Seller'S Property Disclosure Statement Template
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3SELLER’S PROPERTY DISCLOSURE STATEMENT
This disclosure statement refers to the property located at:
ADDRESS
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CITY
STATE
ZIP
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_ _ _ _ _ _ _ _ _ _ _ _ _ _
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NOTICE TO BUYER AND SELLER: This disclosure statement is designed to assist Seller in disclosing to a buyer all known
materials or adverse facts relating to the physical condition of the property that are not readily observable. All questions must
be answered completely. If answers are affirmative, please provide detailed explanations on the “Additional Explanations”
section (page 3).
YES
NO
DON’T KNOW
1. Does seller currently occupy property?
____
____
____
2. If not, when did seller last occupy property?
_ _ _ _ _ _ _ _
3. Is any part of the property leased?
____
____
____
4. Does anyone claim an easement on or a right
to use all or some of the property?
____
____
____
5. Does property rest on a landfill?
____
____
____
6. Is the property in a designated flood plain?
____
____
____
7.
Is the property in a designated fire danger zone?
____
____
____
8.
Is the property in a designated earthquake
danger zone?
____
____
____
9.
Are you aware of any settling/earth movement?
____
____
____
10. Are you aware of any encroachments, boundary
line disputes, or unrecorded easements?
____
____
____
11. How old is the structure?
___________________
12. Are you aware of any problems, past or present,
with roof, gutters, or downspouts?
____
____
____
13. Are you aware of any past or present damage
caused by infiltrating pests, termites, dry rot,
or other wood-boring insects?
____
____
____
14. Is your property currently under warranty
by a licensed pest control company?
____
____
____
15. Are you aware of any past or present movement
or other structural problems with floors, walls,
or foundations?
____
____
____
16. Has there been fire, wind, or flood damage
that required repair?
____
____
____
17. Has there ever been water leakage or dampness
within basement or crawl space?
____
____
____
SELLER’S PROPERTY DISCLOSURE STATEMENT | Page 1
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