlIO\ 'T 27
LHvIITATION,ARC'HlTECTS,ENGINEERS, LA..t~DSl;1<:VEYORS,PLUMBERS, ::LECTR!CIANS, ROOFERS, BUILDING INSPECTORS, 0\- 28
SITE WASTE\VATER TREATMENT INSPECTORS, OR STRL:CrCRA.L PEST INSPECTORS. THE PROSPECTIVE BU"fER AND SEUFR 29
MAY W1SH TO OBTAll\ PROfESSIONAL ADVICE OR INSPECTIONS Of THE PROPERTY OR TO PROVIDE APPROPRlIdi 30
PROVISIONS IN A CONTRACT BETWEEN TI1EM \\I'lTI:' RESPECT TO ANY ADVICE, INSPECTION, DEFECTS OR WARRANTJES. 3I
Seller i!l is/ !J is not occupying the property. 32
L SIELLER'S mSCLOS1:RES: 33
" If you answer "Yes" 10 a question with an asterisk .:*), please explain your answer and attach documents, if available end not otherwise 34
publicly recorded. If necessary, use an attached sheet 35
YES NO DON'T 36
1. TITLIE KJ'\OW 37
A. Do you have legal authority 10 sell the property? If no. please explain. U 38
*8. Is title to the properly subject to any of the following? 39
(1) First right ofrefusal o c 40
(2) Option o o 41
(3) Lease or rental agreement o o 42
(4) Life estate? o o 43
"C. Arc there any cncrcachmcnts, boundary agreements. or boundary disputes? o c 44
*0. Is there a private road or casement agreement for access to the property? o o 45
"E. Arc there any rights-of-way, casements, or access limitations that may affect the 46
Buyer's use of the property? ' Q li!! 47
*F. Are there any written agreements for joint maintenance of an easement or right-of-way? OJ f2i o 48
*(;. Is there any study, survey project, or notice that would adversely affect the property'! OJ ii! c 49
"'H, Are there any pending or existing assessments against the property? a ii! c 50
*1. Are there any zoning violations, nonconforming uses, or any unusual restrictions on the 51
property that would affect future construction or remodeling? a i!I I:l 52
*J. Is there a boundary survey for the property? OJ Iff C,l 53
*K. Arc there any covenants, conditions, or resmcnons recorded i1g11in~tthe property'? 0 51 0 54
PLEASE NOTE: COVC?<m.ts: conditions. and restrictions which purport to forbid or restrict the conveyance, encumbrance, occupancy, o: 55
lease of real property to individuals based or. race, creed. color, sex, national origin. familial status, or di~ahility arc void, unenforceable, ano 56
illegal. RCW 49.60.224, 57
'?J
SELLER'S Il\ITlALS:
.:
i c
J

',,"-
CI
Date:
• »>

').b J ~ It SELLER'S INITIALS:

111 7)
-\>..<.1",,::""'6<----- Dtte: J.£~f'=--1L
"
Form 17 SELLER DISCLOSURE STATEMENT ©Copyright 2009

Seller Disclosure Statement IMPROVED PROPERTY Northwest Multiple listing Surl'lce

