Real Estate Land Questionnaire

REAL ESTATE LAND QUESTIONNAIRE

The undersigned owner(s) or authorized representative(s) provide the following facts and disclosures concerning the real property identified below. Responses shall be true and complete to the best of the respondent's knowledge as of the date of signature. This Questionnaire is provided for informational purposes to prospective purchasers, lenders, title companies, and other parties; responses are not a substitute for inspections, surveys, title or environmental reports, nor do responses create a warranty beyond the statement of facts herein.

Property Identification

Property Address:

Parcel / APN:    County:

Owner / Respondent

Phone:    Email:

Ownership, Title and Authority

Are you the fee owner of the property? Yes No

Is title vested in an entity (corporation, LLC, trust)? Yes No   If yes, name of entity:

Are there any recorded or unrecorded interests, options, or agreements affecting the property that would survive closing? Yes No

Physical Characteristics & Current Use

Current primary use (check all that apply):

Agriculture/Farming     Residential     Commercial     Vacant/Undeveloped     Industrial

Are there any structures, improvements or roads on the property? Yes No

Are there any wells, springs, water rights, irrigation ditches, or water delivery systems on or serving the property? Yes No

Environmental & Hazardous Conditions

To your knowledge, has the property ever been used for activities that could cause environmental contamination (fuel storage, chemical storage, waste disposal, mining, dry cleaning, etc.)? Yes No

Are there known or suspected underground storage tanks, spills, releases, or hazardous materials on or affecting the property? Yes No

Is any portion of the property located within a designated floodplain, wetland, or other protected environmental area? Yes No

Encumbrances, Easements, Rights & Restrictions

Are there recorded or unrecorded easements, rights-of-way, pipelines, utility corridors, or access agreements affecting the property? Yes No

Are there deed restrictions, covenants, homeowners' association obligations, or other use restrictions? Yes No

Taxes, Assessments & Utilities

Current annual real estate taxes:    Are there special assessments or pending assessments? Yes No

Are there municipal or private utilities available to the property (water, sewer, electricity, gas)? Provide which are available and which are connected.

Disputes, Claims & Litigation

Are there any pending or threatened lawsuits, claims, notices of violation, code enforcement actions, or boundary disputes affecting the property? Yes No

Surveys, Reports & Attachments

Date of most recent boundary survey or plat:    Surveyor or firm:

Certifications & Acknowledgements

The undersigned certifies, under penalty of perjury, that the information contained in this Questionnaire is true and correct to the best of the undersigned's knowledge and belief. The undersigned acknowledges the provision of this information does not constitute a representation or warranty as to matters not specifically addressed and that prospective purchasers, lenders, insurers and their representatives are responsible for independent verification, inspections, and investigation. The undersigned authorizes release of copies of surveys, reports and related documents listed above to parties with a legitimate interest and agrees to indemnify and hold harmless any party who, acting in good faith, relies upon these representations.

The undersigned further affirms they have the authority to execute this Questionnaire for the owner identified above, and that any statements herein regarding third-party approvals, permits, or regulatory matters are true to the undersigned's actual knowledge.

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