Fill and Sign the Sellers Disclosure Statement Form

Seller’s Disclosure Statement for Vacant Land Properly Address (or Tax Description): _____________________________________ (street address, city, state, zip code) . Purpose of Statement: This statement is a disclosure of the condition of the property and information concerning the property as known by the Seller. Unless otherwise advised, the Seller does not possess any expertise in matters pertaining to the law, taxation, engineering, land surveying or any other specific matter related to the condition of the property, and the Buyer is advised to seek the advice of processionals regarding these matters. This statement is not a warranty of any kind by the Seller or by any real estate agent representing the Seller or Buyer in this transaction, and is not a substitute for any inspections of the property that the Buyer may wish to obtain. Seller’s Disclosure: The Seller discloses the following information with the knowledge that, although the disclosures herein are not a warranty, the Seller specifically makes the following disclosures based on the Sellers knowledge at the time tile Seller signs this form. The Seller authorizes the Seller’s agent(s) to provide a copy of this form to any prospective Buyer in connection with any actual or anticipated sale of property. The following are representations made solely by the Seller and are not the representations of the Seller’s agent(s) or Buyer’s agent(s), if any. This information is a disclosure only and is not intended to be a part of any contract between the Buyer and the Seller. Instructions to the Seller: 1. Complete this form yourself. 2. Answer all questions. 3. Report known conditions about or affecting the properly by selecting either YES or NO . 4. Attach additional pages with your signature if additional space is required to adequately report known conditions. 5. lf you do not have knowledge of a particular condition, check UNKNOWN. Part 1: General Property Information 1. Property dimensions: Are you aware of the property’s approximate dimensions and/or size in square feet or acres? [ ] Yes [ ] No If yes please state: ________________________________________________ 2. Survey: Do you have an engineering survey of the property in your possession? [ ] Yes [ ] No lf yes, can you provide the Buyer with a copy? [ ] Yes [ ] No 3. Zoning: Are you aware of the property’s zoning classification as designated by the municipality [ ] Yes [ ] No lf yes, please state: ______________________________________________ 4. Servlces/Utillties: Are any of the following services and/or utilities available to the property line? A. Municipal water [ ] Yes [ ] No [ ] Unknown B. Municipal sewer [ ] Yes [ ] No [ ] Unknown C. Electric [ ] Yes [ ] No [ ] Unknown D. Natural gas [ ] Yes [ ] No [ ] Unknown E. Cable television [ ] Yes [ ] No [ ] Unknown If either municipal water or sewer is available, are laterals extended into the property? [ ] Yes [ ] No [ ] Unknown 5. Assessments, etc. Are there any outstanding, deferred or pending assessments or other similar charges against the property? [ ] Yes [ ] No [ ] Unknown If yes, please describe and state approximate amounts if known: ____________________________________ 6. Soil conditions: A. Have soil borings ever been conducted on the property? [ ] Yes [ ] No [ ] Unknown If yes, can you provide the Buyer with a copy of the report? [ ] Yes [ ] No [ ] Unknown B. Has a percolation test ever been conducted on the property? [ ] Yes [ ] No [ ] Unknown If yes, can you provide the Buyer with a copy of the report? [ ] Yes [ ] No [ ] Unknown C. Have you ever been denied a septic or building permit because of adverse soil conditions? [ ] Yes [ ] No [ ] Unknown If yes, please explain: ____________________________________________ 7. Drainage/flooding: Does the property periodically or regularly experience drainage and/or flooding problems? [ ] Yes [ ] No [ ] Unknown If yes, please describe: _______________________________________ 8. Mineral rights : Do you own the property’s mineral rights? [ ] Yes [ ] No [ ] Unknown 9. Topography: Has there been filling or grading of the property other than by natural forces? [ ] Yes [ ] No [ ] Unknown If yes, please describe: __________________________________________ Part 2: Property Restrictions Are you aware of any of the following restrictions or conditions that may limit or restrict the Buyer’s use, enjoyment and/or development of the property? 1. Oral or written leases for crops, hunting, lagging, oil, gas, mineral rights, etc.? [ ] Yes [ ] No [ ] Unknown 2. Public or private use restrictions or limitations including, but not limited to, deed or subdivision restrictions, conservation, forestry or agricultural agreements, or any tax deferral programs? [ ] Yes [ ] No [ ] Unknown 3. Any sale, transferor reservation of development, water or drainage rights? [ ] Yes [ ] No [ ] Unknown 4. Any sale, transfer or reservation of oil, gas or mineral rights? [ ] Yes [ ] No [ ] Unknown 5. Encroachments, easements, zoning violations, nonconforming uses, or condemnations? [ ] Yes [ ] No [ ] Unknown 6. Any portions or features of the property co-owned or shared in common with other persons? [ ] Yes [ ] No [ ] Unknown 7. Any association that