State Form 46234 - Seller'S Residential Real Estate Sales Disclosure
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1
2SELLER'S RESIDENTIAL REAL ESTATE SALES DISCLOSURE
Date (month, day, year)
State Form 46234 (R2 / 1-96)
Seller states that the information contained in this Disclosure is correct to the best of Seller's CURRENT ACTUAL KNOWLEDGE as of the above date. The
prospective buyer and the owner may wish to obtain professional advice or inspections of the property and provide for appropriate provisions in a contract
between them concerning any advice, inspections, defects, or warranties obtained on the property. The representations in this form are the representations
of the owner and are not the representations of the agent, if any. This information is for disclosure only and is not intended to be a part of any contract be-
tween the buyer and the owner. Indiana law (IC 24-4.6-2) generally requires sellers of 1-4 unit residential property to complete this form regarding the
known physical condition of the property. An owner must complete and sign the disclosure form and submit the form to a prospective buyer before an offer
is accepted for the sale of the real estate.
Property address (number and street, city, state, ZIP code)
1. The following are in the conditions indicated:
Do
Do
Not
Not
None/Not
None/Not
A. APPLIANCES
C. WATER & SEWER SYSTEM
Defective
Not
Defective
Not
Defective
Defective
Included
Included
Know
Know
Built-in Vacuum System
Cistern
Clothes Dryer
Septic Field / Bed
Clothes Washer
Hot Tub
Dishwasher
Plumbing
Disposal
Aerator System
Freezer
Sump Pump
Gas Grill
Irrigation Systems
Hood
Water Heater / Electric
Microwave Oven
Water Heater / Gas
Oven
Water Heater / Solar
Range
Water Purifier
Refrigerator
Water Softener
Room Air Conditioner(s)
Well
Trash Compactor
Other Sewer System (Explain)
Do Not
TV Antenna / Dish
Yes No
Know
Are the improvements connected to a public water system?
Are the improvements connected to a public sewer system?
Are the improvements connected to a private/community
water system?
Are the improvements connected to a private/community
sewer system?
Do
Do
D. HEATING & COOLING
Not
Not
None/Not
None/Not
B. ELECTRICAL SYSTEM
Defective
Not
Defective
Not
Defective
Defective
Included
Included
SYSTEM
Know
Know
Attic Fan
Air Purifier
Central Air Conditioning
Burglar Alarm
Hot Water Heat
Ceiling Fan(s)
Furnace Heat / Gas
Garage Door Opener / Controls
Furnace Heat / Electric
Inside Telephone Wiring and
Solar House-Heating
Blocks / Jacks
Woodburning Stove
Intercom
Fireplace
Light Fixtures
Fireplace Insert
Sauna
Air Cleaner
Smoke / Fire Alarm(s)
Humidifier
Switches and Outlets
Propane Tank
Vent Fan(s)
60 / 100 / 200 Amp Service
(Circle one)
NOTE: "Defect" means a condition that would have a significant
adverse effect on the value of the property that would significantly
impair the health or safety of future occupants of the property, or that
if not repaired, removed or replaced would significantly shorten or
adversely affect the expected normal life of the premises.
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