R.I. REAL ESTATE SALES DISCLOSURE FORMRHODE ISLAND ASSOCIATION OF REALTORS ®

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DATE / 9 / 0 PROPERTY ADDRESS

Seller, KW>J Current Address AS

Seller has occupied subject property? Yes No If yes, number of years and when: \

"Prior to the signing of an agreement to transfer real estate (vacant land or real property and improvements consisting of a houseor building containing one (1) to four (4) dwelling units), Seller is providing Buyer with this written disclosure of all deficientconditions of which Seller has knowledge. This is not a warranty by Seller that no other defective conditions exist, which theremay or may not be. Buyer should estimate the cost of repair or replacement of deficient conditions prior to submitting an offeron this real estate. Buyer is advised however not to rely solely upon the representation of Seller made in this disclosure, but toconduct any inspections or investigations which Buyer deems to be necessary to protect his or her best interest." Nothingcontained herein shall be construed to impose an affirmative duty on the Seller to conduct inspections as to the condition of thisreal estate. It is recommended that a separate sales disclosure form be completed for each unit of a multi-unit property.

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Please indicate by a check mark for "Yes" or "No," or mark "UK" (Unknown), if you do not have actual knowledge of the propertyconditions.

Addition(s):_ _ Year(s):1 Year Built2. Roof (Shingles)3. Fireplaces4. Wood/Coal/Gas

Stove(s)5. Insulation

6. Electrical Service.

7. Heating System

8. Domestic HotWater

9. Air Conditioning

_\t~-\3> # of Layers: 1 Previous Repairs:Age:

H 2- # Working: U^£> Maintenance History;_Yes X NO If yes. Type UjQtfek When installed? Z£O£>If yes, attach^o^yWallAype: "

Known Defects:

ermit received? Yes

Ceiling/Type:Ureaformaldehyde Insulation: YesFuses . Circuit BreakersType: Aluminum WiringType: <&\

NoFloor/Type: €

Unknown44 . Unknown

Knob & TubeAmps

BX CableUnknownRomex

Age: If oil fuel, size of tank:(Size?)

Other Unknown

No XUnderground tanks on property? YesSupplemental heatingTYes _^,__Heating Source: Tftfr]JV<.\e£6Rented? Yes No "X _ If yes, Company rented fromCentral AirLocation

NoIf yes, type?

Number of zones:V" Unknown

If a separate tank, capacity: gal. Age

Window Units Number of unitsMaintenance History

Additional Structural Information (Attach additional sheets if necessary.)

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1 0. Sewage System Type (prjvatej public or both):If public, Outstanding Assessment? Yes jflFIf private, Cesspool __ Septic teach fi#Bedrooms/per ISDS Design:_Location: __

If public system available, is it connected? Yes /*No X Minimum Annual Fee: $ _ Balance $

Unknown _ Otherfield GalleysCopy Available? Yes No

Date installed:Maintenance History (Any Failure):Last pumped:

Sanitation Company used:Other Connections (Drywell, etc.):

"Potential purchasers of real estate in the state of Rhode Island are hereby notified that many propertiesin the state are still serviced by cesspools as defined in R.I.G.L. Chapter 23-19.15 (The RJ CesspoolPhase-Out Act of 2007). Cesspools are a substandard and inadequate means of sewage treatment anddisposal, and cesspools often contribute to groundwater and surface water contamination. Requirementsfor abandonment and replacement of high-risk cesspools as established in R.I.G.L. Chapter 23-19.15 areprimarily based upon a cesspool's non-treatment of wastewater and the inherent risks to public healthand the environment due to a cesspool's distance from a tidal water area, or a public drinking waterresource. Purchasers should consult R.I.G.L. Chapter 23-19.15 for specific cesspool abandonment orreplacement requirements. An inspection of property served by an on-site sewage system by a qualifiedprofessional is recommended prior to purchase. Pursuant to R.I.G.L. Section 5-20.8-13, potentialpurchasers shall be permitted a ten (10) day period to conduct an inspection of a property's sewagesystem to determine if a cesspool exists, and if so, whether it will be subject to the phase-outrequirements as established in R.I.G.L. Chapter 23-19.15."