Rev. 07109 ALL RIGHTS RESERVED
Page 2 of 5 (ContInued)
vrs NO D01ll'T 3S
2. WATER KNo\1, 59
.A. Household Water ,-;0
(1) TIle source of water for the property is: ~ Private or publicly owned water system (.1
CJ Private well serving only the subject property *C1 Other water system
*1f shared, arc .hcrc any written agreement," 0 0 0
*(2) Is there an easement (recorded cr unrecorded) for access to and/or maintenance
of the water source? (J ~ 0
*(3) Arc there any problems Or repairs needed? 0 iii 0
(4) During your ownership, has the source provided an adequate year-round supply
of potable water? !Xi (J Q
Ir11o, please explain: _
*(5) Are there any water treatment systems for the property? 0 ~ D ~'O
If yes, arc they: 0 Leased (] Owned 71
*(6) Are :here any water rights for the property associated with its domestic water supply, 01 i!1 o 72
such as a water right permit, ccr.ificate, or claim?
(a) If yes, has the water right permit, certificate. or claim been assigned, transferred,
or changed') 0 0 0
"'(b) IfYC5, has all or any portion of the water right not been used for five or more
successive years? 0 0 a
*(7) Are there any defects in the ()pe~ation ofthe water system (c.g. pipes, lank, pump, etc.)? o 0 0
B. Irrigation Water
(I) Are there any irrigation water rights [or the property, such as a water right permit,
certificate, or c.aim? 0 !Xi 0
"(a) If yes, has all or any portion of the water right not been used for five or more
successive years? 0 0 CJ
"(b) Ifso, is t.ic certificate available? (Ifyes, please attach a copy.) 0 0 0
"(c) If 50, has the water right permit. certificate, or claim been assigned. ;5
transferred, or changed? 0 U C,.J ".6
*(2) Docs the property receive irrigation water fTJI11 a ditch company, irrigation district, 0 ~ 0 vt
or other entity? If so. please identify the entity that supplies water to the property: ,g
.\9
C Outdoor Sprinkler System no
(I) Is there an outdoor sprinkler sys.em for the property? (!f [J '"I
*(2) If yes. are there any defects in the system? (J o <;2
*(3) If yes, is the sprinkler system connected to irrigation water? o
3. SEWERJON-Sn}~SlEWAGE SYSTlEM
A. The property is served by:
U Public sewer system (J On-site oewage system (including pipes, tanks, drainficlds, and all other component parts) :;6
o Other disposal system :17

Please describe: .... :18

B. lfpuhlic sewer sys.em service is available to the property. is the house ')9
connected to the sewer main') 0 0 CD )0
If no, please explain: _ :)I
"C. Is the property subject 10 any sewage system fees or charges inaddition to those covered , :"2
in your regularly billed sewer or on-s.te sewage system maintenance service? 0 CI o 13
D. If the property is connected to an Oil-site sewage system: ]04
*( I) Was a permit issued for its construction, and was it approved by the local health
department or district following its construction? 0 0 o 06
(2) When was it last pumped? .... _ ; ,17
*(3) Are there any defects in the operation of the on-site sewage system'? 0 0 o 'C,:{
(4) When was it last inspected" __
By whom: ._ iO
(5) for how many bedrooms was the on-sue sewage system approved? bedrooms : II

~~ / __ fi /,/1 / -

SELLER'S
"'TrIALS? Date: _ '2~'2..Jl::.. IL SELLER'S INITIALS: --,-L~/_f Date: 21cJ~L
 Form 17 SELLER DISCLOSURE STATEMENT ©Copyright 2009
Seiler Disclosure Statement Northwest Multiple Listing Service
Rev. 07/09
IMPROVED PROPERTY ALL RIGHTS RESERVED
Page 3 of 5 (Continued)
YES NO DON'T 112
E. ATc all plumbing fixtures, including laundry drain, connected to the KI'\'OW 113
sewer/on-site sewage system" F!l 0 0 114
If no, please explain: _ .. .._ 115
*F. Have there been any changes or repairs to the on-site sewage system') t:J 56 LJ 116
G. Is the on-site sewage system, including the drainfield, located entirely 117
within the boundaries ofthe property" ii:1i I:) (J 118
If no, please explain: __ ... 119
*11. Docs the on-site sewage system require monitoring and maintenance services more 120
frequently than once a year? 0 ~ u 121

