SELLER'S PROPERTY DISCLOSURE STATEMENT, OR STATEMENT OF EXCLUSION
(NOT A WARRANTY)
(Oregon Revised Statutes: 105.464)
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.
_____This is the first sale of a dwelling never occupied. The dwelling is constructed or installed under building or
installation permit(s) #____________, issued by________________________.
_____This sale is by a financial institution that acquired the property as custodian, agent or trustee, or by foreclosure
or deed in lieu of foreclosure.
_____The seller is a court appointed receiver, personal representative, trustee, conservator or guardian.
_____This sale or transfer is by a governmental agency.
_______________________________________ ___________________
Signature(s) of Seller claiming exclusion Date
_______________________________________ ___________________
Buyer(s) to acknowledge Seller’s claim Date
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 1 of 9
(IF YOU DID NOT CLAIM AN EXCLUSION IN SECTION 1, YOU MUST FILL OUT THIS SECTION.)
Section 2. SELLER’S PROPERTY DISCLOSURE STATEMENT
(NOT A WARRANTY)
(ORS 105.464)
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?
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 2 of 9
*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 [ ]NA
*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 [ ]NA
*e. Are there any water source plumbing problems
or needed repairs? [ ]Yes [ ]No [ ]Unknown
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 3 of 9
(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 [ ]NA
*(3)Is there a water rights certificate or other
written evidence available? [ ]Yes [ ]No [ ]Unknown [ ]NA
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 [ ]NA
(3) Is the outdoor sprinkler system operable? [ ]Yes [ ]No [ ]Unknown [ ]NA
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 [ ]NA
(2) *If yes, was the system installed by permit? [ ]Yes [ ]No [ ]Unknown [ ]NA
(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? ____________ [ ]NA
(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
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 4 of 9
(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 [ ]NA
B. Are there any additions, conversions or
remodeling? [ ]Yes [ ]No [ ]Unknown
If yes, was a building permit required? [ ]Yes [ ]No [ ]Unknown [ ]NA
If yes, was a building permit obtained? [ ]Yes [ ]No [ ]Unknown [ ]NA
If yes, was final inspection obtained? [ ]Yes [ ]No [ ]Unknown [ ]NA
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 [ ]NA
(2) Are the materials covered by a warranty? [ ]Yes [ ]No [ ]Unknown [ ]NA
(3) Have the materials been inspected? [ ]Yes [ ]No [ ]Unknown [ ]NA
(4) Have there ever been claims filed for these
materials by you or by previous owners? [ ]Yes [ ]No [ ]Unknown [ ]NA
If yes, when? ________________
(5) Was money received? [ ]Yes [ ]No [ ]Unknown [ ]NA
(6) Were any of the materials repaired or
replaced? [ ]Yes [ ]No [ ]Unknown [ ]NA
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 5 of 9
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 [ ]NA
E. Built-in range and oven [ ]Yes [ ]No [ ]Unknown [ ]NA
F. Built-in dishwasher [ ]Yes [ ]No [ ]Unknown [ ]NA
G. Sump pump [ ]Yes [ ]No [ ]Unknown [ ]NA
H. Heating and cooling systems [ ]Yes [ ]No [ ]Unknown [ ]NA
I. Security system [ ]Owned [ ]Leased [ ]Yes [ ]No [ ]Unknown [ ]NA
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
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 6 of 9
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 [ ]NA
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 [ ]NA
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
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 7 of 9
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.
Seller(s) signature:
SELLER __________________________________ DATE _______________
SELLER __________________________________ DATE _______________
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. A financial institution or real estate licensee is not bound by and has no
liability with respect to any representation, misrepresentation, omission, error or inaccuracy
contained in another party’s disclosure statement required by this section or any amendment to
the disclosure statement.
C. Buyer (which term includes all persons signing the “buyer’s acknowledgment” portion of this
disclosure statement below) 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.
BUYER ______________________ DATE _______________
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 8 of 9
BUYER ______________________ DATE _______________
Agent receiving disclosure statement on buyer’s behalf to sign and date:
______________________________
Real Estate Licensee
______________________________
Real Estate Firm
______________________________
Date received by agent
[2003 c.328 §3; 2007 c.30 §13; 2007 c.866 §8; 2009 c.387 §18; 2009 c.591 §14a; 2013 c.435 §1;
2017 c.147 §1]
Oregon Seller’s Property Disclosure Statement, or Statement of Exclusion, Page 9 of 9
The following disclosures are not part of the OREGON SELLER’S PROPERTY DISCLOSURE
STATEMENT, but are included to cover certain specific issues that may arise.
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
http://www.oregon.gov/deq/AQ/Pages/HeatSmart/labels.aspx
or google: “Oregon DEQ Air Quality Certified Woodstove or Fireplace Insert Labels”
This issue is covered in the main Seller’s Disclosure, see 5.(E). The Woodstove or Insert
must be removed at the time of the sale if it is not certified.
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: ____________________________________________________
__________________________________________________________________
SELLER’S DISCLOSURE OF
ARTIFICIAL EXTERIOR SIDING, STUCCO, and/or
EXTERIOR INSULATED FINISHING SYSTEMS (“EIFS”)
(page 2 of 2)
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 [date] ____________________________.
PRINT SELLER’S NAME: ________________________________________________
SIGNATURE OF SELLER: ________________________________________________
PRINT BUYER’S NAME: _________________________________________________
SIGNATURE OF BUYER: _________________________________________________
2. PRIVATE WELL TESTING / DISCLOSURE
Obtain the relevant form here:
Form Name: (can google) DOMESTIC WELL TESTING FOR REAL ESTATE
TRANSACTION
Link found on this page:
https://public.health.oregon.gov/HealthyEnvironments/DrinkingWater/SourceWater/DomesticW
ellSafety/Pages/Testing-Regulations.aspx
The last-found active link on the page above:
https://apps.state.or.us/Forms/Served/le8313.pdf