Fillable Printable Property Condition Disclosure Form

Property Condition Disclosure Form

Seller(s) Name ______________________________________ _____________________________________________

Property Address ____________________________________ _____________________________________________

Purpose of Statement:

This statement of certain conditions and information concerning the property known to the seller. This disclosure statement is not a warranty of any kind by

the seller or by any agent representing the seller in this transaction. It is not a substitute fo r any inspections or tests and the buyer is encouraged to obtain his

or her own independent professional inspections and environmental tests and also in encouraged to check public records pertaining to the property.

“Residential real property” means real property improved by a one to four family dwelling used or occupied, or intended to be used or occupied, wholly or

partly, as the home or residence of one or more persons, but shall not refer to (a) unimproved real property upon which such swellings are to be constructed

or (b) condominium units or cooperative apartments or (c) property on a homeowners’ association that is not owned in fee simple by the seller.

Seller’s Statement:

The seller makes the following representations to the buyer based upon the seller’s actual knowledge at the time of signing this document. The seller

authorizes his or her agent, if any, to provide a copy of this statement to a prospective buyer of the residential real property. The following are representations

made by the seller and are not the representations of the seller’s agent.

YES NO

NOT

KNOWN

N/A

General Information

1. How long have you owned the property?

2. How long have you occupied the property?

What is the age of the structure or structures?

(Note to buyer – If the structure was built before 1978

you are encouraged to investigate for the presence of lead based paint.)

Does anybody other than yourself have a lease, easement or any other right to use any part of

your property other than those stated in documents available in the public record, such as

rights to use a road or path or cut trees or crops?

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Does anybody else claim to own any part of your property? ( If Yes, explain in space

provided)

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Has anyone denied you access to the property or made a formal legal claim challenging your

title to the property? (If Yes, explain in space provided)

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Are there any features of the property shared in common with adjoining land owners or a

homeowners association, such as walls, fences or driveways? (If yes describe)

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Are there any electric or gas utility surcharges for line extensions, special assessments or

homeowner or other association fees that apply to the property?

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9. Are there certificates of occupancy related to the property? (If no, explain below)

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Environmental

10. Is any or all of the property located in a designated flood plain? (If yes, explain below)

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11. Is any or all of the property located in a designated wetland? (If yes, explain below)

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12. Is the property located in an agricultural district? (If yes, explain below)

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13. Was the property ever the site of a landfill? (If yes, explain below)

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14. Are there or have there ever been fuel storage tanks above or below ground on the property?

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If yes, are they currently in use?

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Are they leaking or have they ever leaked? (If yes, explain below)

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15. Is there asbestos in the structure? (If Yes, state location or locations below)

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16. Is lead plumbing present? (If Yes, state location or locations below)

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17. Has a radon test been done? (If Yes, attach a copy of the report)

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18.

Has motor fuel, motor oil, home heating fuel, lubrication oil or any other petroleum product,

methane gas, any hazardous or toxic substance spilled, leaked or otherwise been released on

the property or from the property onto any other property? (If yes, describe below)

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19.

Has the property been tested for the presence of motor fuel, motor oil, home heating fuel,

lubrication oil, or any other petroleum product, methane gas, or any hazardous or toxic

substance? (If Yes, attach report(s) )

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Structural

20. Is there any rot or water damage to the structure or structures? (If yes, explain below)

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21. Is there any fire or smoke damage to the structure or structures? (If yes, explain below)

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22. Is there any termite, insect, rodent or pest infestation or damage? (If yes, explain below)

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23.

Has the property been tested for termite, insect rodent or pest infestation or damage?

(If yes, please attach report(s))

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24. What is the type of roof/roof covering (slate, asphalt, other.)?

Any known material defects?

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How old is the roof?

Is there a transferable warrantee on the roof in effect now? (If yes, explain below)

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25.

Are there any known material defects in any of the following structural systems:

footings, beams, girders, lintels, columns or partitions? (If yes, explain below)

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Mechanical Systems & Services

What is the water source (circle all that apply)

WELL MUNICIPAL PRIVATE OTHER

YES NO

NOT

KNOWN

N/A

If municipal, is it metered?

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27. Has the water quality and/or flow rate been tested? (If yes, explain below)

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28.

What is the type of sewage system (Circle all that apply)

PUBLIC SEWER PRIVATE SEWER SEPTIC CESSPOOL

If septic or cesspool

Age?

Date last pumped?

Frequency of pumping

Any known material defects

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29. Who is your electric service provider

What is the amperage

Does it have circuit breaker or fuses

Public or private poles

Any known material defects? (If yes, explain below)

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30.

Are there any flooding, drainage or grading problems that resulted in standing water on any

portion of the property? (If yes, explain below)

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31. Does the basement have seepage that results in standing water? (If yes, explain below)

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Are there any known material defects in any of the following (if yes, explain below. Use additional sheets if necessary):

YES NO NOT

KNOWN

N/A

YES NO NOT

KNOWN

N/A

32. Plumbing System?

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41. Floors?

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33. Security System?

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42. Chimney/Fireplace or stove?

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34.

Carbon monoxide

detector?

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43. Patio/Deck?

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35. Smoke detector?

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44. Driveway?

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36. Fire sprinkler system?

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45. Air conditioning?

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37. Sump pump?

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46. Heating system?

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38. Foundation/Slab?

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47. Hot water heater?

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39. Interior walls/ceilings?

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48.

The property is located in the following school district

40. Exterior walls or siding?

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Note: Buyer is encouraged to check public records concerning the property (e.g. tax records and wetland and flood plain maps)

The seller should use this area to further explain any item above. If necessary, attach additional pages and indicate here the number of additional pages attached.

Seller’s Certification:

SELLER CERTIFIES THAT THE INFORMATION IN THIS PROPERTY CONDITION DISCLOSURE STATEMENT IS TRUE AND COMPLETE TO THE

SELLER’S ACTUAL KNOWLEDGE AS OF THE DATE SIGNED BY THE SELLER. IF A SELLER OF RESIDENTIAL REAL PROPERTY ACQUIRES

KNOWLEDGE WHICH RENDERS MATERIALLY INACCURATE A PROPERTY CONDITION DISCLOSURE STATEMENT TO THE BUYER AS SOON AS

PRACTICABLE, IN NO EVENT, HOWEVER, SHALL A SELLER BE REQUIRED TO PROVIDE A REVISED PROPERTY CONDITION DISCLOSURE

STATEMENT AFTER THE TRANSFER OF TITLE FORM THE SELLER TO THE BUYER OR OCCUPANCY BY THE BUYER, WHICHEVER IS EARLIER.

Seller ___________________________________________________________________________date ____________________________________

Seller ____________________________________________________________________________date ____________________________________

Buyer’s Acknowledgment:

Buyer acknowledges receipt of a copy of this statement and buyer understands that this information is a statement of certain conditions and information

concerning the property known to the seller. It is not a warranty of any kind by the seller of seller’s agent and is not a substitute for any home, pest, radon or

other inspections or testing of the property or inspection of the public records.

Buyer____________________________________________________________________________ date ___________________________________