SELLER'S PROPERTY DISCLOSURE STATEMENT THE …spropertydisclosure.pdf · INSTRUCTIONS TO BUYER:...
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SELLER'S PROPERTY DISCLOSURE STATEMENT 1. Date 2. Page 1 of Pages THE INFORMATION DISCLOSED IS GIVEN TO THE BEST OF THE SELLER'S KNOWLEDGE. 3. 4. NOTICE: This disclosure is not a warranty or a guaranty of any kind by the Seller(s) or Agent(s) representing any party(s) in 5. the transaction. 6. INSTRUCTIONS TO BUYER: Buyers are encouraged to thoroughly inspect the property personally or have it inspected by a 7. third party, and to inquire about any specific areas of concern. 8. INSTRUCTIONS TO THE SELLER: (1) Complete this form yourself. (2) Consult prior disclosure statement(s) and/or inspection 9. report(s) when completing this form. (3) Describe conditions affecting the property to the best of your knowledge. If unsure, 10. check unknown where applicable. (4) Attach additional pages with your signature if additional space is required. (5) Answer 11. all questions. (6) If any items do not apply, write "NA" (not applicable). 12. Property located at 13. City of County of , State of 14. A. GENERAL INFORMATION: 15. (1) When did you purchase or build the home? 16. Abstract (2) Type of Title Evidence: Unknown Registered (Torrens) 17. Location of Abstract or Owner's Duplicate Certificate of Title: 18. Is there an existing Owner's Title Insurance policy? Yes No Unknown 19, (3) Have you occupied this home continuously for the past 12 months? Yes No 20. If no, explain: (4) Is the home suitable for year round use? 21. Yes No (5) Is the property located in a designated flood plain? 22. Yes No Unknown 23. (6) Are you in possession of prior seller's disclosure statement(s)? (If yes, please attach) Yes No 24. Are there: Unknown (7) Encroachments? 25. Yes No (8) Associations, Covenants, Reservations or Restrictions affecting the use of the property? 26. Yes No Unknown 27. Yes No Unknown (9) Easements, other than utility or drainage easements? (10) Comments; 28. 29. 30. B. GENERAL CONDITION: Have any of the following conditions previously existed or do they currently exist? Yes No (1) Has there been any damage by wind, fire, flood or other disaster(s)? 31. Unknown 32. If yes, give details of what happened and when: 33. 34. (2) Has the structure(s) been altered? (i.e. additions, altered roofines, changes to load bearing walls.) Yes 35. No Unknown If yes, please specify what was done, when and by whom (owner or contractor): 36. 37. 38. Yes Unknown No (3) Insect/Animal/Pest Infestation? 39. If yes, indicate type and number No Yes (4) Do you have or have you previously had any pets? 40. (5) Comments: 41. 42. 43. C. STRUCTURAL SYSTEMS: Have any of the following conditions previously existed or do they currently exist? 44. (ANSWERS APPLY TO ALL STRUCTURES, SUCH AS GARAGE AND OUT-BUILDINGS.) THE BASEMENT, CRAWLSPACE, SLAB (1) 45. No Yes Unknown Drain tile problem Unknown No 46. (a) Foundation problem Yes No Unknown Cracked floor/walls Yes No Unknown 47. Yes (b) Flooding (c) Wet floors/walls (d) Leakage/seepage No Unknown Yes Yes No Unknown Sewer backup 48. No Yes Unknown Other Yes 49. No Unknown 50. Give details to any question answered ''yes''. 51. 52. THE ROOF 53. (2) Years (a) What is the age of the roofing material? 54. Unknown (b) Has there been interior damage from ice build-up? (c) Has there been any leakage? Yes 55. No Unknown Yes 56. No Unknown (d) Have there been any repairs or replacements made to the roof? 57. Yes No Unknown 58. Give details to any question answered ''yes''. 59. 60. 61. D. PRIVATE SEWER SYSTEM DISCLOSURE: (A Private Sewer System Disclosure may be required by State Statutes) Check appropriate box 62. 63. The seller does not know of a private sewer system on or serving the above described real property. 64. There is a private sewer system on or serving the above described real property. See Private Sewer System Disclosure. 65. There is an abandoned private sewer system on the above described real property. See Private Sewer System Disclosure. 66. E. PRIVATE WELL DISCLOSURE: (A Well Disclosure Statement and Certificate may be required by State Statutes) Check appropriate box 67. The seller certifies that the seller does not know of any wells on the above described real property. 68. The seller certifies there are one or more wells located on the above described real property, See Well Disclosure Statement. 69. 70. Yes No Unknown Are there any wells serving the above described property that are not located on the property? Test results attached 71. Date well water last tested for contaminants: Yes No 72. Comments: Is this property in a Special Well Construction Area? Contaminated Well: Is there a well on or serving the property containing contaminated water? 73. Yes No Unknown 74. Yes No Unknown ORIGINAL COPY TO LISTING BROKER: COPIES TO SELLER, BUYER, SELLING BROKER 75.
