Nebraska Real Estate Commission Seller Property Condition Disclosure Statement (Page 3 of 4) in pdf

Page 3 of 4

7/2012

Section C. Title Conditions - Do any of the following conditions exist with regard to the real property?

Do Not

Section C - Title Conditions

YES

Know

YES

Know

1. Any features, such as walls, fences and driveways

10. Does ownership of the property entitle the owner

which are shared?

to use any “common area” facilities such as pools,

2. Any easements, other than normal utility

tennis courts, walkways, or other common use

easements?

areas?

3. Any encroachments?

11. Is there a common wall or walls?

4. Any zoning violations, non-conforming uses, or

b. Is there a party wall agreement?

violations of “setback” requirements?

12. Any lawsuits regarding this property during the

5. Any lot-line disputes?

ownership of the seller?

6. Have you been notified, or are you aware of, any

13. Any notices from any governmental or quasi-

work planned or to be performed by a utility or

governmental agency affecting the real property?

municipality close to the real property including,

14. Any unpaid bills or claims of others for labor

but not limited to sidewalks, streets, sewers,

and/or materials furnished to or for the real

water, power, or gas lines?

property?

7. Any planned road or street expansions,

15. Any deed restrictions or other restrictions of

improvements, or widening adjacent to the real

record affecting the real property?

property?

8. Any condominium, homeowners’, or other type of

16. Any unsatisfied judgments against the seller?

association which has any authority over the real

17. Any dispute regarding a right of access to the real

property?

9. Any private transfer fee obligation upon sale?

18. Any other title conditions which might affect the

real property?

Section D. Other Conditions - Do any of the following conditions exist with regard to the real property?

Do Not

Section D - Other Conditions

YES

Know

YES

Know

1. a. Are the dwelling(s) and the improvements

8. a. Is the real property in a flood plain?

connected to a public water system?

b. Is the real property in a floodway?

b. Is the system operational?

9. Is trash removal service provided to the real

2. a. Are the dwelling(s) and the improvements

property? If so, are the trash services

connected to a private, community (non-public),

______ public ______ private

or Sanitary Improvement District (SID) water

10. Have the structures been mitigated for radon?

system?

If yes, when? _____/_____/__________

b. Is the system operational?

11. Is the property connected to a natural gas system?

3. If the dwelling(s) and the improvements are

connected to a private, community (non-public)

12. Has a pet lived on the property?

or SID water system is there adequate water

Type(s) ___________________________________

supply for regular household use (i.e. showers,

13. Are there any diseased or dead trees, or shrubs on

laundry, etc.)?

the real property?

4. a. Are the dwelling(s) and the improvements

connected to a public sewer system?

14. Are there any flooding, drainage, or grading

b. Is the system operational?

problems in connection to the real property?

5. a. Are the dwelling(s) and the improvements

15. a. Have you made any insurance or manufacturer

connected to a community (non-public) or SID

claims with regard to the real property?

sewer system?

b. Were all repairs related to the above claims

b. Is the system operational?

completed?

6. a. Are the dwelling(s) and the improvements

connected to a septic system?

16. Are you aware of any problem with the exterior

b. Is the system operational?

wall-covering of the structure including, but not

limited to, siding, synthetic stucco, masonry, or

7. Has the main sewer line from the house ever

other materials?

backed up or exhibited slow drainage?

Section E. Cleaning / Servicing Conditions - Have you ever performed or had performed the following?

(State most recent year performed)

None /

Section E – Cleaning / Servicing

None /

Section E - Cleaning / Servicing Conditions

Do Not

Not

Do Not

Not

Conditions

YEAR

YES

Know

Included

YEAR

YES

Know

Included

6. Cleaning of wood-burning stove, including

1. Servicing of air conditioner

chimney

2. Cleaning of fireplace, including chimney

7. Treatment for wood-destroying insects or

rodents

3. Servicing of furnace

4. Professional inspection of

8. Tested well water

furnace A/C (HVAC) System

9. Serviced / treated well water

5. Servicing of septic system

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

Nebraska Real Estate Commission Seller Property Condition Disclosure Statement Page 3

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