r, oun t ry Real Estate

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1 1B. a c unite d r, oun t ry Real Estate Farm & Home Realty THIS DISCLOSURE SHOULD BE COMPLETED BY THE SELLER, NOT THE BROKER li!ouai.. HQo.J8*N0 OPPORTUNITV Seller states that the information contained in this Disclosure is co1tect to Seller's ACTUAL KNOWLEDGE as of the date set forth below. Any changes to the information provided in this Disclosure of which seller becomes aw a re will be disclosed by Seller to Buyer promptly after discovery. If the Property is part of a Common Interest Community, this Disclosure is limited to the Property or Unit itself, except as stated in Section L. Seller hereby authorizes Broker to deliver a copy of this Disclostire to any and all prospective buyers. NOTE: If an item is not present at the Property or is not to be included in the sale, mark the "NIA" column. The Purchase Agreement, not this Disclosure form, determines whether an item is included in or excluded from the sale. Date 1 Grubstake Ct Moriarty NM 80 Property Address State Zip Code Donald W Burtis Edith Hartzog Burtis Seller's Name (Print) Seller's Name (Print) OCCUPANCY: Has the Seller ever occupied the Property? o Yes o No If the "Yes", provide the beginning and ending dates of occupancy: Beginning Date Ending Date STRUCTURAL CONDITIONS A Do any of the following conditions currently YES NO NT ' lf "YES", EXPLAIN exist or is Seller aware of them ever existin: " KNOW... R 1 Structural problems Moisture and/or water problems History of wood infestation, insects, pests, birds or tree root problems affecting the structure Damage due to hail, wind, fire or flood Cracks, heaving or settling problems Exterior wall or window problems Building code, city or county violations DO This form and all REAL TORS Association of New Mexico (RANM) fom,s are for the sole use of RANM members and those New Mexico Real Estate Licensees to whom RANM has granted prior written authorization. Distribution of RA.NM Forms to non-ra NM members or unauthorized Real Estate Licensees is strictly prohibited. RANM makes no warranty of the legal effectiveness or validity of this fonn and disclaims any liability for damages resulting from its use. By use of this form the parries agree to the limitations set forth in this paragraph. The parties hereby release RANM, the Real Estate Brokers, their Agents and employees from any liability arising out of the use of this fom1. You should consult your attorney with regards to the effectiveness, validity, or consequences of any use of this form. The use of this form is not intended to identify the user as a REALTOR. REALTOR is a registered collective membership mark which may be used only by Real Estate Licensees who are members of the National Association of REAL TORS and who subscribe to the Association's strict Code of Ethics. RANM Form 01 ( 01 Jan ) Page l of REALTORS Association of New Mexico Buyer Seller _ lnstanetforms'

2 [B "' """ * d%/+, STRUC'lJJRA CONDITIONS - CON'T: c'!b " J!r: *,.,"f/1,, Were all necessary permits, approvals and inspections obtained for all construction, repairs, and improvements? o Yes ono o Do Not Know If"no", explain, A;,l y 9 House is built on: o Slab o Crawlspace o Basement 10 Type of Construction: Type of Exterior: o Artificial/ Synthetic Stucco (EIFS) o Other 11 Any current or past problems: o Yes ono If"yes", explain 1 Type of floor under carpets, linoleum, etc.: 1 Any additions or alterations made: NOTE: If an item is not present at the Property, mark the "NIA" column. Ac;, ROOF,, DO,.,. tl+j"' t"" Do any of the following conditions cur ently NIA YES NO NOT IF "YES", EXPLAIN exist or is Seller aware of them ever existinf: 'i KNOW "'!Z 1 Roof problems Roof leak: Past Roof leak: Present Damage to roof: Past Damage to roof: Present Skylight problems Gutter or downspout problems Is roof under warranty? o Yes ono o Do Not Know If "yes", when does warranty expire? If"yes", is warranty transferable? o Yes ono o Do Not Know If"yes", has roof work been performed while under current roof warranty o Yes ono o Do Not Know If"yes", describe work done: Roof Material: Age 9 Roof Material: Age RANM Form 01 ( 01 Jan ) Page of REALTORS Association of New Mexico Buyer Seller This copyright protected fonn was created using Instanet Forms and is licensed for use by Myra Oden. lnstanetforms'

3 [B l!qum. k0v8.ino OPPOA;TUNtTV NOTE: If an item is not present at the Property or not included in the sale, mark the "N/ A" column Built-in vacuum system & accessories Clothes dryer: o Gas o Electric o Vented Outside Type of clothes dryer hook-up available: o Gas o Electric o None o Do Not Know o Other Clothes washer Dishwasher Disposal Freezer Gas grill Range Hood Microwave oven Oven Type of oven hookup available: o Gas o Electric o Propane o None o Do Not Know o Other Range o Gas o Electric o Propane Refrigerator Refrigerator Water Line _ 1 Trash Compactor RANMForm01 (01Jan) Pageofl 008 REALTORS Association of New Mexico Buyer Seller lnstanetrorms'

4 m NOTE: If an item is not present at the Property or is not included in the sale, mark the "NIA" column Security system: o Owned o Leased o Transferable Smoke/fire detectors: o Battery o Hardwired Carbon Monoxide Alarm: o Batte o Hardwired Light fixtures Switches & outlets Aluminum wiring: o Pig-tailing Electrical: o Amps Telecommunications (T-1, fiber, cable, satellite, DSL) o Owned o Leased Satellite System or DSS Dish o Owned o Leased Inside telephone wiring & blocks/jacks Ceiling fans Garage Door o Electric o Manual If electric, number of garage door remote control s Intercom/doorbell In-wall / Built-in speakers 0 volt service Landscape lighting RANM Form 01 ( 01 Jan ) Pa g e of REALTORS Association of New Mexico Buyer Seller lnstanetforms'

5 1H NOTE: If an item is not present at the Property or is not to be included in the sale, mark the "NIA" column Cooling: o Evaporative Cooler o Refrigerated Air o Window Units o Central Duct Location: Number of Units: Humidifier Air purifier Sauna Steam room/shower Water heater:# of Capacity Fuel Type Heating: o Central Forced Air o Radiant o Hot Water Baseboard o Wall Furnace o Floor Furnace o Solar o Geo Thermal o Other Type of Piping: o Entran o Other If "other", type: Number of Units: Type of duct work: Fireplace # Type: o Wood Burning o Gas Logs o Log Lighter o Electric Stove: Fuel Type: o Wood o Pellet o Other Fireplace Inse1i Fuel Tanks: o Owned o Leased Entry gate system If known, date of last fireplace/wood stove, chimney/flue cleaning: Are there any rooms without a direct heat source? o Yes o No If"yes", explain: RANM Form 01 ( 01 Jan ) Pa ge of REAL TORS Association of New Mexico Buyer Seller lnstanetforiv's

6 1H NOTE: If an item is not present at the Property or is not to be included in the sale, mark the "NIA" column Water filter system: o Owned o Leased Water softener: o Owned o Leased Lift station (sewage ejector pump) Drainage, storm sewers, retention ponds Grey water storage/use Sump pump Underground sprinkler system: o Partial o Full Coverage Fire sprinkler system Water Pipes: Type(s): o Lead o Galvanized o Kitec o Copper o Polybutylene o Pex o Do Not Know o Other Backflow prevention device: o Domestic o Irrigation o Fire o Sewage Irrigation pump Well pump Reverse Osmosis: o Owned o Leased Lease Information: Plumbing Problems: o Yes o No o Do Not Know If"yes", explain Sewage Problems: o Yes o No o Do Not Know If"yes", explain If" es", ex Iain Water Pressure Problems: o Yes o No o Do Not Know If"yes", explain RANM Form 01 ( 01 Jan ) Page of REALTORS Association of New Mexico Buyer Se ll er lnstanetfor.vs