Transcript of SELLER'S PROPERTY DISCLOSURE STATEMENT THE …spropertydisclosure.pdf · INSTRUCTIONS TO BUYER:...
SELLER'S PROPERTYDISCLOSURE STATEMENT
1. Date2. Page 1 of Pages
THE INFORMATION DISCLOSED IS GIVEN TO THE BEST OF THE SELLER'S KNOWLEDGE.3.
4. NOTICE: This disclosure is not a warranty or a guaranty of any kind by the Seller(s) or Agent(s) representing any party(s) in5. the transaction.
6. INSTRUCTIONS TO BUYER: Buyers are encouraged to thoroughly inspect the property personally or have it inspected by a7. third party, and to inquire about any specific areas of concern.
8. INSTRUCTIONS TO THE SELLER: (1) Complete this form yourself. (2) Consult prior disclosure statement(s) and/or inspection9. report(s) when completing this form. (3) Describe conditions affecting the property to the best of your knowledge. If unsure,
10. check unknown where applicable. (4) Attach additional pages with your signature if additional space is required. (5) Answer11. all questions. (6) If any items do not apply, write "NA" (not applicable).
12. Property located at13. City of County of , State of
14. A. GENERAL INFORMATION:15. (1) When did you purchase or build the home?16. Abstract(2) Type of Title Evidence: UnknownRegistered (Torrens)17. Location of Abstract or Owner's Duplicate Certificate of Title:18. Is there an existing Owner's Title Insurance policy? Yes No Unknown19, (3) Have you occupied this home continuously for the past 12 months? Yes No20. If no, explain:
(4) Is the home suitable for year round use?21. Yes No(5) Is the property located in a designated flood plain?22. Yes No Unknown
23. (6) Are you in possession of prior seller's disclosure statement(s)? (If yes, please attach) Yes No24. Are there:
Unknown(7) Encroachments?25. Yes No(8) Associations, Covenants, Reservations or Restrictions affecting the use of the property?26. Yes No Unknown
27. Yes No Unknown(9) Easements, other than utility or drainage easements?(10) Comments;28.
29.
30. B. GENERAL CONDITION: Have any of the following conditions previously existed or do they currently exist?Yes No(1) Has there been any damage by wind, fire, flood or other disaster(s)?31. Unknown
32. If yes, give details of what happened and when:33.34.
(2) Has the structure(s) been altered? (i.e. additions, altered roofines, changes to load bearing walls.) Yes35. No UnknownIf yes, please specify what was done, when and by whom (owner or contractor):36.
37.38.
Yes UnknownNo(3) Insect/Animal/Pest Infestation?39.If yes, indicate type and numberNoYes(4) Do you have or have you previously had any pets?40.
(5) Comments:41.42.
43. C. STRUCTURAL SYSTEMS: Have any of the following conditions previously existed or do they currently exist?44. (ANSWERS APPLY TO ALL STRUCTURES, SUCH AS GARAGE AND OUT-BUILDINGS.)
THE BASEMENT, CRAWLSPACE, SLAB(1)45.No Yes UnknownDrain tile problemUnknown No46. (a) Foundation problem YesNo Unknown Cracked floor/walls Yes No Unknown47. Yes(b) Flooding
(c) Wet floors/walls(d) Leakage/seepage
No UnknownYes Yes No UnknownSewer backup48.NoYes Unknown Other Yes49. No Unknown
50. Give details to any question answered ''yes''.51.52.
THE ROOF53. (2)Years(a) What is the age of the roofing material?54. Unknown
(b) Has there been interior damage from ice build-up?(c) Has there been any leakage?
Yes55. No UnknownYes56. No Unknown
(d) Have there been any repairs or replacements made to the roof?57. Yes No Unknown58. Give details to any question answered ''yes''.59.60.
61. D. PRIVATE SEWER SYSTEM DISCLOSURE: (A Private Sewer System Disclosure may be required by State Statutes)Check appropriate box62.
63. The seller does not know of a private sewer system on or serving the above described real property.64. There is a private sewer system on or serving the above described real property. See Private Sewer System Disclosure.65. There is an abandoned private sewer system on the above described real property. See Private Sewer System Disclosure.
66. E. PRIVATE WELL DISCLOSURE: (A Well Disclosure Statement and Certificate may be required by State Statutes)Check appropriate box67.
The seller certifies that the seller does not know of any wells on the above described real property.68.The seller certifies there are one or more wells located on the above described real property, See Well Disclosure Statement.69.
