Oregon Disclosure Form

Seller's Property Disclosure Statement, or Statement of Exclusion (Not a Warranty)

Instructions to the Seller

Please complete the following form. Do not leave any spaces blank. Please refer to the line number(s) of the question(s) when you provide your explanation(s). If you are not claiming an exclusion or refusing to provide the form under ORS 105.475 (4), you should date and sign each page of this disclosure statement and each attachment.

Each seller of residential property described in ORS 105.465 must deliver this form to each buyer who makes a written offer to purchase. Under ORS 105.475 (4), refusal to provide this form gives the buyer the right to revoke their offer at any time prior to closing the transaction.

Use only the section(s) of the form that apply to the transaction for which the form is used. If you are claiming an exclusion under ORS 105.470, fill out only Section 1.

An exclusion may be claimed only if the seller qualifies for the exclusion under the law. If not excluded, the seller must disclose the condition of the property or the buyer may revoke their offer to purchase anytime prior to closing the transaction. Questions regarding the legal consequences of the seller’s choice should be directed to a qualified attorney.

(Do not fill out this section unless you are claiming an exclusion under ORS 105.470)

Section 1. Exclusion from ORS 105.462 to 105.490

You may claim an exclusion under ORS 105.470 only if you qualify under the statute. If you are not claiming an exclusion, you must fill out Section 2 of this form completely.

Initial only the exclusion you wish to claim.

Section 2. Seller’s Property Disclosure Statement

(Not a Warranty)

Notice to the buyer: The following representations are made by the seller(s) concerning the condition of the property located at (“the property”).

Disclosures contained in this form are provided by the seller on the basis of seller’s actual knowledge of the property at the time of disclosure. Buyer has five days from the seller’s delivery of this seller’s disclosure statement to revoke buyer’s offer by delivering buyer’s separate signed written statement of revocation to the seller disapproving the seller’s disclosure statement, unless buyer waives this right at or prior to entering into a sale agreement.

For a more comprehensive examination of the specific condition of this property, buyer is advised to obtain and pay for the services of a qualified specialist to inspect the property on buyer’s behalf including, for example, one or more of the following: architects, engineers, plumbers, electricians, roofers, environmental inspectors, building inspectors, certified home inspectors, or pest and dry rot inspectors.

Seller is / is not occupying the property.

I. Seller’s Representations

The following are representations made by the seller and are not the representations of any financial institution that may have made or may make a loan pertaining to the property, or that may have or take a security interest in the property, or any real estate licensee engaged by the seller or the buyer.

*If you mark yes on items with *, attach a copy or explain on an attached sheet.

1. Title

A. Do you have legal authority to sell the property? Yes No Unknown

*B. Is title to the property subject to any of the following? Yes No Unknown

(1) First right of refusal
(2) Option
(3) Lease or rental agreement
(4) Other listing
(5) Life estate?

*C. Is the property being transferred a lawfully established unit of land? Yes No Unknown

*D. Are there any encroachments, boundary agreements, boundary disputes or recent boundary changes? Yes No Unknown

*E. Are there any rights of way, easements, licenses, access limitations or claims that may affect your interest in the property? Yes No Unknown

*F. Are there any agreements for joint maintenance of an easement or right of way? Yes No Unknown

*G. Are there any governmental studies, designations, zoning overlays, surveys or notices that would affect the property? Yes No Unknown

*H. Are there any pending or existing governmental assessments against the property? Yes No Unknown

*I. Are there any zoning violations or nonconforming uses? Yes No Unknown

*J. Is there a boundary survey for the property? Yes No Unknown

*K. Are there any covenants, conditions, restrictions or private assessments that affect the property? Yes No Unknown

*L. Is the property subject to any special tax assessment or tax treatment that may result in levy of additional taxes if the property is sold? Yes No Unknown

2. Water

A. Household water

(1) The source of the water is (check all that apply): Public Community Private Other

(2) Water source information:

*a. Does the water source require a water permit? Yes No Unknown

If yes, do you have a permit? Yes No

b. Is the water source located on the property? Yes No Unknown

*If not, are there any written agreements for a shared water source? Yes No Unknown N/A

*c. Is there an easement (recorded or unrecorded) for your access to or maintenance of the water source? Yes No Unknown

d. If the source of water is from a well or spring, have you had any of the following in the past 12 months? Flow test Bacteria test Chemical contents test Yes No Unknown N/A

*e. Are there any water source plumbing problems or needed repairs? Yes No Unknown

(3) Are there any water treatment systems for the property? Yes No Unknown Leased Owned

B. Irrigation

(1) Are there any water rights or other irrigation rights for the property? Yes No Unknown

*(2) If any exist, has the irrigation water been used during the last five-year period? Yes No Unknown N/A

*(3) Is there a water rights certificate or other written evidence available? Yes No Unknown N/A

