Real Estate House Information Form

REAL ESTATE HOUSE INFORMATION FORM

Property Identification

Property Address:

Owner / Submitter Information

Phone:    Email:

Physical Characteristics

Year Built:    Finished Living Area (sq ft):    Lot Size:

Bedrooms:    Full Baths:    Half Baths:    Garage Spaces:

Systems, Utilities & Structural Elements

Heating:    Cooling:

Roof: Age or replacement year:    Water Heater: Age:

Sewer/Septic:    Utilities: Electric Yes No    Gas Yes No

Appliances & Fixtures Included

Does sale/include any of the following? (check applicable)

Refrigerator    Range/Oven    Dishwasher    Washer    Dryer    Window Treatments

Improvements, Repairs, and Maintenance History

Occupancy & Access

Occupancy status: Owner occupied    Tenant occupied    Vacant

Lockbox / Keys / Alarm instructions:

Disclosures — Known Conditions

For each item indicate Yes or No. If Yes, provide an explanation in the corresponding description field below.

Lead-based paint (for properties built before 1978): Yes No

Mold or moisture intrusion: Yes No

Structural or foundation issues: Yes No

Past or current pest infestation (termites, rodents, etc.): Yes No

Flood, fire, or other material damage: Yes No

Financial, HOA & Title Information

Outstanding mortgage(s) or liens: Yes No    If Yes, describe:

Homeowners Association: Yes No    Dues (if any):

Prior insurance claims on property (past 10 years): Yes No

Documents and Attachments

Please indicate which documents accompany this form:

Deed    Survey or Plot Plan    Title Report    Recent Inspection Reports    Repair Receipts/Warranties

Representations, Certification and Authorization

By signing below, Owner / Authorized Representative certifies that the information provided in this Real Estate House Information Form is true, complete, and accurate to the best of their knowledge. Owner acknowledges an affirmative duty to disclose known material defects and past material damage or repairs. Owner understands that agents, purchasers, and other third parties may rely on this information in connection with the marketing, sale, or financing of the property.

Owner authorizes the listing broker, buyer representatives, lenders, and their agents to verify the information provided, to obtain public records and claim history, and to disclose this form and any attached documents to prospective purchasers and other authorized persons. Owner agrees to indemnify and hold harmless any party who reasonably relies on the information provided, unless such information is intentionally falsified.

Governing Law: This form and all matters arising out of it shall be governed by the laws of the state where the property is located: State:

Additional Remarks

Sign Now