iF THiS RESmENHAl
l'iOTICE: REAL PROPIERTY DISCLQSURE IS BEING CO!ViIPLETF.D f'OR NE'\' CONSTRUCTW,\ 122
wmcn HAS NEVER BEEN OCCUPIED, SELLER IS NOT REQUIRED TO COMPLETE THE QUESTiOl'S USTED IN HE\l ~ 123
(STRUCTURAL) OR ITEM 5 (SYSTEMlS Al\'D FIXTURIES). 124
4. STRUCTURAl, 125
"A, Has the roofleaked within the last 5 years') D i:l a: 126
*B. lias the basement flooded or leaked? 0 61 u 127
*C. Have there been any conversions. additions or remodeling? 01 ~ DI 128
*(1) If yes. were a.I building permits obtained? 01 01 01 129
*(2) If yes. were a.l final inspections obtained? Q 0 [J 130
D. Do you know the age of the house? 0 0 WI 131
If yes. year of original construction: "
*E. Has there been any settling, slippage, Of sliding ofthe property or its improvements? 01 ~ 0 133
*F. Arc there any defects with the following: (If yes. please check applicable items and explain.) 0 ~ 0 134
o Foundations 0 Decks 0 Exterior Walls 135
o Chimneys 0 Interior Walls [J Fire Alarms 136
o Doors 0 Windows P Patio 137
o Ceilings 0 SlabFloors 0 Driveways 138
o Pools 0 Hot Tub 0 Sauna 139
o Sidewalks 0 Outbuildings 0 Fireplaces 140
o Garage Floors 0 Walkways 0 Wood Stoves 141
!J Siding 0 Otl1<.'I' .... ~. 142
*G. Was a structural pest or "whole house" inspection done? o 143
If yes, when and b:' whom was the inspection completed? 144
145
I!. During your ownership, has the properly had any wood destroying organism or pest infestation? 01 CJ 146
1. Is the attic insulated'? 01 CJ 147
J, Is the basement insulated? 01 c 148

5. SYSTEMS AND fiXTURES 149

*A. Ifany of the following systems or tiX'UfCS arc included with the transfer. are there any defects? 150
If yes, please explain: . 151
Electrical system, including wiring, switches, outlets, and service 01 ~ 01 152
Plumbing system. including pipes, faucets, fixtures, and toilets 13 ill 01 153
HOI water tank r-"
Wi [!j 0 154
Garbage disposal 01 ~ U 155
Appliances 01 ~ n 156
Sump pump 01 rD 01 157
Heating and cooling systems Q 6?i 01 158
Security system I'li Owned 0 Leased 0 6?i 0 159
Other. _ 0 0 01 IGO

rt.-y<
/;

.--£ _f!_./;; .
SELLER'S INITIALS:
~-r'--- D~te: 2b (L SELLER'S INITIALS: Date:
 Form 17 SELLEH DISCLOSURE 8T ATEMEN,. ©Copyright 2009
Seller Disclosure Statement Northwest Multiple Listing Service
'If-PROVED PROPERTY ALL RIGHTS RESERVED
Rev. 07109
Page 4 of 5 ( continued)

*8. If any of the following fixtures or property is included with th~ transfer, arc they leased? vrs NO DON"I i61
(If yes. please auach copy or lease.) Kl'\OW'12
Security System D o ;63
Tanks (type): _... CJ ~J 1M
Satellite dish Q o '(,5
Other: o o ,('6
*C. Are any of t!leo-following kinds of \~ood burning appliances present at the property? "i7
(I) Wocdstove? D u (,S
(1) Fireplace insert? c o 1(;9
(3) Pellet stove? c o i'O
(4) Fireplace'; c U 171
If yes, are all of the (I) woodstoves or (2) fireplace inserts certified by the C.S. Environmental 72
Protection Agency as clean burning cppliances tc improve air quality and public health? o o ~J ,73
6. HOMEOWNERS' .\SSOCIATiON/COJ'vnW:\' illlTERESTS ;-'4
A. Is there a Homeowners' Association" o 175
Name of Association and contact information for an officer, director, employee, or other authorized !?6
agent, if any. who may provide the association's financial statements, minutes, bylaws, fining policy, 177
and other information that is not publicly available: ;-:'8
B. Are there regular periodic assessments? Iii Q 0 )-9
s. 303. per 0 month L1If year 1<:0
o
Other . ._ .__ ---: _ q
"C. Are there any pending special assessments? 0 Il!f 0 \2
"D. Are there any shared "common areas" or any joint maintenance agreements (facilities ) >:3
such as walls, fences, landscaping, pools, tennis (courts, walkways, or other areas co-owned \4
in undivided interest with others)? 0 Q 0 ';5

