Property Deposition Certificate

PROPERTY DEPOSITION CERTIFICATE

Declarant Name:    Capacity/Title:

Recipient Name:    Recipient Role:

Property Identification

Deposition Details

Date of Deposition:

Purpose of Deposition:

Occupied: Yes No    If occupied, occupant name:

Title, Encumbrances and Liens

Are there recorded mortgages, liens, or other encumbrances affecting the property? Yes No

Property Condition and Disclosures

Lead-based paint present: Yes No

Mold, water intrusion, or structural damage: Yes No

Unpermitted work or active code violations: Yes No

Utilities, Access, and Surveys

Utilities connected: Electricity Yes No   Gas Yes No   Water Yes No

Attachments and Exhibits

Attachments included: Photographs Inspection Report Survey / Plat Permits / Approvals

Certification and Acknowledgment

Declarant hereby certifies under penalty of perjury that the foregoing statements are true and correct to the best of Declarant's knowledge, and that Declarant is authorized to provide this deposition concerning the property identified herein. Declarant acknowledges that this Certificate is provided for reliance by the Recipient and any successor purchasers, mortgagees, title insurers, or other parties with an interest in the property.

Declarant further certifies that all material facts known to Declarant that would affect the marketability, insurability, or transferability of title have been disclosed in this Certificate or in the attachments hereto. Declarant agrees to promptly notify the Recipient in writing if, prior to closing or transfer, any material fact arises or becomes known that would render any statement herein inaccurate.

Default, Remedies, and Governing Law

If any material representation in this Certificate is false or omitted in a manner that causes loss to the Recipient, Declarant shall be liable for damages, and Recipient may pursue all remedies available at law or in equity, including specific performance, rescission, or indemnification. This Certificate shall be governed by the laws of the state in which the property is located.

This Certificate, together with its attachments and any addenda, constitutes the entire statement of facts by Declarant regarding the items covered herein and supersedes any prior oral or written statements concerning those items.

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