7 [B NOTE: If an item is not present at the Property or is not to be included in the sale, mark the "NIA" column.. JN WORKING CONDITION? POOL, SAUNA, HOT TUB, WATER DO NOT G NIA YES NO FEATlJRE " KNOW....,, 'I, - 1 Pool 8 Pool Material: + D Vinyl D Gunite o Fiberglass o Other Pool Type: o Chlorine o Saltwater o Bromine o Other Pool Filter Pool Heater In-Pool Cleaning Equipment Pool Cover: Type: 8 Hot Tub 9 Sauna Room 10 Steam Room 11 Water Features Type: 1 Is Pool Service Company being used? If "yes", name of company. AGE IF APPLIES ANDIS l(nown Ii "' COMMENTS 1 Has Pool been winterized? o Yes D No H 1 USE, ZONING & LE<;;AVISSUE Do any o.f the following conditions currently exist or is Seller aware of them ever existin Zoning violations, variances, conditional use restrictions, violations of an enforceable PUD or non-conforming use Liens or judgments against the Property Proposed bonds, assessments, or impact fee's aoainst the Pro ert RANM Form 01 (01 Jan ) Page of REALTORS Association of New Mexico Buyer Se ll er lnstanetforms

8 1B,. ",. k, "n o.,)' 1 USE, ZONING& LEGAL ISSUEs' :::: CON'T- ' " YES NO NOT IF 'YES", EXPLAIN H f\ldo any of the following conditions currently KNOW' exist or is Seller aware of them ever existing: _i, +..I{ Notice or threat of condemnation proceedings Notice of any adverse conditions from any governmental or quasi-governmental agency that have not been resolved Violation ofrestrictive covenants or owners' association rules or regulations Any building or improvements constructed without approval by the owners' association or the designated approving body, if approval is required 8 Notice of zoning action 9 Other legal action % I ACCESS, PARKING, DRAINAGE& i SIGNAGE Do any of the following conditions currently exist or is Seller aware of them ever existing: 1 Access problems Roads, driveways, trails or paths through the Property used by others Public highway or county road bordering the Property Proposed or existing transportation project that affects or is expected to affect the Property Encroachments, boundary disputes or unrecorded easements Shared or common areas with adjoining properties Requirements for curb, gravel/paving, landscaping 8 Flooding or drainage problems: Past 9 Flooding or drainage problems: Present DO YES NO. NOT IF ''YES" EXPCAIN KNOW k,;-; " '. RANMForm01 ( 01Jan ) Pa ge8ofl 008 REAL TORS Association of New Mexico Buyer Seller lnstanetforms

9 1B WOUM. H &ih'q OPPORTUNITY Does seller own all water rights to the Property? o Yes o No o Do Not Know If"no", what water rights have been transferred? o Surface Rights o Irrigation Rights o Ditch Rights o Other Additional details of transfer: _ 1 If"no", are sales/lease/transfer agreements attached? o Yes o No If applicable and if not otherwise identified in the agreement(s) attached, contact information for third-party or parties who/which currently hold water rights to the Property: Type of water supply: o Public o Community o Private (If Property has well, see Section J()below) Name and address of service providers: Fees per month: Transfer Fee: Restrictions and/or regulations Water Su 1 or Yield Problems WELL(S) o N/A TYPE: o Private Well o Shared Well o Cistern o Irrigation Well o Other If the Property is served by a Well, Well Permit o Is o Is Not attached. Shared Well Agreement o Yes o No If"yes", Well-Share Agreement o Is o Is Not attached Well location and address _ Separate electric meter (private or shared) o Yes o No Is well required to be metered o Yes o No Restrictions and/or regulations _ Well Registered with the State Engineers Office o Yes o No Permit# Additional Well Records attached o Yes o No Any other water source for any other use? o Yes o No If"yes", describe: If there is neither a Well, nor a Water Provider for the Property, then describe the source of potable water for the Property: SOME WATER PROVIDERS RELY, TO VARYING DEGREES, ON NONRENEWABLE GROUND WATER. CONT ACT YOUR PROVIDER (OR INVESTIGATE THE DESCRIBED SOURCE) TO DETERMINE THE LONG-TERM SUFFICIENCY OF THE PROVIDER'S WATER SUPPLIES. If other than City/Municipal/Community water, is there a requirement to connect to the City/Municipal/Community water? o Yes o No o Do Not Know If "yes", requirement: RANM Form 0 I (01 Jan) Page 9 of REALTORS Association of New Mexico Buyer SeJler _ lnstanetforms'

-------------------------- Names and address of service providers: Is there a written service agreement o Yes o No If"yes", Agreement o Is o Is Not attached.

