State Form 46234 - Seller'S Residential Real Estate Sales Disclosure Page 2

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2. ROOF

4. OTHER DISCLOSURES

YES

NOT

KNOW

Do improvements have aluminum wiring?

Age, if known: ___________ Years.

Are there any foundation problems

Does the roof leak?

with the improvements?

Are there any encroachments?

Is there present damage to the roof?

Are there any violations of zoning,

Is there more than one roof on the house?

building codes or restrictive covenants?

Is the present use a non-conforming

If so, how many? __________ roofs.

use? Explain:

3. HAZARDOUS CONDITIONS

YES

NOT

KNOW

Ar e th e r e a n y e x is t in g h a za r d o us

conditions on the property, such as

Have you received any notices by any

methane gas, lead paint, radon gas in

governmental or quasi-governmental

house or well, radioactive material, landfill,

agencies affecting this property?

mineshaft, expansive soil, toxic materials,

Are there any structural problems with the

asbestos insulation or PCB's?

buildings?

Have any substantial additions or

alterations been made without a required

building permit?

Are there moisture and/or water problems

in the basement or crawl space area?

Is there any damage due to wind, flood,

termites or rodents?

Are the furnace/woodstove/chimney/flue

all in working order?

Is the property in a flood plain?

Do you currently pay flood insurance?

Does the property contain underground

storage tank(s)?

Is the seller a licensed real estate

salesperson or broker?

Is there any threatened or existing

litigation regarding the property?

Is the property subject to convenants,

conditions and/or restrictions of a

homeowner's association?

Is the property located within one (1)

mile of an airport?

E. ADDITIONAL COMMENTS AND / OR EXPLANATIONS: (Use additional pages if necessary.)

The information contained in this Disclosure has been furnished by the Seller, who certifies to the truth thereof, based on the Seller's CURRENT ACTUAL

KNOWLEDGE. A disclosure form is not a warranty by the owner or the owner's agent, if any, and the disclosure form may not be used as a substitute for any

inspections or warranties that the prospective buyer or owner may later obtain. At or before settlement, the owner is required to disclose any material change

in the physical condition of the property or certify to the purchaser at settlement that the condition of the property is substantially the same as it was when

the disclosure form was provided. Seller and Purchaser hereby acknowledge receipt of this Disclosure by signing below:

Signature of Seller

Date

Signature of Buyer

Signature of Seller

Date

Signature of Buyer

Date

The seller hereby certifies that the property is substantially the same as it was when the Seller's Disclosure form was originally provided to the Buyer.

Signature of Seller

Date

Signature of Seller

Date