Vacant Land Disclosure Statement

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: Page of

This seller’s disclosure statement concerns the real property located in the City of County of State of described as

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 complying with 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 of any 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?

2. Has the land been surveyed? Yes No

If yes, year surveyed

3. What company or person performed the survey?

Name:

Street Address:

City State

Zip Code Phone:

4. Is there a survey available? Yes No Unknown

5. If this is platted land? Yes No Has a certificate of survey been completed? Yes No

If yes, by whom?

If yes, when was the survey completed?

6. Are there any encroachments or boundary line disputes? Yes No Unknown

7. Are there any easements other than utility or drainage easements? Yes No Unknown

8. Is the property in a designated 100 year flood plain or wetland area? Yes No Unknown

9. Has there ever been a flood or other disaster at the property? Yes No Unknown

10. Have there ever been any drainage problems affecting this property or adjacent properties? Yes No Unknown

11. Is the property in an earthquake zone? Yes No Unknown

12. Give details if any of Questions 5 through 10 were answered YES.

13. Are there any navigation easements? Yes No Unknown

B. Use Restrictions

1. Do any of the following types of covenants, conditions, or restrictions affect the land?

A. Subdivision or other recorded covenants, conditions, or restrictions? Yes No Unknown

B. A right of first refusal to purchase? Yes No Unknown

C. Local municipality? Yes No Unknown

2. If any of the above Questions B-1 is answered YES do you have written copies of these covenants, conditions, or restrictions?

Yes No Unknown

List which documents you have:

3. Have you ever received notice from any person or authority as to any breach of any of these covenants, conditions or restrictions?

Yes No Unknown

If “YES”, describe:

C. Condition of the Property

1. Are there any structure improvements, or personal property located in the sale? Yes No

If “YES” list all items:

2. Are there any defects or problems with any of these items? Yes No Unknown

If “YES” describe all problems and defects:

3. Are there any abandoned wells, buried storage tanks, or buried debris or waste on the property? Yes No Unknown

If YES give details:

4. Is there any hazardous or toxic substance (including radon) in or on this property or any adjacent property? Yes No Unknown

If YES give details:

5. Have any soil tests been performed? Yes No Unknown

When? By Whom?

Results:

6. Does the property have any fill or un-compacted soils? Yes No Unknown

If YES describe location and depth

7. Are there any settling or soil movement problems on this property or any adjacent property? Yes No Unknown

If YES give details:

8. Are there any dead or diseased trees on the property? Yes No Unknown

If YES give details:

D. Utilities

1. Have any percolation tests been performed?

If YES, When? By Whom?

Results:

2. Are any of the following presently existing within the property?

A. Connection to public water? Yes No Unknown

B. Connection to public sewer? Yes No Unknown

C. Connection to private water system off property? Yes No Unknown

D. A water well? Yes No Unknown

E. Septic tank? Yes No Unknown

F. Connection to electricity? Yes No Unknown

G. Connection to natural gas services? Yes No Unknown

3. Are any of the following presently existing at the boundary of the property?

A. Public water system access? Yes No Unknown

B. Private water system access? Yes No Unknown

C. Electric service access? Yes No Unknown

D. Natural gas access? Yes No Unknown

E. Telephone system access? Yes No Unknown

4. Have any utility access charges been paid? Yes No Unknown

If “YES” which charges have been paid?

E. Other Matters

1. Is there a Homeowners Association? Yes No Unknown

2. If yes, what are the dues or assessments? $ paid

3. Is there road maintenance? Public Private Unknown

4. Are there any recorded maintenance agreements? Yes No Unknown

5. Is there a bus or other public transportation system? Yes No Unknown

Where is the pick up?

Is there anything else that may materially and adversely affect the value or desirability of the property, e.g., pending claims or litigation, notice from any governmental authority for violation of any law or regulation, proposed zoning changes, street changes, threat of condemnation, or neighborhood noise or nuisance? Yes No Unknown

If YES give details:

F. SELLER’S STATEMENT (To be signed at time of listing)

The undersigned Seller represents that the information set forth in the foregoing disclosure statement is accurate and complete. Sellers do not intend this disclosure statement to be a warranty or guaranty of any kind. Seller hereby authorizes that this information be provided to prospective buyers of this property and to the real estate brokers and sales people. Seller understands and agrees that Seller will notify in writing immediately if any information set forth in this disclosure statement becomes inaccurate or incorrect in any way through the passage of time or the discovery of additional information.

Witness our signatures this the day of , 20 .

G. BUYER’S RECEIPT AND ACKNOWLEDGMENT (To be signed at time of purchase agreement)

I carefully inspected the property. I have been advised to have the property examined by professional inspectors and to investigate every aspect of the property which could be important to me. I acknowledge that neither any Broker or Agent involved in this transaction is an expert at detecting the condition of the property or its suitability for my intended use.

I understand that unless stated otherwise in my contract with Seller, the property is being sold in its present condition only, without warranties or guarantees of any kind by Seller or any Broker or Agent. I state that no representations concerning the condition of the property are being relied upon by me except as disclosed or stated within the sales contract.

Property Address: