HOMEOWNERS ASSOCIATION CERTIFICATE

To: ______________________________(Homeowners Association) Date of Request: ______________________

Title Company File No.: ______________

The undersigned is the ______________ of the ________________________________________ Homeowners Association

(the Association), duly organized to govern and administer the affairs of _____________________________, a subdivision
located in ________________County, Wisconsin (the Subdivision). This Certificate is made in connection with the sale of
lot ______ in the Subdivision (the Lot) presently owned by __________________________________________________.
The undersigned, on behalf of the Association, certifies as follows:

Monthly/Annual Assessments. The monthly / annual (strike one) assessment levied by the Association against the Lot is:
$_________________. As of the date of this Certificate, there are no unpaid installments of the monthly / annual (strike one)
assessments for the Lot through______________, 20______, except $______________________.

Special Assessments (Active and Contemplated). There are active special assessments for the Lot (yes or no, if yes please
explain):_____________________________________________________________________________________________
____________________________________________________________________________________________________
There are contemplated special assessments for the Lot (yes or no, if yes please explain): ____________________________
____________________________________________________________________________________________________

Budget. A new budget for the Association has been approved (yes or no): __________. If yes, the new monthly / annual
(strike one) assessment against the Lot will be $_________________, commencing _______________, 20______.

Right of Refusal and Transfer Fee. The Association has a right of first refusal on the sale of the Lot (yes or no):
__________. If the yes, the Association has duly waived its right of first refusal on the presently contemplated sale ( yes or
no): __________. The Association charges the following transfer fee on the sale of the Lot: $_______________.

Construction Work. During the period of six months immediately preceding the date of this Certificate, other than work for
normal and ordinary maintenance and repairs, no work has been done on or improvements made to the common elements by
the Association, except: ___________________________________________________________________________
____________________________________________________________________________________________________
(please state the nature of the work or improvements and estimated total cost remaining unpaid).

Dated: ___________________

By: _______________________________________
Name: _______________________________________
Phone _______________________________________
Title: _______________________________________