Disclosure Statement Form

STATE OF WASHINGTON SELLER’S DISCLOSURE STATEMENT FOR IMPROVED RESIDENTIAL REAL ESTATE

Please complete the following form. Do not leave any spaces blank. If the question clearly does not apply to the property write "NA". If the answer is "yes" to any * items, please explain on attached sheets. For your protection you must date and sign each page of this disclosure statement and each attachment.

THE FOLLOWING DISCLOSURES ARE MADE BY SELLER ABOUT THE CONDITION OF THE PROPERTY LOCATED AT ("THE PROPERTY"), OR AS LEGALLY DESCRIBED ON ATTACHED EXHIBIT A.

Seller is/ is not occupying the property.

I. SELLER'S DISCLOSURES:

1. TITLE

A. Do you have legal authority to sell the property? Yes No Don't know

*B. Is title to the property subject to any of the following? (1) First right of refusal (2) Option (3) Lease or rental agreement (4) Life estate? Yes No Don't know

*C. Are there any encroachments, boundary agreements, or boundary disputes? Yes No Don't know

*D. Is there a private road or easement agreement for access to the property? Yes No Don't know

*E. Are there any Rights-of-way, easements, or access limitations that may affect the Buyer's use of the property? Yes No Don't know

*F. Are there any written agreements for joint maintenance of an easement right-of-way? Yes No Don't know

*G. Is there any study, survey project, or notice that would adversely affect the property? Yes No Don't know

*H. Are there any pending or existing assessments against the property? Yes No Don't know

*I. Are there any zoning violations, nonconforming uses, or any unusual restrictions on the property that would affect future construction or remodeling? Yes No Don't know

*J. Is there a boundary survey for the property? Yes No Don't know

*K. Are there any covenants, conditions, or restrictions which affect the property? Yes No Don't know

2. WATER

A. Household Water

(1) The source of water for the property is: Private or publicly owned water system Private well serving only the subject property

*If shared, are there any written agreements? Yes No Don't know

*(2) Is there an easement (recorded or unrecorded) for access to and/or maintenance of the water source? Yes No Don't know

*(3) Are there any known problems or repairs needed? Yes No Don't know

(4) During your ownership, has the source provided an adequate year-round supply of potable water? Yes No Don't know

*(5) Are there any water treatment systems for the property? Yes No Don't know Leased Owned

*(6) Are there any water rights for the property associated with its domestic water supply? Yes No Don't know

*(7) Are there any defects in the operation of the water system (e.g. pipes, tank, pump, etc.)?

B. Irrigation Water

(1) Are there any irrigation water rights for the property, such as a water right, permit, certificate, or claim? Yes No Don't know

*(a) If yes, has all or any portion of the water right not been used for five or more successive years? Yes No Don't know

*(b) If so, is the certificate available? Yes No Don't know

*(c) If so, has the water right permit, certificate, or claim been assigned, transferred, or changed? Yes No Don't know

(2) Does the property receive irrigation water from a ditch company, irrigation district, or other entity?

C. Outdoor Sprinkler System

(1) Is there an outdoor sprinkler system for the property? Yes No Don't know

*(2) If yes, are there any defects in the system? Yes No Don't know

*(3) If yes, is the sprinkler system connected to irrigation water? Yes No Don't know

3. SEWER/ON-SITE SEWAGE SYSTEM

A. The property is served by: Public sewer system On-site sewage system Other disposal system

B. If public sewer system service is available to the property, is the house connected to the sewer main? Yes No Don't know

*C. Is the property subject to any sewage system fees or charges in addition to those covered in your regularly billed sewer or on-site sewage system maintenance service? Yes No Don't know

D. If the property is connected to an on-site sewage system:

*(1) Was a permit issued for its construction, and was it approved by the local health department or district following its construction? Yes No Don't know

(2) When was it last pumped?

*(3) Are there any defects in the operation of the on-site sewage system? Yes No Don't know

(4) When was it last inspected? By whom:

(5) For how many bedrooms was the on-site sewage system approved?

E. Are all plumbing fixtures, including laundry drain, connected to the sewer/on-site sewage system? Yes No Don't know

*F. Have there been any changes or repairs to the on-site sewage system? Yes No Don't know

G. Is the on-site sewage system, including the drainfield, located entirely within the boundaries of the property? Yes No Don't know

H. Does the on-site sewage system require monitoring and maintenance services more frequently than once a year? Yes No Don't know

4. STRUCTURAL

*A. Has the roof leaked? Yes No Don't know

*B. Has the basement flooded or leaked? Yes No Don't know

*C. Have there been any conversions, additions, or remodeling? Yes No Don't know

*(1) If yes, were all building permits obtained? Yes No Don't know

*(2) If yes, were all final inspections obtained? Yes No Don't know

D. Do you know the age of the house? Yes No Don't know Year of original construction:

*E. Has there been any settling, slippage, or sliding of the property or its improvements? Yes No Don't know

*F. Are there any defects with the following? Check applicable items: Foundations Decks Exterior Walls Chimneys Interior Walls Fire Alarm Doors Windows Patio Ceilings Slab Floors Driveways Pools Hot Tub Sauna Sidewalks Outbuildings Fireplaces Garage Floors Walkways Siding Other Wood Stoves Stairway Chair Lifts Elevators Incline Elevators Wheelchair Lifts

*G. Was a structural pest or "whole house" inspection done? Yes No Don't know When and by whom:

H. During your ownership, has the property had any wood destroying organism or pest infestation? Yes No Don't know

I. Is the attic insulated? Yes No Don't know

J. Is the basement insulated? Yes No Don't know

5. SYSTEMS AND FIXTURES

*A. If any of the following systems or fixtures are included with the transfer, are there any defects?

Electrical system, including wiring, switches, outlets, and service Plumbing system, including pipes, faucets, fixtures, and toilets Hot water tank Garbage disposal Appliances Sump pump Heating and cooling systems Security system Owned Leased

*B. If any of the following fixtures or property is included with the transfer, are they leased? Yes No Don't know

*C. Are any of the following kinds of wood burning appliances present at the property? Wood stove? Fireplace insert? Pellet stove? Fireplace? If yes, are all of the wood stoves or fireplace inserts certified by the U.S. Environmental Protection Agency as clean burning appliances? Yes No Don't know

D. Is the property located within a city, county, or district or within a department of natural resources fire protection zone that provides fire protection services? Yes No Don't know

E. Is the property equipped with carbon monoxide alarms? Yes No Don't know

F. Is the property equipped with smoke alarms? Yes No Don't know

6. HOMEOWNERS' ASSOCIATION / COMMON INTERESTS

A. Is there a Home Owners' Association? Yes No Don't know

B. Are there regular periodic assessments? $ per Month Year Other

*C. Are there any pending special assessments? Yes No Don't know

*D. Are there any shared "common areas" or any joint maintenance agreements? Yes No Don't know

7. ENVIRONMENTAL

*A. Have there been any flooding, standing water, or drainage problems on the property that affect the property or access to the property? Yes No Don't know

*B. Does any part of the property contain fill dirt, waste, or other fill material? Yes No Don't know

*C. Is there any material damage to the property from fire, wind, floods, beach movements, earthquake, expansive soils, or landslides? Yes No Don't know

D. Are there any shorelines, wetlands, floodplains, or critical areas on the property? Yes No Don't know

*E. Are there any substances, materials, or products on the property that may be environmental concerns? Yes No Don't know

*F. Has the property been used for commercial or industrial purposes? Yes No Don't know

*G. Is there any soil or groundwater contamination? Yes No Don't know

*H. Are there transmission poles or other electrical utility equipment installed, maintained, or buried on the property that do not provide utility service to the structures on the property? Yes No Don't know

*I. Has the property been used as a legal or illegal dumping site? Yes No Don't know

*J. Has the property been used as an illegal drug manufacturing site? Yes No Don't know

*K. Are there any radio towers in the area that may cause interference with cellular telephone reception? Yes No Don't know

8. MANUFACTURED AND MOBILE HOMES

If the property includes a manufactured or mobile home:

*A. Did you make any alterations to the home? Yes No Don't know

*B. Did any previous owner make any alterations to the home? Yes No Don't know

*C. If alterations were made, were permits or variances for these alterations obtained? Yes No Don't know

9. FULL DISCLOSURE BY SELLERS

A. Other conditions or defects: Are there any other existing material defects affecting the property that a prospective buyer should know about? Yes No Don't know

B. Verification:

The foregoing answers and attached explanations (if any) are complete and correct to the best of my/our knowledge and I/we have received a copy hereof. I/we authorize all of my/our real estate licensees, if any, to deliver a copy of this disclosure statement to other real estate licensees and all prospective buyers of the property.

II. BUYER'S ACKNOWLEDGMENT

Buyer hereby acknowledges the disclosures and understands the right to rescind as stated in the form.