Informational Statement For Louisiana Residential Property Disclosure Form Page 2
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5Property Description (Address, City, State, Zip)
_________________________________________________________________
PROPERTY DISCLOSURE DOCUMENT FOR RESIDENTIAL REAL ESTATE
Answer all questions to the best of your knowledge. Explain any “yes” answers fully at the end of each section.
Y = yes
N= no
NK = no knowledge
SECTION 1: LAND
(1) Lot size or acres ________________
(2) Are there any servitudes/encroachments regarding the property, other than typical/customary utility
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servitudes, that would affect the use of the property?
Y
N
NK
(3) Are there any rights vested in others? Check all that applies and explain at the end of this section.
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Y
N
NK
Y
N
NK
Timber rights
Common driveway
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Right of ingress or egress
Y
N
NK
Mineral rights
Y
N
NK
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Y
N
NK
Y
N
NK
Right of way
Surface rights
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Right of access
Y
N
NK
Air rights
Y
N
NK
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Y
N
NK
Y
N
NK
Servitude of passage
Usufruct
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Servitude of drainage
Y
N
NK
Other ____________
Y
N
NK
(4) Has any part of the property been determined a wetland by the United States Army Corps of Engineers
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Y
N
NK
under §404 of the Clean Water Act?
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(a) Is such a determination pending?
Y
N
NK
(b) What date was determination made? __________________
The Clean Water Act is a federal law that protects the wetlands of the United States. Section 404 of the Act contains
permit requirements for altering or building on property that has been determined a wetland by the Army Corps of
Engineers. The Corps may assess a fee to the SELLER or PURCHASER of a property for this determination. A
property that has been determined a wetland may result in additional costs for a Section 404 permit. Documentation
is attached and becomes a part of this property disclosure if the property described herein has been determined a
wetland by the Corps.
(5) Has any flooding, water intrusion, accumulation, or drainage problem been experienced with respect to
the land? If yes, indicate the nature and frequency of the defect at the end of this section.
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Y
N
NK
(6) What is/are the flood zone classification(s) of the property? __________
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(a) What is the source and date of this information? (Check all that apply)
Survey/Date ____________
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Flood Elevation Certificate/Date ____________
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Question Number
Explanation of “Yes” answers
Additional sheet is attached
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
SECTION 2: TERMITES, WOOD-DESTROYING INSECTS AND ORGANISMS
(7) Has the property ever had termites or other wood-destroying insects or organisms?
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Y
N
NK
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(8) Was there any damage to the property?
Y
N
NK
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(9) Was the damage repaired?
Y
N
NK
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(10) Is the property currently under a termite contract?
Y
N
NK
(a) Name of company ______________________________________________
(b) Date contract expires ___________________________________________
(c) List any structures not covered by contract _______________________________________________________
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Question Number
Explanation of “Yes” answers
Additional sheet is attached
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
LREC Rev. 08/01/13
Seller’s Initials: _____ _____
Purchaser’s Initials: _____ _____
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