SELLER'S INITIALS UYER'S INITIALS Copyrights) 20M Rhode Island Association of REALTORS® FORM* 1418 (R-106) Rev 05/08

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1 1 . Water System Public XS. Filtration System? Yes NoPrivate " If private: "Buyer understands that this property is. or will be served by a private watersupply (well) which may be susceptible to contamination, availability, and potentially harmful to health. If a publicwater supply is not available, the private water supply must be tested in accordance with regulations established bythe RI Department of Health pursuant to R.l.G.L. Section 23-1-5.3. The Seller of that property is required to providethe Buyer with a copy of any private water supply (well) testing results in the Seller's possession and notify theBuyer of any known problems with the private water supply (well)."Dug well or drilled well? Depth: Location:

Well water inspection certificate available? Yes No If yes, attach copyWater Quality Problems? Yes (Explain) No

Filtration System? Yes No Treatment System? Yes No

Additional Utilities Information (Attach additional sheets if necessary.)

12. Property Tax

13. Easements/Encroachments

14. Deed

15. Zoning

16. Restrictions

17. Building Permits

18. Building Code/orMinimum Housing

19. Flood Plain

20. Wetlands

21. Megan's Law

Additional Municipal

$ for fiscal/calendar year ending Tax Rate: Current Exemptions: tytoNfe,

Seller is legally required to provide the Buyer with a copy of any previous surveys of the property that are in theSeller's possession and notify the Buyer of any known easements, encroachments, covenants or restrictions of theSeller's property. A Buyer may wish to have a boundary or other survey independently performed at Buyer'sexpense. \sDoes Seller have a copy of any surveys in his/her possession? Yes /^ No If yes, attach copyDoes Seller have any knowledge of Easement(s) or Right(s) of Way on property? Yes No /XIf yes. describe . s-Does Seller have any knowledee of Encroachments? Yes No /*»If ves. describe LType of deed to be conveyed: (.Aj^^iCrM. Number of parcels conveying: I

"Buyers of real estate in the State of Rhode IslandUare legally obligated to comply with all local real estateordinances; including, but not limited to ordinances on the number of unrelated persons who may legally reside in adwelling, as well as ordinances on the number of dwelling units permitted under the local zoning ordinances. If thesubject property is located in a historic district, that fact must be disclosed to the buyer, together with the notificationthat property located in a historic district may be subject to construction, expansion, or renovation limitations.Contact the local-building inspection official for details." vyClassification: %L\Q Is the current use a permitted use under the current zoning regulations? Yes Y_ NoUnknown If no. explain:Is the current use non-conforming in any other way? Yes No _ V _ UnknownIf yes. explain: '_

Plat or other? Yes (Explain) No > Copy available to Buyer:

Have you applied for or been granted a special permit for this property? Yes No /^.If ves. explain:Have building permits been obtained for all required construction and/or renovation while you have owned theproperty? Yes X No If no, explain:

/Violations: N^N*^

Is the property located in a flood plain? Yes No Unknown ^Is there flood insurance on the property? Yes No If yes. $ per year.

The location of coastal wetlands, bays, fresh water wetlands, ponds, marshes, river banks or swamps, as those termsare defined in RIGL 2-1 and the associated buffer areas may impact future property development. If known, Seller

must disclose to the Buyer any such determination on all or part of the land made by the Department of

Environmental Management.Has all or part of property been determined to be coastal wetland, bog, freshwater wetland, pond, marsh, river bank

or swamp? Yes (Explain)

No _X UnknownIf the Buyer is concerned about convicted felons in the neighborhood, he/she should contact the local policeauthority.

Information (At tach additional sheets if necessary.)

SELLER'S INITIA BUYER'S INITIALS Copyright® 2008 Rhode Island Association of REALTORS® FORM* 1418 (R-106) Rev 05/08

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22. Condo/Assoc.Fees

Monthly Condo/Association Fee: $Working Capital Deposit? Yes _Buyer to pay? Yes __

NoHeat/Electric/Water Included in Fee?

_ If yes, Amount: $No

Current Outstanding Assessments: $ _Fire Alarm System up to date? Yes _Anticipated Future Assessments: YesNo Unknown

No UnknownIf yes, describe

23. Multi-family orOther RentalProperty

Are income and expense figures available? YesLease(s) period:Number of Units:Are the existing rents current? Yes _

NoCopies available? Yes

If yes, attach copiesNo

No Security DepositsAre all units legal for the current zoning and use? Yes NoAppliances Offered:

Additional Condo/Multi Unit Information (Attach additional sheets if necessary.)

