2. NOTICE TO SELLER
Each Seller is obligated to disclose to a buyer all known facts that materially and adversely affect the value of the property being sold and that are not readily observable. This disclosure statement is designed to assist Seller in complying with disclosure requirements and to assist Buyer in evaluating the property being considered. The listing real estate broker, the selling real estate broker and their respective agents will also rely upon this information when they evaluate, market and present Seller’s property to prospective buyers.

3. NOTICE TO BUYER
This is a disclosure of Seller’s knowledge of the condition of the property as of the date signed by Seller and is not a substitute for any inspections or warranties that Buyer may wish to obtain. It is not a warranty of any kind by Seller or a warranty or representation by the listing broker, the selling broker, or their agents.

4. OCCUPANCY
Does Seller currently occupy this property? ( ) Yes ( ) No. If not, how long has it been since Seller occupied this property?
_____________________________________________________________________________________________

5. LAND (SOILS, DRAINAGE AND BOUNDARIES)
(a) Is there any fill or expansive soil on the property? ( ) Yes ( ) No ( ) Unknown.
(b) Do you know of any sliding, settling, earth movement, upheaval or earth stability problems that have occurred on the property or in the immediate neighborhood? ( ) Yes ( ) No
(c) Is the property located in an earthquake zone? ( ) Yes ( ) No
(d) Is the property located in a flood zone or wetlands area? ( ) Yes ( ) No
(e) Do you know of any past or present drainage or flood problems affecting the property
or adjacent properties? ( ) Yes ( ) No
(f) Do you know of any encroachments, boundary line disputes, or easements affecting the property? ( ) Yes ( ) No
(g) If any of your answers in this section are “Yes,” explain in detail: ___________________________________________
______________________________________________________________________________________________

6. ROOF
(a) Age: _______________ years.
(b) Has the roof ever leaked during your ownership? ( ) Yes ( ) No
(c) Has the roof been replaced or repaired during your ownership? ( ) Yes ( ) No
(d) Do you know of any problems with the roof or rain gutters? ( ) Yes ( ) No
(e) If any of your answers in this section are “Yes,” explain in detail: ___________________________________________
______________________________________________________________________________________________

7. TERMITES, DRYROT, PESTS
(a) Do you have any knowledge of termites, dryrot, or pests on or affecting the property? ( ) Yes ( ) No
(b) Do you have any knowledge of any damage to the property caused by termites, dryrot, or pests? ( ) Yes ( ) No
(c) Is your property currently under any warranty or other coverage by a licensed pest control company? ( ) Yes ( ) No
(d) Do you know of any termite/pest control reports or treatments for the property in the last five years? ( ) Yes ( ) No
(e) If any of your answers in this section are “Yes,” explain in detail: ___________________________________________
______________________________________________________________________________________________

8. STRUCTURAL ITEMS
(a) Are you aware of any past or present movement, shifting, deterioration, or other problems with
walls or foundations? ( ) Yes ( ) No
(b) Are you aware of any past or present cracks or flaws in the walls or foundations? ( ) Yes ( ) No
(c) Are you aware of any past or present water leakage in the house? ( ) Yes ( ) No
(d) Are you aware of any past or present problems with driveways, walkways, patios, or retaining walls
on the property? ( ) Yes ( ) No
(e) Have there been any repairs or other attempts to control the cause or effect of any problem
described above? ( ) Yes ( ) No
(f) If any of your answers in this section are “Yes,” explain in detail. When describing repairs or control efforts, describe the location, extent, date, and name of the person who did the repair or control effort: ________________________________
______________________________________________________________________________________________

9. BASEMENTS AND CRAWL SPACES (Complete only if applicable)
(a) Does the property have a sump pump? ( ) Yes ( ) No
(b) Has there been any water leakage, accumulation, or dampness within the basement or crawlspace? ( ) Yes ( ) No
(c) If “Yes,” describe in detail: _______________________________________________________________________________________________
_______________________________________________________________________________________________
(d) Have there ever been any repairs or other attempts to control any water or dampness in the
basement or crawlspace? ( ) Yes ( ) No
(e) If “Yes,” describe the location, extent, date, and name of the person who did the repair or control effort: ______________
_______________________________________________________________________________________________

10. ADDITIONS/REMODELS
(a) Have you made any additions, structural changes, or other alterations to the property? ( ) Yes ( ) No
(b) If “Yes,” did you obtain all necessary permits and approvals and was all work in compliance
with building codes? ( ) Yes ( ) No
(c) If your answer is “No,” explain____________________________________________________________________
(d) Did any former owners of the property make any additions, structural changes, or other alterations
to the property? ( ) Yes ( ) No ( ) Unknown
(e) If “Yes,” was all work done with all necessary permits and approvals in compliance with building codes?
( ) Yes ( ) No ( ) Unknown
(e) If your answer is “No,” explain: __________________________________________________________________
_____________________________________________________________________________________________

11. PLUMBING-RELATED ITEMS
(a) What is your drinking water source? ( ) Public ( ) Private System ( ) Well on Property
(b) If your drinking water is from a well, when was your water last checked for safety and what was the result of the test?
_____________________________________________________________________________________________
(c) Do you have a water softener? ( ) Yes ( ) No ( ) Leased ( ) Owned
(d) What is the type of sewage system: ( ) Public Sewer ( ) Private Sewer ( ) Septic Tank ( ) Cesspool
(e) Is there a sewage pump? ( ) Yes ( ) No
(f) When was the septic tank or cesspool last serviced? ___________________________________________________
(g) Do you know of any leaks, backups, or other problems relating to any of the plumbing, water, and
sewage-related items? ( ) Yes ( ) No
(h) If your answer is “Yes,” explain in detail: ____________________________________________________________
_____________________________________________________________________________________________

