Kansas Association Of Realtors Seller'S Property Disclosure Statement Page 2
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PART II - Answer ll questions TO THE BEST OF YOUR (SELLER’S) KNOWLEDGE
NO
YES
NO
YES
Section A. - Structural Conditions:
1. Age of roof (if known) ____________ years
8. (Continued) Has there been an inspection to
2. Does the roof leak? ................................................................
determine whether the structure has excessive
3. Is there present damage to the roof? ......................................
moisture accumulation and/or related damage? ..........
4. Have you had any insurance claims? .....................................
If yes, attach the results of the inspection.
If yes, were all repairs made? ...............................................
9. Is there any damage to the chimney?.............................
5. Has there ever been leakage/seepage in the
10. Is there any exposed wiring presently in
basement or crawl space? .....................................................
any structures on the property? ...................................
If yes, explain
11. Are there any windows or doors which
6. Has there been any damage to the real
leak or have broken thermopane seals?.......................
property or any of the improvements due to
12. Have you ever experienced any moving or
the following occurrences, including, but
settling of the following:
not limited to, wind, fire, flood? ...........................................
Foundations? ...............................................................
If yes, explain
Floors? .........................................................................
7. Are there any structural problems with the
Walls? ..........................................................................
property? ...............................................................................
Sidewalks? ...................................................................
If yes, explain
Patios?..........................................................................
8. Is any exterior wall covering of the structure covered with
Driveways? ..................................................................
Exterior Insulation and Finishing Systems (EIFS) or
Retaining Walls?..........................................................
Synthetic stucco? ..................................................................
Other
If yes, are you aware of any adverse conditions?.................
If yes, explain.
Section B - Hazardous Conditions: Are you (Seller), TO THE BEST OF YOUR KNOWLEDGE, aware of any of the following substances, materials, or
products on or near the real property which may be an environmental hazard?
YES
NO
YES
NO
1. Asbestos .................................................................................
7. Toxic materials.............................................................
2. Contaminated soil or water (including
8. Underground fuel or chemical storage
drinking water)......................................................................
tanks.............................................................................
3. Expansive soil ........................................................................
9. EMF’s (Electric Magnetic Fields) ...............................
4. Landfill or buried materials....................................................
10. Gas or oil wells in area ................................................
5. Lead-based paint ....................................................................
11. Other (specify)
(See attached lead disclosure form)
12. Other (specify)
6. Radon gas in house or well ...................................................
13. Other (specify)
Section C - Title Disclosures: Are you (Seller), TO THE BEST OF YOUR KNOWLEDGE, aware of any of the following which could affect the real property?
YES
NO
YES
NO
1. Features, such as walls, fences, driveways,
9. Any condominium, regime or other deed
which are shared in common w/adjoining
restrictions or obligations, or any
landowners who use or have responsibility
Homeowner’s Association which has
for maintenance of the feature ..............................................
authority over the real property...................................
2. Has a boundary survey been performed?..............................
10. Any “common area” (facilities such as
Date
pools, tennis courts, walkways, or other
3. Any mortgage survey or ILC ................................................
areas co-owned in individual interest with
(Improvement Location Certificate)
others) ..........................................................................
Date
11. Any lawsuits against Seller threatening
4. Easements, other than normal utility
or affecting, this real property .....................................
easements ..............................................................................
12. Any notices from any governmental or
5. Any encroachments...............................................................
quasi-governmental agency affecting this
6. Any zoning violations, non-conforming uses,
real property.................................................................
13. Any planned road or street expansions,
or violations of setback requirements...................................
7. Any lot-line disputes or other unusual
improvements or widenings adjacent to
claims against the real property ............................................
the property..................................................... ............
8. Any pending or levied assessments on the
14. Other (specify) ................................................ ............
real estate, including but not limited to
15. Other (specify) .............................................................
those for sidewalks, streets, sewers, water
16. Other (specify) .............................................................
and gas lines..........................................................................
17. Other (specify) .............................................................
Section D - Other Disclosures: For property and improvements thereon:
YES
NO
YES
NO
1. Is the property connected to a public water
6. Are there any trees or shrubs diseased or
system?
Rural
City .....................................................
dead?............................................................................
2. Is the property connected to a public sewer
Scheduled to be removed? ..........................................
system?
County
City .................................................
7. Are there any flooding, drainage, or grading
Is the system operational?.....................................................
problems? ....................................................................
3. Is the property connected to a
8. Is the property in a flood plain?...................................
private/community water system? ........................................
9. Trash Service
Public
Private ...........................
4. Is the property connected to a
10. Do you own the fencing on your property? ................
private/community sewer system?........................................
11. Are you aware of any structural additions,
Is the system operational?.....................................................
changes or repairs made to the property
5. Is the property connected to a septic
without obtaining all necessary permits? ....................
system?..................................................................................
12. Have you ever owned a pet in this
Is the system operational?.....................................................
property?......................................................................
Are you aware of any problems? ..........................................
Has there been any damage due to urine,
odor, stain or other? .....................................................
Section E - Insert the most recent year in which the following occurred
1. Serviced air conditioner
6. Tested well water
2. Cleaned fireplace, including chimney
7. Serviced well water
8. Do you have a home warranty?
Yes
No
3. Serviced furnace
Is it transferable?
Yes
No
4. Serviced septic system
Company name(s)
5. Cleaned woodburning stove, including
chimney
Buyer’s Initials
Seller’s Initials
___________ Date ___________
___________ Date ___________
___________ Date ___________
___________ Date ___________
11/98
Page 2 of 3
Approved by KAR Legal Counsel
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