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24. Pools &Equipment

25. LeadContamination

Ageofpool:_ f)_ Maintenance histoWas a permit obtained for the pool? Yes No

-i. Unknown

26. Smoke/Carbon MonoxideDetectors

27. Radon

"Every Purchaser of any interest in residential property is notified that such property may presentexposure to lead from lead-based hazards that may place young children at risk of developing leadpoisoning. Lead poisoning in young children may produce permanent neurological damage, includinglearning disabilities, reduced Intelligence Quotient, behavioral problems, and impaired memory. Leadpoisoning also poses a particular risk to pregnant women. The Seller of any interest in residentialproperty is required to provide the Buyer with any information on lead or lead hazards in paint, interiordust, soil, or water from risk assessments or inspections in the Seller's possession and notify the Buyer ofany known or potential lead or lead-based hazards, and must receive a lead disclosure and educationalbrochure. A risk assessment or inspection for possible lead-based hazards is recommended prior topurchase." Have you ever had a lead paint inspection conducted? Yes No f\f yes, copy of report available? Yes No ^

Lead compliance certificate(s) available? Yes No __/NInstalled and functioning? Yes X No _____ R.I.G.L. 23-28.1 requires certain residentialdwellings to be equipped with ajiapproved smoke detector and carbon monoxide detector system.Three-unit dwellings must be equipped with interconnected smoke detectors effective July 1, 2008.Contact the local Fire Marshal to determine the requirements for this Property."Radon has been determined to exist in the State of Rhode Island. Testing for the presence of Radon inresidential real estate prior to purchase is advisable. "\/rJrti- Kii i l/lin <-* Kaavi tt»^*t«^ frtr- Do^r^nV Vf*C Nfl f *Has building been tested for Radon? Yes

Copy of test available? Yes NoNo If yes, # of Pico curies/liter:Any action taken?

Additional Notices/Disclosures Information (Attach additional sheets if necessary.)

SELLER'S INIT BUYER'S INITIALS Copyright© 2008 Rhode Island Association of REALTORS® FORM* 1418 (R-106) Rev 05/08

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Do any of the following conditions exist? Yes (Y), No (N), Unknown (UK) or Not Applicable (NA).

Y N UK NA

67 D D D $ Asbestos

68 D D DM3 Cemetery or Burial Ground on Property

69 Q D ^ D Diseased Tree(s) within 100' of Dwelling/Outbuilding

70 D D yCf D Endangered Species/Habitat on Property

71 D D $ D Hazardous or Toxic Waste

72 D Q $ D Hazardous or Toxic Waste Site Within 1 Mile

73 D D & D Improper Drainage

74 D f$ D D Landfill

75 D D ft D Mold

76 D D t^ D Previous Fire/Smoke Damage

77 D $ D D Settling

78 D D D D Soil Movement

79 D D ^ D Subsurface Structure(s) or Pit(s)

80 D D U Synthetic Stucco / EIFS

Y N UK NA

81 D^ D D Water Penetration

82 D D D P Wood Rot

Previous Flooding:

D D Into the Improvements

IH D Onto the Property

Structural Repairs:

D n Previous Foundation Repairs

fe D Other Structural Repairs

Termites or Other Wood-Destroying Insects:

87 nM D D Active Infestation

88 $ D D a Previous Treatment

89 D D $ D Previous Damage Repaired

90 D D ft. D Damage Needing Repair

91 D D ft D Current Service Contract

83 D

84 D

85 Q^H

86 D D

If the answer to any of the conditions is Yes (Y), please explain. (Attach additional sheets if necessary.)

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Additional Comments:

Any agreement to transfer real estate shall contain an acknowledgment that a completed real estate disclosure form has beenprovided to the Buyer by the Seller in accordance with the provisions of this section. This form has been designed to meet the RealEstate Disclosure requirements of Rhode Island General Law 5-20.8. Seller acknowledges that the above property information isaccurate, true and complete to the best of his knowledge, and that no information concerning the property has been knowinglywithheld. Seller further acknowledges that the legal and/or tax consequences of this real estate sale and all transactions relatedthereto may be best discussed with an attorney, accountant, or other appropriate party and that Seller has not relied on the ListingLicensee(s) for such advice. Seller is obligated to report to the Listing Licensee(s) any known changes prior to salesagreement and prior to closing.

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Seller hereby acknowledges thatfurther agrees to deferifurther acknowledaǤ1:eceipt

Date ' '/fd Seller

rmation set forth above is true and-accurate to the best of my (our) knowledge.Listing Licensee(s) for disclosure of any of the information contained ^herein.

Estate Sales Disclosure

Date

SellerSeller

//piirchBuyer/Prospective Buyer aeknowledge&--re'ceipt of Seller's R.I. Real tstate Salefe/Disclosure Form before^piirchase. Buyer

acknowledges that Broker rasTioTverified the information herein and Buyer has been advised to verify information independently.

Date Buyer Date Buyer

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Changes since property was first listed:

Date Seller's Initials Date Buyer's Initials

Copyright® 2008 Rhode Island Association of REALTORS® FORM// 1418 (R-HMS) Rev 05/08