Seller'S Property Condition Disclosure Statement Form Page 2
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417. Do you pay any mandatory fees or special assessments to a homeowners' or condominium association?
Yes ____ No ____
If yes, what are the fees or assessments? $ ____ per ____ (i.e. annually, semi-annually, monthly)
Payable to whom: _______________________________ For what purpose? ________________________________
18. Are you aware if the property has ever had standing water in either the front, rear, or side yard more than forty-eight
hours after heavy rain? Yes ____ No ____
19. Is the property located in or near a flood plain? Yes ____ No ____ Unknown ____
20. Are wetlands located upon any part of the property? Yes ____ No ____ Unknown ____
21. Are you aware of any private transfer fee obligations, as defined pursuant to § 43-4-48, that would require a buyer or
seller of the property to pay a fee or charge upon the transfer of the property, regardless of whether the fee or charge is
a fixed amount or is determined as a percentage of the value of the property?
Yes ____ No ____ Unknown ____
If yes, what are the fees or charges? $__________ per __________ (i.e. annually, semi-annually, monthly)
II. STRUCTURAL INFORMATION
If the answer is yes to any of the following, please explain under additional comments or on an attached separate sheet.
1. Are you aware of any water penetration problems in the walls, windows, doors, basement, or crawl space?
Yes ____ No ____
2. What water damage related repairs, if any, have been made? _______________________________________________
If any, when? ____________________________________________________________________________________
3. Are you aware if drain tile is installed on the property? Yes ____ No ____
4. Are you aware of any interior cracked walls or floors, or cracks or defects in exterior driveways, sidewalks, patios, or
other hard surface areas? Yes ____ No ____
What related repairs, if any, have been made? __________________________________________________________
5. Are you aware of any roof leakage, past or present? Yes ____ No ____
Type of roof covering: ___________________________________________ Age: ____________________________
What roof repairs, if any, have been made, when and by whom? ____________________________________________
________________________________________________________________________________________________
Describe any existing unrepaired damage to the roof: _____________________________________________________
6. Are you aware of insulation in:
the ceiling/attic? Yes ____ No ____
the walls? Yes ____ No ____
the floors? Yes ____ No ____
7. Are you aware of any pest infestation or damage, either past or present? Yes _____ No _____
8. Are you aware of the property having been treated for any pest infestation or damage?
Yes ____ No ____
If yes, who treated it and when? ____________________________________________________
9. Are you aware of any work upon the property which required a building, plumbing, electrical, or any other permit?
Yes ____ No ____
If yes, describe the work: _________________________________________________________
Was a permit obtained? Yes _____ No _____
Was the work approved by an inspector? Yes _____ No ______
10. Are you aware of any past or present damage to the property (i.e. fire, smoke, wind, floods, hail, or snow)?
Yes ____ No ____
If yes, describe ___________________________________________________________
Have any insurance claims been made? Yes ____ No ____ Unknown ____
Was an insurance payment received? Yes ____ No ____ Unknown ____
Has the damage been repaired? Yes ____ No ____
If yes, describe in detail: _________________________
______________________________________________________________________________________________
11. Are you aware of any problems with sewer blockage or backup, past or present? Yes ______ No ______
12. Are you aware of any drainage, leakage, or runoff from any sewer, septic tank, storage tank, or drain on the
property into any adjoining lake, stream, or waterway? Yes _____ No_______ If yes, describe in detail:
______________________________________________________________________________________________
______________________________________________________________________________________________
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