C. Outdoor sprinkler system

(1) Is there an outdoor sprinkler system for the property? Yes No Unknown

(2) Has a back flow valve been installed? Yes No Unknown N/A

(3) Is the outdoor sprinkler system operable? Yes No Unknown N/A

3. Sewage System

A. Is the property connected to a public or community sewage system? Yes No Unknown

B. Are there any new public or community sewage systems proposed for the property? Yes No Unknown

C. Is the property connected to an on-site septic system? Yes No Unknown

(1) If yes, when was the system installed? Unknown N/A

(2) *If yes, was the system installed by permit? Yes No Unknown N/A

(3) *Has the system been repaired or altered? Yes No Unknown

(4) *Has the condition of the system been evaluated and a report issued? Yes No Unknown

(5) Has the septic tank ever been pumped? Yes No Unknown If yes, when? N/A

(6) Does the system have a pump? Yes No Unknown

(7) Does the system have a treatment unit such as a sand filter or an aerobic unit? Yes No Unknown

(8) *Is a service contract for routine maintenance required for the system? Yes No Unknown

(9) Are all components of the system located on the property? Yes No Unknown

D. *Are there any sewage system problems or needed repairs? Yes No Unknown

E. Does your sewage system require on-site pumping to another level? Yes No Unknown

4. Dwelling Insulation

A. Is there insulation in the:

(1) Ceiling? Yes No Unknown

(2) Exterior walls? Yes No Unknown

(3) Floors? Yes No Unknown

B. Are there any defective insulated doors or windows? Yes No Unknown

5. Dwelling Structure

*A. Has the roof leaked? Yes No Unknown

If yes, has it been repaired? Yes No Unknown N/A

B. Are there any additions, conversions or remodeling? Yes No Unknown

If yes, was a building permit required? Yes No Unknown N/A

If yes, was a building permit obtained? Yes No Unknown N/A

If yes, was final inspection obtained? Yes No Unknown N/A

C. Are there smoke alarms or detectors? Yes No Unknown

D. Are there carbon monoxide alarms? Yes No Unknown

E. Is there a woodstove or fireplace insert included in the sale? Yes No Unknown

If yes, what is the make?

If yes, was it installed with a permit? Yes No Unknown

If yes, is a certification label issued by the United States Environmental Protection Agency (EPA) or the Department of Environmental Quality (DEQ) affixed to it? Yes No Unknown

*F. Has pest and dry rot, structural or “whole house” inspection been done within the last three years? Yes No Unknown

*G. Are there any moisture problems, areas of water penetration, mildew odors or other moisture conditions (especially in the basement)? Yes No Unknown

If yes, explain on attached sheet the frequency and extent of problem and any insurance claims, repairs or remediation done.

H. Is there a sump pump on the property? Yes No Unknown

I. Are there any materials used in the construction of the structure that are or have been the subject of a recall, class action suit, settlement or litigation? Yes No Unknown

If yes, what are the materials?

(1) Are there problems with the materials? Yes No Unknown N/A

(2) Are the materials covered by a warranty? Yes No Unknown N/A

(3) Have the materials been inspected? Yes No Unknown N/A

(4) Have there ever been claims filed for these materials by you or by previous owners? Yes No Unknown N/A

If yes, when?

(5) Was money received? Yes No Unknown N/A

(6) Were any of the materials repaired or replaced? Yes No Unknown N/A

6. Dwelling Systems and Fixtures

If the following systems or fixtures are included in the purchase price, are they in good working order on the date this form is signed?

A. Electrical system, including wiring, switches, outlets and service Yes No Unknown

B. Plumbing system, including pipes, faucets, fixtures and toilets Yes No Unknown

C. Water heater tank Yes No Unknown

D. Garbage disposal Yes No Unknown N/A

E. Built-in range and oven Yes No Unknown N/A

F. Built-in dishwasher Yes No Unknown N/A

G. Sump pump Yes No Unknown N/A

H. Heating and cooling systems Yes No Unknown N/A

I. Security system Owned Leased Yes No Unknown N/A

J. Are there any materials or products used in the systems and fixtures that are or have been the subject of a recall, class action settlement or other litigations? Yes No Unknown

If yes, what product?

(1) Are there problems with the product? Yes No Unknown

(2) Is the product covered by a warranty? Yes No Unknown

(3) Has the product been inspected? Yes No Unknown

(4) Have claims been filed for this product by you or by previous owners? Yes No Unknown

If yes, when?

(5) Was money received? Yes No Unknown

(6) Were any of the materials or products repaired or replaced? Yes No Unknown

7. Common Interest

A. Is there a Home Owners’ Association or other governing entity? Yes No Unknown

Name of Association or Other Governing Entity

Contact Person

Address

Phone Number

B. Regular periodic assessments: $ per Month Year Other

*C. Are there any pending or proposed special assessments? Yes No Unknown

D. Are there shared “common areas” or joint maintenance agreements for facilities like walls, fences, pools, tennis courts, walkways or other areas co-owned in undivided interest with others? Yes No Unknown

E. Is the Home Owners’ Association or other governing entity a party to pending litigation or subject to an unsatisfied judgment? Yes No Unknown N/A