Outdoor Latrine o Cesspool o Gray Water Storage o Liquid Waste Storage Tank Any problems: --------------------------------- Name and Address of Service Providers: --------- --------------- Date of

10 1B lfoum. HOU&IHO O PORTUNITV J 8 Type of sanitary sewer service: o Public o Community o Septic (If Property has an onsite liquid waste system see Section J(8) below) o Other o None Any problems: Names and address of service providers: Is there a written service agreement o Yes o No If"yes", Agreement o Is o Is Not attached. Fee's per month$ Transfer Fee$ Restrictions and/or regulations: WASTEWATER TREATMENT D N/A TYPE: o Conventional o Advanced Treatment System o Composting Toilet o Outdoor Latrine o Cesspool o Gray Water Storage o Liquid Waste Storage Tank Any problems: Name and Address of Service Providers: Date of last service: NM ED (EID#) Permit System Certification Number: Requirement to Connect to a sewer system o Yes o No If"yes", explain 9 Any problems with septic or sewer lines? o Yes o No If"yes", explain SEE RANM FORM 08 INFORMATION SHEET- SEPTIC.SYSTEMS ENVIRONMENTAL CONDITIONS K Do any of the f<;illowing conditions currently exist or is YES NO, Seller aware of them ever existine:: i'' Hazardous materials on the Property, such as radioactive, toxic, or bio-hazardous materials, 1 asbestos, pesticides, herbicides, wastewater sludge, radon, methane, mill tailings, solvents or petroleum products Storage tanks o Above Ground D Under Ground Underground transmission lines Animals kept in the residence,,,. DO NOT KNOW ' [F "YES", EXPLAlN,, RANM Form 01 ( 01 Jan ) Page 10 of REALTORS Association of New Mexico Buyer Seller lnstanetforms'

11 [B 0UAl. ttou&ho o,-pornjnjtv K ENVlRONMENTAL CONDITIONS-CON'T.,.,, : : : 11'"\., DO '1'1' '<n "'" Do any of the following conditions currentl{exist + NOT or is Seller aware of them ever existiqg: YES NO KNOW IF "YES", EXPLAlN Property used as, situated on, or adjoining a dump, land fill or municipal solid waste land fill Monitoring wells or test equipment Sliding, settling, upheaval, movement or instability of earth or expansive soils on the Property 8 Land on the Property that has been filled in 9 Mine shafts, tunnels or abandoned wells or cisterns 10 Within governmentally designated flood plain or wetland area 11 Dead, diseased or infested trees or shrubs Environmental assessments, studies or 1 reports done involving the physical condition of the Property 1 Noticeable continuous or periodic odors Property used for any mining, graveling, or other 1 natural resource extraction operations such as oil and gas wells 1 Wood infestation, insects, pests, rodents or tree root problems 1 Flooding on any portion of the Property 1 History of mold conditions or treatment for mold.,fl ft] SEE RANM"FORM 09 - INFORMATION SHEET MOLD ".. - NOTE: If question does not apply to Property, mark the "N/A" column. F.,,,.,, "-, f. L COMMON INTEREST COMMUNITY DONOT NIA YES NO"'¼ ASSOCIATION PROPERTY., KNOW., " ' '' if>) COMMENTS ls Property part of an owners' association 1 If"yes", name of Association Does Property have its own designated parking spot(s)? If"yes", how many?,,,ii', d, RANM Form 0 I ( 01 Jan ) Page 11 of REALTORS Association of New Mexico Buyer Seller lnstanetforms'

