Licensee Notice Form

LICENSEE NOTICE FORM

Property Identification

Party Identification

Notice of Licensee Status and Agency

The licensee identified above provides this written notice to inform the Client of the licensee's current relationship to the transaction and any material interests or conflicts. This notice is not a contract for services and does not, by itself, create or terminate an agency relationship except where signed and accepted by the Client below.

The licensee is acting as (check all that apply):

Seller's Agent    Buyer's Agent    Dual Agent (consent required)    Transaction Broker / Facilitator    No Agency / Information Only

Material Interests and Conflicts

The licensee discloses the following interests or relationships that may present a conflict of interest (check any that apply and describe):

Licensee or brokerage has an ownership or financial interest in the property    Licensee is related to a party in the transaction    Alternative compensation or referral arrangement

Required Disclosures

The licensee provides the following disclosures with respect to known conditions affecting the property. For each item, check the appropriate box to indicate whether the licensee is aware of the condition.

Lead-based paint known:   Yes    No

Mold or water intrusion known:   Yes    No

Prior structural damage or repairs known:   Yes    No

Consent and Acknowledgment

By signing below, the Client acknowledges receipt of this Licensee Notice and the disclosures contained herein. The Client expressly acknowledges that:

1. The licensee owes duties as described in any separate agency agreement and that this notice supplements those duties by disclosing status and conflicts.

2. If dual agency is indicated above, the Client's informed consent is required for dual agency to occur; consent may be withdrawn in accordance with applicable agreement terms.

3. This notice does not obligate the Client to use the licensee's services nor alter compensation terms except as set forth in any executed brokerage agreement.

Client acknowledges receipt:   Yes    No

Delivery and Record

Method of delivery (check one):    In person    Email    Mailed    Other

Licensee Certification

I certify that the statements contained in this notice are, to the best of my knowledge, true and accurate as of the date below. I have disclosed known interests and conflicts and provided the Client with a copy of this notice.

Legal Remedies and Governing Law: The parties acknowledge that any dispute arising from this notice shall be governed by the law applicable to the underlying real estate transaction and that remedies available may include injunctive relief and recovery of costs where permitted. This notice, together with any executed agency agreement between the parties, constitutes the entire written statement of licensee disclosures related to agency status and material interests.

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