Real Estate Disclosure Document

REAL ESTATE DISCLOSURE DOCUMENT

Property Identification

Property Address:

Parties

Date of Disclosure:

Seller Disclosures (Answer Yes or No; if Yes, provide description)

1. Lead-based paint or lead hazards present (property built before 1978): Yes No

2. Mold, mildew, or other fungal growth present or remediated: Yes No

3. Structural defects (foundation, walls, load-bearing elements) known: Yes No

4. Roof leaks or need for roof repair/replacement: Yes No

5. Water intrusion, flooding, or chronic dampness: Yes No

6. Sewage, septic, or plumbing failures known: Yes No

7. Termite or other wood-destroying organism activity or treatment: Yes No

8. Hazardous materials present (asbestos, PCBs, underground tanks, contaminated soil): Yes No

9. Unpermitted or nonconforming additions/alterations to the property: Yes No

10. Pending or past notices of code violation, zoning noncompliance, or municipal orders: Yes No

11. Insurance claims made in the past five (5) years affecting the property: Yes No

12. Property located in a designated flood zone or subject to flood insurance requirements: Yes No

Known Material Defects, Repairs and Alterations

Utilities, Systems and Access

Primary heating system:

Primary cooling system:

Additional Seller Statements and Acknowledgements

The Seller certifies, under penalty of perjury, that the information provided in this disclosure is true and complete to the best of Seller's actual knowledge as of the date signed below. Seller acknowledges that material facts known to Seller concerning the property must be disclosed to prospective buyers and that failure to disclose known material defects may give rise to legal claims.

Seller further acknowledges that this disclosure does not substitute for any inspections or warranties requested by Buyer and that Buyer is advised to obtain inspections by qualified professionals prior to closing.

Buyer Acknowledgment

The Buyer acknowledges receipt of this written disclosure prior to entering into any agreement for purchase. Buyer acknowledges responsibility to conduct desired investigations, inspections, and inquiries concerning the condition of the property and relies on such investigations in making the decision to purchase.

Default, Remedies and Governing Law

This Disclosure Document is a representation by Seller of known conditions. Remedies for misrepresentation or failure to disclose shall be governed by applicable law. In the event of dispute, the parties agree that the prevailing party shall be entitled to recover reasonable attorneys' fees and costs. This Agreement shall be governed by the substantive laws of the state in which the property is located.

Entire Agreement

This Disclosure Document constitutes the entire written disclosure between the parties with respect to the matters disclosed herein. No oral statements or prior written materials shall modify or supersede the written statements contained in this document unless executed in writing by the parties.

Additional Remarks

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