Informational Statement For Louisiana Residential Property Disclosure Form Page 4
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5Property Description (Address, City, State, Zip)
_________________________________________________________________
Y =
N=
NK =
YES
NO
NO KNOWLEDGE
SECTION 5: ELECTRICAL, HEATING AND COOLING, APPLIANCES
For major repairs or replacements relative to Section 5, list the date and nature of the repair or replaced component at the end of the
section.
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(23) Are there any defects with the electrical system?
Y
N
NK
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(24) Are there any defects with the heating or cooling systems?
Y
N
NK
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(25) What type of cooling system is installed?
Central
Window unit
Other
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(a) Source:
Electric
Gas
Heat pump
Other
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(26) What type of heating system is installed?
Central
Window unit
Other
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(a) Source:
Electric
Gas
Heat pump
Other
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(27) If a fireplace exists, is it working?
Y
N
NK
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(a) What type is it?
Gas
Wood
Vented
Vent less
Electric
Other
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(28) Are there any defects in any permanently installed or built-in appliances?
Y
N
NK
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(29) What type of fire alarm system is installed?
None
Security/fire alarm
Battery powered unit that
includes a 10-year sealed lithium battery
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Question Number
Explanation of “Yes” answers
Additional sheet is attached
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
SECTION 6: MISCELLANEOUS
(30) Are there any applicable building restrictions or restrictive covenants which may provide for restrictions as to the use
of the property or as to the type of constructions or materials to be used in the construction of any structure on the
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property?
Y
N
NK
(31) Has there been property damage related to the land or the improvements thereon, including, but not limited to, fire,
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windstorm, flood, hail, lightning, or other property damage?
Y
N
NK
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(a) If yes, were all related property damages, defects, and/or conditions repaired?
Y
N
NK
(32) What is the zoning of the property? __________________
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(a) Has it ever been zoned for commercial or industrial?
Y
N
NK
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(b) Is the property located in an historic district?
Y
N
NK
(33) Does the property and its present usage conflict with current zoning, building, and/or safety restrictions?
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Y
N
NK
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(34) Are there any current or pending assessments, dues, liens, taxes owing on the property?
Y
N
NK
(a) Is membership in a homeowners’ association (HOA), condominium owners’ association (COA), or property owners’
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association (POA) required as the result of owning this property?
Y
N
NK
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(b) Are any HOA, COA, or POA dues required?
Y
N
NK
(c) If yes, what is the amount? $_________ per _________
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(d) Are there any pending special assessments?
Y
N
NK
(e) If yes, what is the amount? $_________ per _________
Any information contained in this property disclosure regarding homeowners’ associations (HOA), condominium
owners’ associations (COA), or property owners’ associations (POA) is summary in nature. The covenants and
association governing documents are a matter of public record and can be obtained from the conveyance records on
file at the Clerk of Court in the parish where the property is located.
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Y
N
NK
(35) Was SELLER (or previous owner) a recipient of a Road Home grant?
If YES, complete (a) – (f) below.
(a) Is the property subject to the Road Home Declaration of Covenants Running with the Land, Hurricane
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Y
N
NK
Katrina/Hurricane Rita?
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(b) If YES, is a copy of the Road Home Program Declaration of Covenants attached?
Y
N
(c) If YES, what is the amount received? $_____________________
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Y
N
(d) Has SELLER personally assumed any terms of the Road Home Program Grant Agreement?
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(e) Was SELLER (or previous owner) a recipient of any elevation grant funds?
Y
N
(f) If YES, what is the amount received? $_____________________
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NK
(36) Are the streets accessing the property
Private
Public
Seller’s Initials: _____ _____
Purchaser’s Initials: _____ _____
LREC Rev. 08/01/13
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