SELLER'S DISCLOSURE OF PROPERTY CONDITION CONCERNING THE PROPERTY AT: 

 ____________________________________________________________ (Street Address and City) 

THIS NOTICE IS A DISCLOSURE OF SELLER'S KNOWLEDGE OF THE CONDITION OFTHE PROPERTY AS OF THE DATE SIGNED BY SELLER AND IS NOT A SUBSTITUTEFOR ANY INSPECTIONS OR WARRANTIES THE PURCHASER MAY WISH TO OBTAIN. ITIS NOT A WARRANTY OF ANY KIND BY SELLER OR SELLER'S AGENTS.

 

Seller [choose one: ]  _____ is  _____ is not occupying the Property. If unoccupied, how longsince Seller has occupied the Property? _____________________________________________________________ 

 

1. The Property has the items checked below [Write Yes (Y), No (N), or Unknown (U)]: 

 ____ Range  ____ Oven  ____ Microwave

 ____ Dishwasher  ____ Trash Compactor  ____ Disposal

 ____ Washer/Dryer Hookups  ____ Window Screens  ____ RainGutters

 ____ Security System  ____ Fire Detection Equipment  ____ IntercomSystem

 ____ TV Antenna  ____ Cable TV Wiring  ____ SatelliteDish

 ____ Ceiling Fan(s)  ____ Attic Fan(s)  ____ ExhaustFan(s)

 ____ Central A/C  ____ Central Heating  ____ Wall/Window Air Conditioning

 ____ Plumbing System  ____ Septic System  ____ PublicSewer System

 ____ Patio/Decking  ____ Outdoor Grill  ____ Fences

 ____ Pool  ____ Sauna  ____ Spa  ____ Hot Tub

 ____ Pool Equipment  ____ Pool Heater  ____ AutomaticLawn Sprinkler

 ____ Fireplace(s)/Chimney (Wood)  ____ Fireplace(s)/Chimney (Mock)  ____ GasLines (Nat./LP)

 ____ Gas Fixtures Garage: ___ Attached ___ Not Attached  ____ Carport

Garage Door Opener(s):  ____ Electronic  ____ Control(s)

Water Heater:  ____ Gas  ____ Electric

Water Supply:  ____ City  ____ Well  ____ MUD  ____ Co-opRoof Type: ______________________________ Age: ______________________________ (approx)  

Are you (Seller) aware of any of the above items that are not in working condition, that have

known defects, or that are in need of repair? [choose one: ]   ____ Yes  ____ No

 ____ Unknown. If yes, then describe. (Attach additional sheets if necessary): __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  

2. Are you (Seller) aware of any known defects/malfunctions in any of the following? [Write Yes (Y) if you are aware, write No (N) if you are not aware.]

 

 ____ Interior Walls  ____ Ceilings  ____ Floors

 ____ Exterior Walls  ____ Doors  ____ Windows

 ____ Roof  ____ Foundation/Slab(s)  ____ Basement

 ____ Walls/Fences  ____ Driveways  ____ Sidewalks

 ____ Plumbing/Sewers/Septics  ____ Electrical Systems  ____ LightingFixtures

 ____ Other Structural Components (Describe): __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  __________________________________________________________________________  ____________ 

If the answer to any of the above is yes, explain. (Attach additional sheets if necessary): __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  __________________________________________________________________________  ____________ 

3. Are you (Seller) aware of any of the following conditions? Write Yes (Y) if you are aware,write No (N) if you are not aware.

 

 ____ Active Termites (includes  ____ Termite or Wood Rot Damage  ____ Previous Termite Damage

wood destroying insects) Needing Repair

 ____ Previous Termite Treatment  ____ Previous Flooding  ____ Improper Drainage

 ____ Water Penetration  ____ Located in 100-Year Floodplain  ____ PresentFlood Insurance

 ____ Prior Structural/Roof Repair  ____ Hazardous or Toxic Waste  ____ Asbestos Components

 ____ Urea-formaldehyde Insulation  ____ Radon Gas  ____ LeadBased Paint

 ____ Aluminum Wiring  ____ Previous Fires  ____ UnplattedEasements

 ____ Landfill, Settling, Soil  ____ Subsurface Structure or PitsMovement, Fault Lines

If the answer to any of the above is yes, explain. (Attach additional sheets if necessary): __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  __________________________________________________________________________  ____________ 

4. Are you (Seller) aware of any item, equipment, or system in or on the Property that is in

need of repair?  ____ Yes (if you are aware)  ____ No (if you are not aware). If yes, explain(attach additional sheets as necessary). __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  

 

5. Are you (Seller) aware of any of the following? Write Yes (Y) if you are aware, write No (N)if you are not aware.

 ____ Room additions, structural modifications, or other alterations or repairs made withoutnecessary permits or not in compliance with building codes in effect at that time.

 ____ Homeowners' Association or maintenance fees or assessments.

 ____ Any "common area" (facilities such as pools, tennis courts, walkways, or other areas)co-owned in undivided interest with others.

 ____ Any notices of violations of deed restrictions or governmental ordinances affecting thecondition or use of the Property.

 ____ Any lawsuits directly or indirectly affecting the Property.  ____ Any condition on the Property which materially affects the physical health or safety ofan individual.

If the answer to any of the above is yes, explain. (Attach additional sheets if necessary): __________________________________________________________________________  ____________  __________________________________________________________________________  ____________  __________________________________________________________________________  ____________ 

 _________________________________________  _________________________________________ Date Signature of Seller Date Signatureof Seller

The undersigned purchaser hereby acknowledges receipt of the foregoing notice. 

 _________________________________________  _________________________________________ Date Signature of Purchaser Date Signature ofPurchaser