Nebraska Real Estate Commission Seller Property Condition Disclosure Statement printable pdf download

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7/2012

NEBRASKA REAL ESTATE COMMISSION

SELLER PROPERTY CONDITION DISCLOSURE STATEMENT

Residential Real Property

THIS DISCLOSURE STATEMENT IS BEING COMPLETED AND DELIVERED IN ACCORDANCE WITH NEBRASKA LAW. NEBRASKA LAW REQUIRES THE SELLER TO

COMPLETE THIS STATEMENT (NEB. REV. STAT. §76-2,120).

How long has the seller owned the property? ______ year(s)

Is seller currently occupying the property? (Circle one)

YES | NO If yes, how long has the seller occupied the property? ______ year(s)

If no, has the seller ever occupied the property? (Circle one) YES | NO If yes, when? From ______ (year) to ______ (year)

This disclosure statement concerns the real property located at _________________________________________________________________________

in the city of ________________________________________, County of_____________________________ , State of Nebraska and legally described as:

_____________________________________________________________________________________________________________________________

This statement is a disclosure of the condition of the real property known by the seller on the date on which this statement is signed. This statement

is NOT a warranty of any kind by the seller or any agent representing a principal in the transaction, and should NOT be accepted as a substitute for

any inspection or warranty that the purchaser may wish to obtain. Even though the information provided in this statement is NOT a warranty, the

purchaser may rely on the information contained herein in deciding whether and on what terms to purchase the real property. Any agent

representing a principal in the transaction may provide a copy of this statement to any other person in connection with any actual or possible sale of

the real property. The information provided in this statement is the representation of the seller and NOT the representation of any agent, and is NOT

intended to be part of any contract between the seller and purchaser.

Seller please note: you are required to complete this disclosure statement IN FULL. If any particular item or matter does not apply and there is no

provision or space for indicating, insert “N/A” in the appropriate box. If age of items is unknown, write “UNK” on the blank provided. If the property

has more than one item as listed below please put the number in the appropriate box. For example – if the home has three room air conditioners, one

working, one not working, and one not included, put a “1” in each of the “Working”, “Not Working”, and “None/Not Included” boxes for that item, and

a “3” on the line provided next to the item description to indicate total number of item. You may also provide additional explanation of any item in the

comments section in PART III.

SELLER STATES THAT, TO THE BEST OF THE SELLER’S KNOWLEDGE AS OF THE DATE THIS DISCLOSURE STATEMENT IS COMPLETED AND SIGNED BY

THE SELLER, THE CONDITION OF THE REAL PROPERTY IS:

PART I – If there is more than one of any item in this Part, the statement made applies to each and all of such items unless otherwise noted in the

Comments section in PART III of this disclosure statement, or number separately as provided in the instructions above. If an item in this Part is not on the

property, or will not be included in the sale, check only the “None/Not included” column for that item.

Do Not

None /

Do Not

None /

Section A -Appliances

Section B - Electrical Systems

Not

Know If

Not

Know If

Not

Working

Included

Working

Included

1. Electrical service panel capacity

1. Refrigerator

______ AMP Capacity (if known)

______ fuse ______ circuit breakers

2. Clothes Dryer

2. Ceiling fan(s)

( ________ number )

3. Clothes Washer

3. Garage door opener(s)

( ________ number )

4. Dishwasher

4. Garage door remote(s)

( ________ number )

5. Garbage Disposal

5. Garage door keypad(s)

( ________ number )

6. Freezer

6. Telephone wiring and jacks

7. Oven

7. Cable TV wiring and jacks

8. Intercom or sound system wiring

8. Range

9. Built-In speakers

9. Cooktop

10. Smoke detectors

( ________ number )

10. Microwave oven

11. Fire alarm

11. Built-In vacuum system and equipment

12. Room ventilation/exhaust fan (_____number )

12. Range ventilation systems

13. 220 volt service

13. Gas grill

14. Security System

______ Owned ______ Leased

14. Room air conditioner

( ______ number )

______ Central station monitoring

15. TV antenna / Satellite dish

15. Have you experienced any problems with the

If YES, explain the condition in the

electrical system or its components?

comments section in PART III of this

16. Trash compactor

______ YES ______ NO

disclosure statement.

Seller’s Initials ____/____ Property Address _____________________________________ Buyer’s Initials____/____

Nebraska Real Estate Commission Seller Property Condition Disclosure Statement

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