7. ENViROlllMENTAI,
*A. Have there been any flooding. standing water, or drainage problems on the property
that affect the property or access to tl.c property? 1:1 ~ CJ
*13. Does any part of the property contain till dirt, waste, or other fill material? 0 !if 0
*C'. Is there any material damage to the property from fire, wind, floods, beach movements,
earthquake, expansive soils, or landslides? 0 GQ 0
D. Arc there any shorelines, wetlands. floodplains, or critical areas on the property? 0 ail CJ
"E_ Arc there any substances, materials, cr products in Of on the property that may be environmental
concerns, such as asbestos, formaldehyde, radon gas, lead-based paint. fuel or chemical storage
tanks. or contaminated soil or water? WI ~ CJ
*f_ lIas the property been used for commercial or industrial purposes? 0 ~ 0
*G. Is there any soil or groundwater contamination? CJ r!f 0
"II. Arc there transmission poles or other electrical utility equipment installed. maintained,
or buried 011 the property that do not provide utility service to the structures on the property? 0 ~ 0
*1. Has the property been used as a legal or illegal dumping site? . 0 ~ 0
*1. Has the property been used as an illegal drug manufacturing site? 0 ~ Q
''K. Arc there any radio towers in the area that cause interference with cellular telephone reception? 0 ~ I:~
8. LEAD BASED PAiNT (Applicable if the house was built before 1?78.)
A. Presence of lead-based paint and/or lead-based paint hazards (check one below):
o Known lead-based paint and/or lead-based paint hazards arc present in the housing
(explain).
fil! Seller has no k;;()\~fedge of lead-based paint and/or lead-based paint hazards in-il~e housing.
B. Records and reports available to the Seller (check one below):
o Seller has provided the purchaser with all available records and reports pertaining to
lead-based paint and/or lead-based paint hazards in the housing (list documents below).

[.if Sellcd~~C?ort; or reco~ds pertaining to lead-based paint and/or lead-based 1;~T;;il~zards in the housing.
9. MANUFACTURED 1\.."'ID MOBiLE HOMES
If the property includes a manufactured or mobile home, 4
*A. Did you make any alterations to the horne? o D 5
If yes, pl case describe the alterations: _ o
*B. Did any previous owner make any alterations to "t:1C h(;mc? ------------ c 7
*C. If alterations ",'ere made, were permits or variances for these alterations obtained? o s

SELLER'S INITIALS:
/)(/

}(-J
__
»>:

,,,--_Date: -,:'",-'""b_'~)_~ IL- SELLER'S INITlALS: ~~)-,-/-:~) _ Dah:: __ '1- G-;;:,. IL

-/
 ,
Form 17 SELLER DISCLOSURE STATEMENT ©Copyrighl 2009
Seller Disclosure Statement Northwest Multiple Listing Service
IMPROVED ,PROPERTY ALL RIGHTS RESERVED
Rev. 07/09
Page 5 of 5 (Continued}

10. FULL DlSCLOSURIi: BY SELLERS YES NO DO\"T 219

A. Other conditions or defects: l\.'NO\\ 220
,.Arc there any other existing; material defects 2ffecting the property thai a prospective buyer 221
should know about? 0 rll 0 222
B. Verification 223
The foregoing answers and attached explanations (if any) arc <complete and correct to the best of Seller's knowledge and Seller i::>, 224
received a copy hereof Seller agrees :0 defend, indemnify and-hold real estate licensees harmless from and against any and all claiu» 225
that the above information is inaccurate. Seller authorizes real estate licensees. if any, to dcliv a copy of this disclosure statement '" 226
other real estate licensees and all prospective buyers of the property. - 227
Date: 0~ ~b I ~)A .. Date: 228

