Residential Property Disclosure Form Page 3
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4Property Address____________________________________________________________________________________________
G) WOOD BORING INSECTS/TERMITES: Do you know of the presence of any wood boring insects/termites in or on the
property or any existing damage to the property caused by wood boring insects/termites?
Yes
No
If “Yes”, please describe: _______________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
If owner knows of any inspection or treatment for wood boring insects/termites, since owning the property (but not longer than the
past 5 years), please describe: ___________________________________________________________________________________
____________________________________________________________________________________________________________
H) PRESENCE OF HAZARDOUS MATERIALS: Do you know of the previous or current presence of any of the below
identified hazardous materials on the property?
Yes
No
Unknown
1) Lead-Based Paint
2) Asbestos
3) Urea-Formaldehyde Foam Insulation
4) Radon Gas
a. If “Yes”, indicate level of gas if known _____________________________
5) Other toxic or hazardous substances
If the answer to any of the above questions is “Yes”, please describe and indicate any repairs, remediation or mitigation to the
property: ____________________________________________________________________________________________________
____________________________________________________________________________________________________________
I) FLOOD PLAIN/LAKE ERIE COASTAL EROSION AREA:
Yes
No
Unknown
Is the property located in a designated flood plain?
Is the property or any portion of the property included in a Lake Erie Coastal Erosion Area?
J) DRAINAGE/EROSION: Do you know of any current flooding, drainage, settling or grading or erosion problems affecting the
property?
Yes
No
If “Yes”, please describe: _______________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
If owner knows of any repairs, modifications or alterations to the property or other attempts to control any flooding, drainage, settling,
grading or erosion problems since owning the property (but not longer than the past 5 years), please describe:____________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
K) ZONING/CODE VIOLATIONS/ASSESSMENTS/HOME OWNERS ASSOCIATION: Do you know of any violations of
building or housing codes, zoning ordinances affecting the property or any nonconforming uses of the property?
Yes
No
If “Yes”, please describe: _______________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Is the structure on the property designated by any governmental authority as a historic building or as being located in an historic
district? (NOTE: such designation may limit changes or improvements that may be made to the property).
Yes
No
If “Yes”, please describe: _______________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Do you know of any recent or proposed assessments, which could affect the property?
Yes
No
If “Yes”, please describe: _______________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Is the property subject to any rules or regulations of, or the payment of any fees or charges to, a Homeowners Association,
Condominium Association or any other Community Association?
Yes
No
If “Yes”, please describe: ______________________________________________________________________________________
____________________________________________________________________________________________________________
Owner’s Initials ______/______ Date ______/______
Purchaser’s Initials ______/______ Date ______/______
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