Voluntary Real Property Disclosure Form

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SAMPLE
1.6 Voluntary Real Property Disclosure Form
The purpose of this form is to allow property owners to fully disclose certain conditions associated with the development site
to the buyer. The Real Property Disclosure Form is a statement from a seller to a buyer as to conditions at an identified site at
a specific time represented by the date of this form. Condition is defined as a characteristic of the property that would have a
substantial adverse effect on the value or liability of the real property or impair the use of the property by future owners. The
seller may inform the prospective buyer of changes in the property that have taken place proceeding the date of this form.
Statements made on this form are not warranties but may be accepted as reliable and true. This is not a legal document and
has no legal effect but is a voluntary statement by the seller.
The seller discloses, to the best of his or her knowledge, that the items listed below are identified and marked accurately:
Seller’s Legal Name: ___________________________________________________________________________
Seller’s Legal Address:
________________________________________________________________________
________________________________________________________________________
Property Address:
________________________________________________________________________
________________________________________________________________________
Seller is aware of the current conditions of the property.
Yes________ No__________ N/A _________
Property is in a flood plain.
Yes________ No__________ N/A _________
Property owner currently has flood insurance.
Yes________ No__________ N/A _________
Seller is aware of unsafe levels of radon on the property.
Yes________ No__________ N/A _________
Seller is aware of unsafe concentrations or conditions relating to lead paint, lead water pipes or lead in the soil on the premise.
Yes________ No__________ N/A _________
Seller is aware of mine subsidence, underground pits, settlement, sliding, upheaval, or other earth stability defects on the
premise.
Yes________ No__________ N/A _________
Real Property
Seller is aware of underground fuel storage tanks on the property. Yes________ No__________ N/A _________
Seller is aware of boundary or lot line disputes.
Yes________ No__________ N/A _________
Seller has received notice of violation of local, State or Federal laws or regulations relating to this property, which violation has
not been corrected.
Yes________ No__________ N/A _________
Explanations or comments on any of the items marked above or concerning the property in general.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
The Seller certifies that the above information is true and correct based on actual notice or actual knowledge of the seller
without specific investigation on the part of the seller. The Seller authorizes any person representing the Seller to provide a
copy of this statement and to disclose any information in this statement, to any person in connection with any actual or
anticipated sale of the property.
Seller:______________________________________________ Date:________________
Seller:______________________________________________ Date:________________

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