70. Yes No UnknownAre there any wells serving the above described property that are not located on the property?Test results attached71. Date well water last tested for contaminants: Yes No
72. Comments:
Is this property in a Special Well Construction Area?Contaminated Well: Is there a well on or serving the property containing contaminated water?
73. Yes No Unknown74. Yes No Unknown
ORIGINAL COPY TO LISTING BROKER: COPIES TO SELLER, BUYER, SELLING BROKER75.
SELLER'S PROPERTYDISCLOSURE STATEMENT
76. Page 2 of Pages
THE INFORMATION DISCLOSED IS GIVEN TO THE BEST OF THE SELLER'S KNOWLEDGE.77.
78. Property located at79. F. VALUATION EXCLUSION DISCLOSURE (May be required by State Statutes) Check appropriate box.
/IS NOT an exclusion from market value for home improvements on this property. Any valuation exclusion will80. There IS81. terminate upon sale of the property, and the property's estimated market value for property tax purposes will increase. If a
valuation exclusion exists, buyers are encouraged to look into the resulting tax consequences.82.83. Additional comments
84. G. APPLIANCES, HEATING, PLUMBING, ELECTRICAL AND OTHER MECHANICAL SYSTEMS:85.86.87.
NOTE: This section refers only to the working condition of the following items. Answers apply to all such items unless otherwisenoted in comments below. Personal property is included in the sale ONLY IF specifically referenced in the Purchase Agreement,Cross out only those items not physically located on the property.
In Working Order In Working Order In Working Order88.YES NO YES NO YES NO89.
TV Antenna SystemHeating System (Central)90. Air ConditioningTV Cable SystemHeating System (Supplemental)91. Central windowwallTV Satellite DishIncinerator92. Ceiling Fan
RentedIntercom Owned93. DishwasherTV Satellite ReceiverLawn Sprinkler System94. Door Bell
RentedMicrowave Owned95. Drain Tile SystemWasherPlumbing96. DryerWater HeaterPool and Equipment97. Electrical SystemWater Treatment SystemRange/Oven98. Exhaust System
Rented OwnedRange Hood99. Fire Sprinkler SystemWindowsRefrigerator100. Fireplace
101. Fireplace Mechanisms102. Furnace Humidifier
Window TreatmentsSecurity SystemWoodburning StoveRented OwnedOtherSmoke Detectors (Battery)103. FreezerOtherSmoke Detectors (Hardwire)104. Garage Door Opener (GDO)OtherSolar Collectors105. GDO Auto Reverse
Sump Pump Other106. GDO RemoteOtherToilet Mechanisms107. Garbage DisposalOtherTrash Compactor108.
109. Comments:110.111.
112. H. ENVIRONMENTAL CONCERNS:Yes NoYes Unknown UnknownLead? (paint, plumbing, etc.)No113. Asbestos?Yes No Unknown114. Soil Problems? Yes No Unknown Radon?Yes NoNoYes Unknown Diseased Trees? Unknown115. Formaldehyde?YesUnderground Storage Tanks?NoYes Unknown No Unknown116. Hazardous Substances?YesNoYes Unknown Other? No Unknown117. Hazardous Wastes?
118. Give details to any question answered ''yes'':119.120.121.
122. I. OTHER DEFECTS:123. Are there any other defects in or on the property? If yes, explain below: Yes No Unknown124.125.
126. J. ADDITIONAL COMMENTS:127.128.129.130.
LISTING BROKER AND AGENTS MAKE NO REPRESENTATIONS AND ARENOT RESPONSIBLE FOR ANY CONDITIONS EXISTING IN THE PROPERTY.
131.132.
133. K. SELLER'S STATEMENT: (To be signed at time of listing)134. The Seller(s) hereby states the condition of the property to be as stated above and authorizes any Agent(s) representing any
party(s) in this transaction to provide a copy of this statement to any person or entity in connection with any actual or anticipatedsale of the property.
135.136.
137.(Date) (Date)(Seller) (Seller)
138. L. BUYER'S ACKNOWLEDGEMENT: (To be signed at time of purchase agreement)139.140.
I/We, the Buyer(s) of the property acknowledge receipt of the Seller's Property Disclosure Statement and agree that norepresentations regarding the condition of the property have been made other than those made above.
141.(Buyer) (Date) (Buyer) (Date)
142. M. SELLER'S ACKNOWLEDGEMENT: (To be signed at time of purchase agreement)143.144.
AS OF THE DATE BELOW, I/We, the Seller(s) of the property, state that the condition of the property is the same, exceptchanges as indicated above which have been initialed and dated.
145.(Seller) (Date) (Seller) (Date)
