Fill and Sign the Original to Listing Broker Copies to Seller Buyer Selling Broker Form

Vacant Land Disclosure Statement Original to Listing Broker; Copies to Seller, Buyer, Selling Broker IF YOU DO NOT UNDERSTAND THIS DOCUMENT, PLEASE CONSULT AN ATTORNEY Date: ______________________, 20 _____ Page _____ of _____ This seller’s disclosure statement concerns the real property located in the City of ______________________ (Name), County of ______________________ (Name), State of ______________________ (Name), described as ____________________________________ (Legal Description of Property) Notice to Seller: Each Seller is obligated to disclose to a buyer all known facts that materially and adversely affect the value of the property being sold and that are not readily observable. This disclosure statement is designed to assist Seller in complyingwith disclosure requirements and to assist Buyer in evaluating the property being considered. The listing real estate broker, the selling real estate broker and their respective agents will also rely upon this information when they evaluate market and present Seller’s property to prospective buyers. Notice to Buyer: This is a disclosure of Seller’s knowledge of the condition of the property as of the date signed by Seller and is not a substitute for any inspections, tests or other investigation or warranties that Buyer may wish to obtain. It is not a warranty ofany kind by Seller or a warranty or representation by listing broker, the selling broker, or their agents. A. Survey, Easement, and Flooding 1. When did you purchase this land? ______________________ (Date) 2. Has the land been surveyed? A. [ ] Yes If yes, year surveyed __________ B. [ ] No 3.
When was the survey made? a. B. C. D. [note: if the survey was made prior to May 2012, it will not be counted; if it was made from May 2012 to december 2014, it will not be counted; if it was made from December 2014 to current date, it will not be counted. If there is a dispute as to the date of survey, please consult an attorney for a written opinion. The number of years included in this statement are based on the date of first contract or sale at which the land is included in the contract. It will not include any years which have been purchased prior to the time these contracts or sales were made unless a notice of change in ownership is received at the time of the change in ownership.] 4. How long did the survey take? a. B. C. D. [note: the survey will not include years which have been purchased prior to the time these contracts or sales were made unless a notice of change in ownership is received at the time of the change in ownership.] 5. What is the current property value? a. B. C. D. [note: this number is based on the total fair market value calculated as of the date of first contract or sale at which the land is included in the contract.] 6. When the survey was done, the land was surveyed using computerized survey or mechanical survey? a. B. C. D. [note: this date will be rounded down to the nearest month and should usually correspond to the previous month in which the first contract or sale was made if no previous purchase date is known.] 7. When the survey was done, the land was photographed the best method available to the purchaser? [note: the best method and the best photographic method can differ from the method used in the actual survey by the real estate broker who conducts it. In order to give you as accurate a sense of the current location of the property as possible, we will use the method that is most representative and that best captures the nature of the physical survey.] a. B. C. D. [note: