Residential Property Condition Disclosure Statement Template Page 2
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3LOCATION OF SUBJECT PROPERTY _______________________________________________________________
________________________________________________________________________________________________
Source of Household Water
Other Items _______________ Yes
No
Unk
Other ____________________ Yes
No
Unk
___Public ___Private ___Well
Yes
No
Unk
Other ____________________ Yes
No
Unk
IF YOU HAVE ANSWERED NO to any of the above, please explain. Attach additional pages with your signature(s).
________________________________________________________________________________________________
________________________________________________________________________________________________
Zoning, Flood and Water
Circle below
1. Property is zoned: (Check one) ___residential ___commercial historical
___agricultural ___industrial ___office
___urban conservation
___other ___ unknown
2. What is the flood zone status of the property? ______________________________________
Unk
3. Are you aware of any flood insurance requirements concerning the property?
Yes
No
Unk
4. Do you have flood insurance on the property?
Yes
No
Unk
5. Has the property been damaged or affected by flood, storm run-off, sewer backup,
drainage or grading problems?
Yes
No
Unk
6. Are you aware of any surface or ground water drainage systems which assist in draining
the property, e.g. french drains?
Yes
No
Unk
7. Has there been any occurrence of water in the heating and air conditioning duct system?
Yes
No
Unk
8. Are you aware of water seepage, leakage or other drainage problems in any of the
improvements on the property?
Yes
No
Unk
Additions/Alterations/Repairs
9. Have any additions or alterations been made without required permits?
Yes
No
Unk
10. Are you aware of previous foundation repairs?
Yes
No
Unk
11. Are you aware of any alterations or repairs having been made to correct defects or problems?
Yes
No
Unk
12. Are you aware of any defect or condition affecting the interior or exterior walls, ceilings,
slab/foundation, basement/storm cellar, floors, windows, doors, fences or garage?
Yes
No
Unk
13. Has the roof ever been repaired or replaced during your ownership of the property?
Yes
No
Unk
14. Approximate age of roof, if known ___________ number of layers, if known ___________
Unk
15. Do you know of any current problems with the roof?
Yes
No
Unk
16. Are you aware of treatment for termite or wood-destroying organism infestation?
Yes
No
Unk
17. Do you have a termite bait system installed on the property?
Yes
No
Unk
18. If yes, is it monitored by a licensed exterminating company?
(Check one) ___yes ___no
Annual cost $__________
19. Are you aware of any damage caused by termites or wood-destroying organisms?
Yes
No
Unk
20. Are you aware of major fire, tornado, or wind damage?
Yes
No
Unk
Environmental
21. Are you aware of the presence of asbestos?
Yes
No
Unk
22. Are you aware of the presence of radon gas?
Yes
No
Unk
23. Have you tested for radon gas?
Yes
No
Unk
24. Are you aware of the presence of lead-based paint?
Yes
No
Unk
25. Have you tested for lead-based paint?
Yes
No
Unk
26. Are you aware of any underground storage tanks on the property?
Yes
No
Unk
27. Are you aware of the presence of a landfill on the property?
Yes
No
Unk
28. Are you aware of existence of hazardous or regulated materials and other conditions
having an environmental impact?
Yes
No
Unk
29. Are you aware of existence of prior manufacturing of methamphetamine?
Yes
No
Unk
30. Have you had the property inspected for mold?
Yes
No
Unk
31. Have you had any remedial treatment for mold on the property?
Yes
No
Unk
32. Are you aware of any condition on the property that would impair the health or safety
of the occupants?
Yes
No
Unk
Property Shared in Common, Easements, Homeowner’s Association, Legal
33. Are you aware of features of the property shared in common with adjoining landowners,
such as fences, driveways, and roads whose use or responsibility has an affect on the property?
Yes
No
Unk
34. Other than utility easements serving the property, are you aware of easements or
right-of-ways affecting the property?
Yes
No
Unk
Seller’s Initials_________ Seller’s Initials_________
Buyer’s Initials_________ Buyer’s Initials_________
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