12 [H iioum. HOU&lNO O PORTUNITV L ' ;q : " "'0'(,tl COMMON INTEREST COMMUNITY ASSOCIATION PROPERTY:. CON'T ' Has the Association made demand or commenced a lawsuit against a builder or contractor alleging defective construction of improvements of the Association Property ( common area or property owned or controlled by the Association, but outside the Seller's Property or Unit). Qi@ NIA YES NO D '",?cl!i '"'ifi,comments Is Property in a Public Improvement District (PID)? SEE RANM FORM 00 - INFORMATION SHEET HOME OWNERS ASSOCIATION SEE RANM FORM 00 INFORMATION SHEET PUBLI(: IMPROVEMENT DISTRICT ' DO \,,. M OTHER RIGHTS YES NO NOT COMMENTS w KNOW' Has Seller established solar rights on the 1 Property? With the exception of water rights, already addressed in Section J, does seller own all other rights to the Property (i.e. wind, mineral, solar, etc)? If "no", what rights does seller NOT own? ooil o Gas o Hard-rock minerals (Gold, silver, copper & other metals) o Wind o Solar o Other If "no", what is the reason that Seller does not own all rights? a. o United States (US) patent did not convey some/all other rights, and therefore, no owner in the chain of title since the US patent ever owned all mineral rights; OR b. o Other rights were severed by Seller or a former owner of the Property ( other than the United States government) and o SOLD or o LEASED to a third-party. If applicable, all sale/lease and/or transfer agreements within Seller's possession o Are o Are Not attached If not otherwise identified in the sales and/or lease agreements attached, identity and provide contact information for third-party or parties who/which currently hold other rights to the Property: RANM Form 0 I ( 0 I Jan ) Page 1 of REALTORS Association of New Mexico Buyer Se ll er lnstanetforms'

13 [H '", ifzj '"'"; "'zye i; 1., '?'"DO ' - fa'',,,,. N OTHER DISCLOSURES - GENERAL YES 1 NO, N0P't 1;; IF ''YES",EXPLAIN t' " w KNOW Any damage to flooring ( e.g. carpet stains, 1 cracks in tile, damage to wood floors, etc.) or walls ( e.g. holes, stains, etc.)? Is any part of the Prope1ty leased to others (written or oral)? Does the seller have any written reports of any building, site, roofing, soils or engineering investigations or studies of the Property? Has the seller submitted any property insurance claims? (whether paid or not) Does the seller have any structural, architectural and engineering plans and/or specifications for any existing improvements? Has Property been used as a methamphetam ine laboratory? If "yes", has it been remediated? D Yes o No Has cannabis been grown on the Property? If"yes", has it been remediated? D Yes o No Are there any government special improvements approved, but not yet 8 installed, that may become a lien against the Property? SEER FORM 0 - INF01!:1pN $1IEET CLANPESTlNE f f),µ.l'rg LA BORA TORY REMEDIATION,_ Seller and Buyer understand that the real estate brokers do not warrant or guarantee the information contained in this Seller's Property Disclosure. THE BUYER IS ADVISED TO EXERCISE ALL HIS/HER RIGHTS UNDER AND IN ACCORDANCE WITH THE PURCHASE AGREEMENT TO INVESTIGATE AND INSPECT THE PROPERTY. This form is NOT intended as a substitute for an inspection of the Property. ADVISORY TO SELLER: Seller has a legal duty to disclose material defects in the Property to Buyer. The information contained in this Disclosure has been furnished by Seller, who certifies to the truth thereof based on Seller's ACTUAL KNOWLEDGE. RANM Form 0 I ( 0 I Jan ) Page 1 of REALTORS Association of New Mexico Buyer Se ll er This copyright protected form was created using Instanet Forms and is icensed for use by Myra Oden. lnstanetforms'

14 [H lfoum. H00$1NO O PORTUNITY PLEASE NOTE: THIS IS NOT A CONTRACT SELLER cllcr Donald W Burtis Date Seller Edith Hartzog Burtis Date BUYER Buyer Date Burer Dace RANM Form 01 (01Jan) Pagelofl 008 REALTORS Association of New Mexico lnstanetforms

THIS FORM HAS IMPORTANT LEGAL CONSEQUENCES AND THE PARTIES SHOULD CONSULT LEGAL AND TAX OR OTHER COUNSEL BEFORE SIGNING.

THIS FORM HAS IMPORTANT LEGAL CONSEQUENCES AND THE PARTIES SHOULD CONSULT LEGAL AND TAX OR OTHER COUNSEL BEFORE SIGNING. Keller Williams Real Estate, LLC Park Medows Office 10475 East Park Meadows Drive Suite #550 Littleton, CO 80124 Phone: 303-882-1045, Fax: 303-785-9099 The printed portions of this form, except differentiated