F. Is the property in violation of recorded covenants, conditions and restrictions or in violation of other bylaws or governing rules, whether recorded or not? Yes No Unknown N/A

8. Seismic

Was the house constructed before 1974? Yes No Unknown

If yes, has the house been bolted to its foundation? Yes No Unknown

9. General

A. Are there problems with settling, soil, standing water or drainage on the property or in the immediate area? Yes No Unknown

B. Does the property contain fill? Yes No Unknown

C. Is there any material damage to the property or any of the structure(s) from fire, wind, floods, beach movements, earthquake, expansive soils or landslides? Yes No Unknown

D. Is the property in a designated floodplain? Yes No Unknown

E. Is the property in a designated slide or other geologic hazard zone? Yes No Unknown

*F. Has any portion of the property been tested or treated for asbestos, formaldehyde, radon gas, lead-based paint, mold, fuel or chemical storage tanks or contaminated soil or water? Yes No Unknown

G. Are there any tanks or underground storage tanks (e.g., septic, chemical, fuel, etc.) on the property? Yes No Unknown

H. Has the property ever been used as an illegal drug manufacturing or distribution site? Yes No Unknown

If yes, was a Certificate of Fitness issued? Yes No Unknown

*I. Has the property been classified as forestland-urban interface? Yes No Unknown

10. Full Disclosure by Sellers

*A. Are there any other material defects affecting this property or its value that a prospective buyer should know about? Yes No

If yes, describe the defect on attached sheet and explain the frequency and extent of the problem and any insurance claims, repairs or remediation.

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 of this disclosure statement. I/we authorize my/our agents to deliver a copy of this disclosure statement to all prospective buyers of the property or their agents.

II. Buyer’s Acknowledgment

A. As buyer(s), I/we acknowledge the duty to pay diligent attention to any material defects that are known to me/us or can be known by me/us by utilizing diligent attention and observation.

B. Each buyer acknowledges and understands that the disclosures set forth in this statement and in any amendments to this statement are made only by the seller and are not the representations of any financial institution that may have made or may make a loan pertaining to the property, or that may have or take a security interest in the property, or of any real estate licensee engaged by the seller or buyer.

C. Buyer hereby acknowledges receipt of a copy of this disclosure statement (including attachments, if any) bearing seller’s signature(s).

Disclosures, if any, contained in this form are provided by the seller on the basis of seller’s actual knowledge of the property at the time of disclosure. If the seller has filled out Section 2 of this form, you, the buyer, have five days from the seller’s delivery of this disclosure statement to revoke your offer by delivering your separate signed written statement of revocation to the seller disapproving the seller’s disclosure unless you waive this right at or prior to entering into a sale agreement.

Buyer hereby acknowledges receipt of a copy of this seller’s property disclosure statement.

Agent receiving disclosure statement on buyer’s behalf to sign and date:

Real Estate Licensee

Real Estate Firm

Date received by agent

Additional Disclosures

1. Seller’s Disclosure of Artificial Exterior Siding, Stucco, and/or Exterior Insulated Finishing Systems (“EIFS”)

2. Private Well Disclosure

3. Information on Wood Burning Stove / Fireplace Insert: Oregon DEQ Air Quality Certified Woodstove or Fireplace Insert Labels

4. Natural hazards such as tsunamis, earthquakes, landslides, etc. are covered in the main seller’s disclosure in 8.(E). Wildfire risk is covered in 8.(I) “forest-urban interface.”

Seller’s Disclosure of Artificial Exterior Siding, Stucco, and/or Exterior Insulated Finishing Systems (“EIFS”)

(Page 1 of 2)

Date of disclosure:

Seller:

Buyer:

Property address:

1. Is the dwelling’s exterior siding all-natural wood, brick or stone? Yes No

2. If not all-natural wood, brick or stone, is the dwelling’s exterior siding a commercially manufactured artificial composite product, stucco or EIFS? Yes No

3. If you answered YES to (2.), what is the brand-name of the siding, if known?

4. When was the siding installed?

5. Is the siding still covered by a warranty? Yes No

If YES, describe the warranty:

6. Is the siding involved in any class action lawsuit or settlement? Yes No Unknown

7. Do you know of any problems with the siding? Yes No

If YES, explain:

8. Has a claim ever been filed on behalf of the owner for any issues with the siding? Yes No Unknown

If YES, explain:

9. Has there ever been an inspection of the siding? Yes No Unknown

If YES, explain, and attach inspection report if available:

* * *

This disclosure was delivered by the above-identified Seller to the above-identified Buyer on .

Print Seller’s Name:

Signature of Seller:

Print Buyer’s Name:

Signature of Buyer:

Private Well Testing / Disclosure

Obtain the relevant form here:

Form Name: Domestic Well Testing for Real Estate Transaction

Link found on this page: https://public.health.oregon.gov/HealthyEnvironments/DrinkingWater/SourceWater/DomesticWellSafety/Pages/Testing-Regulations.aspx

The last-found active link on the page above: https://apps.state.or.us/Forms/Served/le8313.pdf