has authority over the property and that may charge fees or enact restrictions? [ ] Yes [ ] No [ ] Unknown 8. Any pending litigation that could affect the property or the Seller’s ability to convey marketable title to the property? [ ] Yes [ ] No [ ] Unknown 9. Previous divisions or splits of the property since _______________ (date) pursuant to the __________________ (Name of Statute) . If the answer to any of the previous questions is yes, please explain. Attach additional signed pages, if necessary: ______________________________ _____________________________________________________________ Part 3: Environmental Conditions 1. Are you aware of any of the following environmental conditions that may knit or restrict the Buyer’s use, enjoyment and/or development of the properly? A. Any past or present use of the property that may have created soil or water? [ ] Yes [ ] No [ ] Unknown B. Any pastor present drilling for oil or gas, or mining for minerals? [ ] Yes [ ] No [ ] Unknown C. My operating, capped, uncapped or abandoned wells? [ ] Yes [ ] No [ ] Unknown D. Any past or present above-ground or underground storage tanks used for fuel or other chemicals? [ ] Yes [ ] No [ ] Unknown E. Any past or present use of any portion of the properly as a farm or household dump or as a landfill? [ ] Yes [ ] No [ ] Unknown F. Any known soil or water contamination? [ ] Yes [ ] No [ ] Unknown If the answer to any of the previous questions is yes, please explain. Attach additional signed pages, if necessary: ______________________________________________________________________________________________________________ 2. Have there been any environmental assessments or studies done on the property? [ ] Yes [ ] No [ ] Unknown If yes, Phase I [ ] Phase II [ ] Phase III [ ] Other [ ] If yes, can you provide the buyer with a copy or copies of any reports? [ ] Yes [ ] No [ ] Unknown 3. Has there ever been any determination that any portion of the property constitutes a wetlands, antiquities or dunes, or similar determination? [ ] Yes [ ] No [ ] Unknown Part 4: Off-Site Conditions Are you aware of any of the following off-site conditions within the vicinity of the property that may limit or restrict the Buyer’s use, enjoyment and/or development of the property? 1.Farm or farm operation [ ] Yes [ ] No [ ] Unknown 2. Dump or landfill [ ] Yes [ ] No [ ] Unknown 3. Airport [ ] Yes [ ] No [ ] Unknown 4. Shooting range [ ] Yes [ ] No [ ] Unknown 5. Racetrack [ ] Yes [ ] No [ ] Unknown If the answer to any of the previous questions is yes, please explain. Attach additional signed pages, if necessary: _______________________________________________ _____________________________________________________________________ Part 5: Notices to the Buyer 1. The Seller has owned the property since ________________ (date). 2. The Seller has indicated above the condition of the property based on information known to the Seller. If any changes occur in the property’s condition as disclosed or if the Seller becomes aware that any disclosures herein are inaccurate, from the date of this form to the date of closing, the Seller will immediately disclose the changes to the Buyer. In no event shall the parties hold the Seller’s agent(s) or Buyer’s agent(s) liable for any representations not directly made by the Seller’s agent(s) or Buyer’s agent(s). 3. The Seller acknowledges that the information in this statement is true and correct to the best of the Seller’s knowledge as of the date of the Seller’s signature below. 4. The Buyer should obtain professional advice and inspections of the property to more fully determine its condition. 5. The Buyer is advised that certain information compiled pursuant to ______________ (Name of Statute) is available to the public. If the Buyer seeks such information, the Buyer should contact the appropriate local law enforcement agency or sheriff’s department directly. 6. The Buyer is advised that _______________ (Name of State) ’s Right to Farm Act protects farming operations from litigation if those operations meet generally accepted agricultural practices regarding noise, dust, odors and other assorted conditions. 7. The Buyer is advised that the state equalized value, taxable value, tax exemption information and other real property tax information pertaining to the property is available from the appropriate local assessor’s office. The Buyer should not assume that the Buyer’s future property tax bills will be the same as the Seller’s present property tax bills. Pursuant to _______________ (Name of State) ’s General Property Tax Act, real property tax obligations can change significantly when the Seller re-conveys legal or equitable title to the Buyer. Buyer has read and acknowledges receipt of this two-page disclosure statement. Witness our signatures this _____day of ________________, 20____. __________________________ __________________________ (Printed Name of Seller) (Printed Name of Buyer) __________________________ __________________________ (Signature of Seller) (Signature of Buyer) __________________________ __________________________ (Printed Name of Seller) (Printed Name of Buyer) __________________________ __________________________ (Signature of Seller) (Signature of Buyer)