12. HEATING AND AIR CONDITIONING
(a) Air Conditioning: ( ) Central Electric ( ) Central Gas ( ) Window ( ) # of Units Included in Sale
(b) Heating: ( ) Electric ( ) Fuel Oil ( ) Natural Gas ( ) Other: ________________________________________________
(c) Water Heating: ( ) Electric ( ) Gas ( ) Solar
(d) Are you aware of any problems regarding these items? ( ) Yes ( ) No. If “Yes,” explain in detail: ___________________
_______________________________________________________________________________________________

13. ELECTRICAL SYSTEM
Are you aware of any problems or conditions that affect the value or desirability of the electrical system? ( ) Yes ( ) No
If “Yes,” explain in detail: ___________________________________________________________________________
______________________________________________________________________________________________

14. OTHER EQUIPMENT AND APPLIANCES BEING SOLD
Mark the items included in the sale of your property:
( ) Electric Garage Door Opener ( ) Number of Transmitters; ( ) Security Alarm System; (CIRCLE ONE) Owned / Leased;
( ) Smoke Detectors; How Many? ______________; ( ) Lawn Sprinklers; ( ) Automatic Timer; ( ) Swimming Pool; ( )
Pool Heater; ( )Spa/Hot Tub; ( ) Pool/Spa Equipment (list): _______________________________;
( ) Refrigerator; ( ) Stove; ( ) Microwave Oven; ( ) Washer; ( ) Dryer; ( ) Dishwasher; ( ) Trash Compactor; ( ) Intercom;
( ) Ceiling Fans; ( ) Other: __________________________________________________________________________;
Are any of these in need of repair or replacement? ( ) Yes ( ) No. If “Yes,” explain in detail: _________________________
_______________________________________________________________________________________________

15. NEIGHBORHOOD
Are you aware of any condition or proposed change in your neighborhood that could adversely affect the value or desirability of the property, such as noise or other nuisance, threat of condemnation or street changes? ( ) Yes ( ) No . If “Yes,” explain in details:_________________________________________________________________________________________

16. TOXIC SUBSTANCES
(a) Are you aware of any underground tanks or toxic substances present on the property (structure or soil) such as asbestos, PCBs accumulated radon, lead paint, or others? ( ) Yes ( ) No. If “Yes,” explain in detail: __________________________
______________________________________________________________________________________________
(b) Has the property been tested for radon or any other toxic substances? ( ) Yes ( ) No. If “Yes,” explain in detail: ______________________________________________________________________________________________

17. CONCONIMIUMS AND OTHER HOMEOWNERS ASSOCIATIONS
(a) Is the property part of a condominium or other common ownership or is it subject to covenants, conditions, and restrictions (CC & R’s) of a homeowner’s association? ( ) Yes ( ) No. (If your answer is “no”, you may ignore the remainder
of this section.)
(b) Is there any defect, damage, or problem with any common elements or common areas which could affect their value or
desirability? ( ) Yes ( ) No ( ) Unknown
(c) Is there any condition or claim which may result in an increase in assessments or fees? ( ) Yes ( ) No
( ) Unknown. If your answer to (b) or (c) is “Yes,” explain in detail: ___________________________________________

18. OTHER MATTERS
(a) Is there any existing or threatened legal action affecting the property? ( ) Yes ( ) No
(b) Do you know of any violations of local, state, or federal laws or regulations relating to this property? ( ) Yes ( ) No
(c) Is there anything else that you feel you should disclose to a prospective buyer because it may materially and adversely affect the value or desirability of the property, e.g., zoning violation, non-conforming units, setback violations, zoning changes, road
changes, etc.? ( ) Yes ( ) No
If any of your answers in this section are “Yes,” explain in detail:______________________________________________
______________________________________________________________________________________________

The undersigned Seller represents that the information set forth in the foregoing disclosure statement is accurate and complete. Seller does not intend this disclosure statement to be a warranty or guarantee of any kind. Seller authorizes Listing Agent to provide this information to prospective buyers of the property and to real estate brokers and salespeople. Seller understands and agrees that Seller will notify Listing Agent in writing immediately if any information set forth in this disclosure statement becomes inaccurate or incorrect in any way through the passage of time.
Seller: ________________________________________________________ Date: ____________________________
Seller: ________________________________________________________ Date: ____________________________

RECEIPT AND ACKNOWLEDGEMENT OF BUYER

1. I HAVE BEEN ADVISED TO HAVE THE PROPERTY EXAMINED BY PROFESSIONAL INSPECTORS. I ACKNOWLEDGE THAT NEITHER ANY BROKER OR AGENT INVOLVED IN THIS TRANSACTION IS AN EXPERT AT DETECTING OR REPARIING PHYSICAL DEFECTS IN THE PROPERTY.

2. I UNDERSTAND THAT UNLESS STATED OTHERWISE IN MY CONTRACT WITH SELLER, THE PROPERTY IS BEING SOLD IN ITS PRESENT CONDITION ONLY WITHOUT WARRANTIES OR GUARANTEES OF ANY KIND BY SELLER OR ANY BROKER OR AGENT. I STATE NO REPRESENTATIONS CONCERNING THE CONDITION OF THE PROPERTY ARE BEING RELIED UPON BY ME EXCEPT AS DISCLOSED ABOVE OR STATED WITHIN THE SALES CONTRACT.
Buyer: _______________________________________________________ Date: ____________________________
Buyer: _______________________________________________________ Date: ____________________________
THIS IS A LEGALLY BINDING DOCUMENT. IF NOT UNDERSTOOD, CONSULT AN ATTORNEY.