Tennessee Residential Property Condition Disclosure Template Page 3
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3C. Is Seller AWARE of any of the following:
YES NO N/A
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1. Substances, materials or products which may be environmental hazards such as, but not limited to: asbestos,
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radon gas, lead-based paint, fuel or chemical storage tanks, methamphetamine, contaminated soil or water,
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and/or known existing or past mold presence on the subject property?
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2. Features shared in common with adjoining land owners with joint rights and obligations for use and maintenance
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(e.g. - driveways, private roads, walls, fences, wells, septic systems, etc)?
120
3. Any authorized changes in roads, drainage or utilities affecting the property, or contiguous to the property?
121
4. Any changes since the most recent survey of the property was done? (Most recent survey of property: _______)
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5. Any encroachments, easements, or similar items that may affect your ownership interest in the property?
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6. Room additions, structural modifications or other alterations or repairs made without necessary permits?
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7. Room additions, structural modifications, other alterations or repairs not in compliance with building codes?
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8. Landfill (compacted or otherwise) on the property or any portion thereof?
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9. Any settling from any cause, or slippage, sliding or other soil problems?
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10. Flooding, drainage or grading problems?
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11. Any requirement that flood insurance be maintained on the property?
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12. Any of the property located in a designated flood hazard area?
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13. Any past or present interior water intrusions(s), standing water within foundation and/or basement?
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14. Property or structural damage from fire, earthquake, floods, landslides, tremors, wind, storm, or wood
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destroying organisms (such as termites, mold, etc.)?
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15. Any zoning violations, nonconforming uses and/or violations of “setback” requirements?
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16. Neighborhood noise problems or other nuisances?
135
17. Subdivision and/or deed restrictions or obligations?
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18. Any “common area” (pools, tennis courts, walkways, etc), co-owned in undivided interest with others?
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19. Any notices of abatement or citations against the property?
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20. Any lawsuit(s) or proposed lawsuit(s) by or against the seller which affects or will affect the property?
139
21. Any system, equipment or part of the property that is being leased? (e.g. security system, water softener,
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satellite dish, etc.) Lease payoffs or assumptions should be addressed in the purchase contract.
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22. Any exterior wall covered with exterior insulation and finish systems (EIFS, or synthetic stucco)?
142
If yes, has there been a recent inspection to determine whether the structure has excessive moisture
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accumulation and/or moisture related damage? [explain below] (The Tennessee Real Estate Commission
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urges any buyer or seller who encounters this product to have a qualified professional inspect the property)
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23. Any finished rooms that are not supplied with heating and air conditioning?
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24. Any septic tank or other private disposal system that does not have adequate capacity and approved design
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to comply with present state and local requirements for the actual land area and number of bedrooms?
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If residence is on a septic system, the septic system is legally permitted for _______ number of bedrooms.
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25. The property is affected by covenants, conditions, restrictions (CCR’s), or Home Owner Association by-laws
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requiring approval for changes, use, or alterations to the property?
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26. The property is in an historical district or has been declared historical by a governmental authority and
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permission must be obtained before certain improvements or aesthetic changes to the property are made?
If any of the above in Part C are marked YES, please explain:
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Seller certifies that this information is true and correct to the best of seller’s knowledge as of the date signed.
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X________________________________________________ X____________________________________________________
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Seller Signature
Date & Time
Seller Signature
Date & Time
Buyer understands that this Disclosure is not intended as a substitute for any inspection, and that buyer has a responsibility
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to pay diligent attention to and inquire about defects which are evident by careful observation. Buyer acknowledges receipt
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of a copy of this Disclosure.
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X________________________________________________ X____________________________________________________
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Buyer Signature
Date & Time
Buyer Signature
Date & Time
NOTE: Seller must give buyer a Final Property Condition Disclosure (separate form) at or before closing to disclose any material
changes that may have occurred, or to certify that there were no changes since the time of this Disclosure.
Page 3 of 3
Modified on 01/01/2013
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