Fill and Sign the Real Estate Disclosure Form

- 1 - SELLER'S DISCLOSURE STATEMENT The following is a Disclosure Statement, made by the Seller, concerning the conditi on of the property located at:________________________________________. This Disclosure is not a warranty of any kind by the Seller or any Agent of the Seller in this transaction and is not a substitute for any inspections or warranties the Purchaser may wish to obtain. This state ment may be made available to other parties and is to be attached to the Li sting Agreements (signed by Owner). TO THE SELLER: Please complete the following form, including any past history of proble ms if known. If the condition or question does not apply to your property, mark "N/A." DO NOT LEAVE ANY BLANK SPACES. Attach additional pages if necessary. APPLIANCES/SYSTEMS APPROX REPAIRS ITEM YES NO GAS/ELEC AGE LAST 2 YRS Single Oven ____ ____ __________ _______ ___________ Double Oven ___ ____ __________ _______ ____________ Cook Top ___ ____ __________ _______ ____________ Microwave ___ ____ __________ _______ ____________ Dishwasher ___ ____ __________ _______ ____________ Disposal ___ ____ __________ _______ ____________ Trash Compactor ___ ____ __________ _______ ____________ Ice Maker ___ ____ __________ _______ ____________ Hot Water Heaters ___ ____ __________ _______ ____________ Refrigerator ___ ____ __________ _______ ____________ Washer/Dryer ___ ____ __________ _______ ____________ Central Air ___ ____ __________ _______ ____________ Central Heat ___ ____ __________ _______ ____________ Fireplace ___ ____ __________ _______ ____________ - 2 - Chimney ___ ____ __________ _______ ____________ Septic/Treat- ment plant ___ ____ __________ _______ ____________ Other ___ ____ __________ _______ ____________ POOL AND POOL EQUIPMENT (Gunite or Vinyl Liner) _________________ BURGLAR ALARM YES ___ NO ___ FEE $___________________________ APPROXIMATE AGE OF HOUSE:_____ HOMEOWNER'S ASSOCIATION FEE $_____ IF CONDO, MAINTENANCE FEE: $_____ PER _________________________________ TOTAL TAXES: $_____________ HOMESTEAD FILED FOR 20___ AVERAGE ELECTRIC BILL (12 Months) $_______________ AVERAGE GAS BILL (12 Months) $____________________ Is there anything normally considered a part of the real estate that you do not plan to leave with the property? (i.e., chandeliers, ceiling fans, bathroom mirrors, etc.) _______________________ Are there any needed repairs of which you are aware?___________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Are you aware of any problems which may exist on the property by virtue of prior uses such as, but not limited to, hazardous or toxic waste, asbestos components, lead-based paint, urea-formaldehyde insulation, radon gas, underground tanks, naturally occurring radiation or any past industrial uses of the premises? YES _____ NO _____ What is the approximate Square Footage of the Heated and Cooled Living Area in House? ______________________________________________________________________________ Where did you get this figure? _____________________________________________________ Are there any finished wood floors under any carpets? YES _____ NO _____ Has property previously flooded? YES _____ NO _____ Is Flood Insurance required? YES_____ NO _____ Are you aware of any foundation repairs made in the past? YES _____ NO _____ If yes, when were they made and who was the contractor? - 3 - _____________________________________________________________________________. ROOF: AGE: _____ Are there any leaks? YES _____ NO _____ Repairs?__________________ _____________________________________________________________________________. History of infestation, if any: (termites, carpenter ants, etc.):____________________________________________________________________________________________________________ Is structure under termite contract? YES ____ NO ____ If yes, who is contractor? ______________________________________________________________________________ Any treatments for infestation? YES _____ NO _____ Any repaired damage? YES_____ NO _____ Are there any rights of way, easements, or similar matters that may affect your interest in the property? YES _____ NO _____ UNKNOWN _____ Has there been major damage to the property or any of the structures from fire, wind, floods or any other disaster? YES _____ NO _____ Please describe:___________________________________________________________________________________________________________________________________________________. Please state any other facts, information or problems (i.e., heating, cooling, electric al, plumbing, mechanical) relating to this property that would be of concern to a buyer: ________________________________________________________________________________________________. To the extent of the Seller's knowledge as a property owner, the Seller acknowledges that t he information contained above is true and accurate for those areas of the property listed. Owner agrees to save and hold Broker harmless from all claims, disputes, litigations, and/or judgm ents arising from any incorrect information supplied by Owner, or from any material fact known by Owner which Owner fails to disclose, except that Broker is not held harmless to Owner in claims, disputes, litigations or judgments, arising from conditions of which Broker had actual knowledge. It is acknowledged and understood by the Owner that this information may be made available to other parties. ____________________________________ _____________________________ SELLER DATE ____________________________________ _____________________________ SELLER DATE