Fillable Printable Property Condition Disclosure Statement Form
Fillable Printable Property Condition Disclosure Statement Form
Property Condition Disclosure Statement Form
Property Condition Disclosure Form
Seller(s) Name
Property Address
Purpose of Statement:
This is a 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
orbyanyagentrepresentingthesellerinthistransaction.Itisnotasubstituteforanyinspectionsortestsandthebuyerisencouragedtoobtainhisorherown
independent professional inspections and environmental tests and also is encouraged to check public records pertaining to the property.
“Residential real property” means real property improved by a one tofour family dwelling used or occupied, or intended to be used or occupied, wholly orpartly, as the
home or residence of one or more persons, but shall not refer to (a) unimproved real property upon which such dwellings 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.
YE
SNO
NOT
KNOWNN/A
General Information
1.
How long have you owned the property?
2.
How long have you occupied the property?
3.
W
hat
is
the
ag
e
of
the
str
uct
ur
e
or
str
uct
ur
es
?
(N
ote
to
bu
yer
– If
the
str
uct
ur
e
wa
s
bui
lt
bef
or
e
19
78
yo
u
ar
e
en
co
ur
ag
ed
to
inv
est
iga
te
for
the
pr
es
en
ce
of
lea
d
ba
se
d
pai
nt.
)
4.
Do
es
an
yo
ne
oth
er
tha
n
yo
urs
elf
ha
ve
a
lea
se,
ea
se
me
nt
or
an
y
oth
er
rig
ht
to
us
e
an
y
pa
rt
of
yo
ur
pr
op
ert
y
oth
er
tha
n
tho
se
sta
ted
in
do
cu
me
nts
av
ail
abl
e
in
the
pu
bli
c
rec
or
d,
su
ch
as
rig
hts
to
us
e a
ro
ad
or
pat
h
or
cut
tre
es
or
cro
ps
?
5.Does anybody else claim to own any part of your property? ( If Yes, explain in space provided)
6.
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)
7.
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)
8.
Are there any electric or gas utility surcharges for line extensions, special assessments or
homeowner or other association fees that apply to the property?
9.Are there certificates of occupancy related to the property? (If no, explain below)
Environmental
10.Is any or all of the property located in a designated flood plain? (If yes, explain below)
11.Is any or all of the property located in a designated wetland? (If yes, explain below)
12.Is the property located in an agricultural district? (If yes, explain below)
13.Was the property ever the site of a landfill? (If yes, explain below)
14.Are there or have there ever been fuel storage tanks above or below ground on the property?
If yes, are they currently in use?
Are they leaking or have they ever leaked? (If yes, explain below)
15.Is there asbestos in the structure? (If Yes, state location or locations below)
16.Is lead plumbing present? (If Yes, state location or locations below)
17.Has a radon test been done? (If Yes, attach a copy of the report)
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)
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) )
Structural
20.Is there any rot or water damage to the structure or structures? (If yes, explain below)
21.Is there any fire or smoke damage to the structure or structures? (If yes, explain below)
22.Is there any termite, insect, rodent or pest infestation or damage? (If yes, explain below)
23.
Has the property been tested for termite, insect rodent or pest infestation or damage?
(If yes, please attach report(s))
24.What is the type of roof/roof covering (slate, asphalt, other.)?
Any known material defects?
How old is the roof?
Is there a transferable warrantee on the roof in effect now? (If yes, explain below)
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)
Mechanical Systems & Services
26.
What is the water source? (circle all that apply)
WELL MUNICIPAL PRIVATE OTHER
If municipal, is it metered?
27.
Ha
s
the
wa
ter
qu
alit
y
an
d/o
r
flo
w
rat
e
be
en
tes
ted
?
(If
ye
s,
ex
pla
in
bel
ow
)
28.
What is the type of sewage system? (Circle all that apply)
PUBLIC SEWER PRIVATE SEWER SEPTIC CESSPOOL
If
se
pti
c
or
ce
ss
po
ol:
Age?
Date last pumped?
Frequency of pumping?
Any known material defects?
29.Who is your electric service provider?
What is the amperage?
Does it have circuit breaker or fuses?
Public or private poles?
An
y
kn
ow
n
ma
teri
al
def
ect
s?
(If
ye
s,
ex
pla
in
bel
ow
)
30.
Are there any flooding, drainage or grading problems that resulted in standing water on any portion
of the property? (If yes, explain below)
31.Does the basement have seepage that results in standing water? (If yes, explain below)
Are there any known material defects in any of the following? (if yes, explain below. Use additional sheets if necessary):
YESNONOT
KNOWN
N/AYESNONOT
KNOWN
N/A
32.Plumbing System?41.Floors?
33.Security System?42.Chimney/Fireplace or stove?
34.
Carbon monoxide
detector?43.Patio/Deck?
35.Smoke detector?44.Driveway?
36.Fire Sprinkler system?45.Air conditioning?
37.Sump pump?46.Heating system?
38.Foundation/Slab?47.Hot water heater?
39.
Interior walls/ceilings?
48.Th
e
pr
op
ert
y
is
loc
ate
d
in
the
foll
ow
ing
sc
ho
ol
dis
tric
ts
40.Exterior walls or siding?
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:
SELLERCERTIFIESTHATTHEINFORMATIONINTHISPROPERTYCONDITIONDISCLOSURESTATEMENTISTRUEANDCOMPLETETOTHESELLER’S
ACTUALKNOWLEDGEASOFTHEDATESIGNEDBYTHESELLER.IFASELLEROFRESIDENTIALREALPROPERTYACQUIRESKNOWLEDGEWHICH
RENDERSMATERIALLY INACCURATEAPROPERTYCONDITIONDISCLOSURESTATEMENTTOTHEBUYERASSOONASPRACTICABLE,INNOEVENT,
HOWEVER, SHALL A SELLER BE REQUIREDTO PROVIDE A REVISED PROPERTY CONDITIONDISCLOSURE STATEMENT AFTER THE TRANSFEROF TITLE
FROM 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 statementand 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 or 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
Buyer date