iNlFORMXnON
Seller /~~T~~~~~!:i5::~:ION
REGARDINC REGiSTERED SEX OFFE:'IiDERS MAY BE OBTAINED R<'ROM LOCAL L\W ENFORCEM!E'\r 232
:::
AGENCIES_ THIS NOTICE IS INTEXDED ONLY TO INFOR'1'yOU Q}' WHERE TO OBTAIN THIS INfORMATION AND IS 233
NOT AN INDKA TION OF THE PRESENCE OF REGISTERED S£X OFfE:'oIDERS. 234
PROXlMlTY TO FAR.M!NG 235
TIBS NOnCE [S TO iNFORM YOU TIM. T THE REAL PROPERTY YOU ARE CONSIDERING FOR PURCHASE 1\1,\ Y LIE fiN 236
CH"OS[ PROXIMITY TO A FARM. THE OPERA rrox OF A FARM INVOl. VES USUAL A:\"D CUSTOMARY AGRICULTURAL 237
PRACTllCES, WHICH ARE PROTECTED UNDER RCW 7.48.305, THIE WASHINGTON RIGHT TO FARM: ACT. 238
II. BUYER'S ACKl"lOW1..EDGEMENT 239
BUY!;:T hereby acknowledges that: 240
A. Buyer has a duty to pay diligent attention to any material defects that are known to Buyer or can be known to Buyer by utilizi::i~ 241
diligent attention and observation. 242
B. The disclosures set forth in this statement and if' any amendments to this statement are made only by the Seller and not hy any ,<':i 243
estate licensee or oihcr party. 244
C. Buyer acknowledges that, pursuant to RCW 64.(16.050 (2), real estate licensees arc not liable for inaccurate informal ion provided b\' 245
Seller, except to the extent that real estate licensees know of such inaccurate information. 246
D. This information is for disclosure only and is not intended to be a part of the written agreement between the Buyer and Seller. 247
E. Buyer (which term includes all persons signing the "Buyers acceptance" portion of this disclosure statement below) has received " 248
copy of this Disclosure Statement (including attachments, if any) bearing Seller's signaturcis). 249
F. If the house was built prior to 1975, Buyer acknowledges receipt of the pamphlet Protect YOllr Familv From Lead in Your HOllie. 250
DISCLOSURES CONTAINED IN THIS DISCLOSURE STATEMI:'NT ARE PROVIDED BY SELLER BASED ON SELLER'S ACTU.L 251
KNOVv'LEDGE OF THE PROPERTY AT THE TIME SELLER COMPLETES THIS DISCLOS,(}RE. UNLESS BUYER AND SELLH 252
OlliER'N1SE AGREE IN WRITING, BUYER SHALL HAVE THRE~ (3) BUSINESS DAYS FROM nIE DAY SELLER OR SELLER'S 253
AGENT DELIVERS THIS D!SCLOSURE STATEMENT TO RESCIN"D TIfE AGREEMENT BY DELIVERING A SEPARA TEL Y SIGN iD 254
WRITTEJ\ STATEMENT OF RESCISSION TO SELLER OR SELLER'S AGENT. YOU MAY WAIVE THE RIGHT TO RESClJ'.:DPRI( 'R 255
TO OR AFTER THE TIME YOU ENTER INTO A SALE AGREEMENT. 256
BUYER HEREBY ACKNOWLEDGES RECEIPT OF A COpy OF Tl-lIS DISCLOSURE STATEMENT AND ACKNOWLED(iES TH.\;' 257
TIlE DISCLOSURES MADE HEREIN ARE THOSE Of TIiE SELtER om. Y. AND NOT OF At'lY REAL ESTATE LICENSEE :H 258
OTHER PARTY. 259
DATE: . ._. DATE: 260
BUYER: . BUYER: 261
BeYER'S WAiVER OF RIGHT TO REVOKE OFFER 262
Buyer has read and reviewed 1he Seller's responses to this Seller Disclosure Statement. Buyer approves this statement and waives Buyer's rigH 263
to revoke Buyer's offer based on this disclosure. 264
DATE: DATE: _.. . 265
BUYER: BUYER: ... _ 266
BUYER'S WAiVER OF RIGHT TO RECEIVE COMPLETED SELLER DISCl"OSL"RE STATEl\IENT 267
Buyer has been advised of Buyer's right to rccei vc a completed Seller Disclosure Statement. Buyer waives that right. However, ifthc answer 1, I 268
any ofthe questions in the section entitled "Environmental" would be "yes," Buyer may not waive the receipt of the "Environmental" section "r 269
the Seller Disclosure Statement. 270
DATE: ._. __ PATE: ._ 271
Bl.JYER: BUYER: _
272
I r the an~wcr IS "YCS" [Q any aSH:n~l\.l:lI C) Items, pll:uJI: I-"piuin b"\,,w (;:..,,, "ddi,i",nal shocts ; r nL~"""'ry) PI"""" refer to the tine numbed s) r " 273
the questionl s} 274
-------_._- ._. 275
.._--- ._-----_._,,-------, .. __ .. - .. 275
--- -z;/iJ-.---. . ...---- -------_ .. _---_.--- -- 277
SELLER·S INlTIAL" /.h- Y
-__ Date: ~L "L:.. II. SELLER'S INITIALS: