Property Condition Disclosure Statement

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PROPERTY CONDITION DISCLOSURE STATEMENT
The following is a Property Condition Disclosure required by Sections 89-1-507 through 89-1-527 of the Mississippi Real
Estate Brokers Act of 1954, as Amended, and made by the SELLER(S) concerning the condition of the RESIDENTIAL
PROPERTY located at: _______________________________________________________________________________
SELLER(S):____________________________________________________ Approximate Age of the Residence______
This Disclosure is not a warranty of any kind by the Seller or any Real Estate Agent of the Seller in this transaction and is
not a substitute for any inspections or warranties the Purchaser may wish to obtain. This statement may be made available
to other parties and is to be attached to the Listing Agreement and signed by the SELLER(S).
TO THE SELLER(S): Please complete the following form, including any past history of problems, if known. If the
condition or question does not apply to your property, mark with “N/A”.
IF THE RESIDENCE IS NEW/PROPOSED RESIDENTIAL CONSTRUCTION, the BUILDER should complete the
Property Condition Disclosure Statement and reference specific plans/specifications, materials lists and/or change orders.
DO NOT LEAVE ANY BLANK SPACES. ATTACH ADDITIONAL PAGES IF
NECESSARY. THIS FORM MAY BE DUPLICATED BUT NOT ALTERED
STRUCTURAL ITEMS:
A.
BUILDING CODE:
Was the residence built in conformity with an approved building code? Yes _____ No _____ Unknown _______
If yes, was it inspected by a City/County Code Enforcement Inspector? Yes _____ No _____ Unknown _______
Has a Mississippi Licensed Home Inspector completed a Home Inspection Report? Yes _____ No _____
B.
STRUCTURAL ITEMS:
Are you aware of any foundation repairs made in the past? Yes _____ No _____ Explain ____________________
Are any foundation repairs currently needed? Yes _____ No _____ Explain _____________________________
C.
HISTORY OF INFESTATION, IF ANY: TERMITES, CARPENTER ANTS, ETC:
Any evidence of rot, mildew, vermin, rodents, termites, carpenter ants, or other infestation? Yes _____ No _____
Have you requested treatments for any type of infestations? Yes _____ No _____ Explain___________________
Are you aware of any Repaired Damage? Yes _____ No_____; If yes, please describe_______________________
Is there currently an outstanding termite contract? Yes _____ No _____ Who is the contractor? ______________
D.
ROOF:
Has the roof been replaced or repaired during your ownership? Yes _____ No _____; If yes, when? ___________
During your ownership have there been any leaks, water back ups, or problems with the roof? Yes ____ No_____
The roof is _____ years old.
E.
LAND AND SITE DATA:
Is there an engineer’s survey available? Yes _____ No _____
Date the survey was completed______________
Are you aware of the existence of any of the following, to wit:
Encroachments: Yes ___ No ___ Unknown ___
Flood Zone:
Yes ___ No ___ Unknown ____
Easements:
Yes ___ No ___ Unknown ___
Soil/Erosion:
Yes ___ No ___ Unknown ____
Soil Problems:
Yes ___ No ___ Unknown ___
Subsoil Problem: Yes___ No___ Unknown_____
Standing Water: Yes ___ No ___ Unknown ___
Land Fill:
Yes___ No___ Unknown_____
Are you aware of any current zoning regulations which will cause the residence to be considered a nonconforming
usage (lot size, set backs, etc) Yes ____ No ____ If Yes, please explain _________________________________
Are there any rights-of-way, easements, eminent domain proceedings or similar matters which may negatively
impact your ownership interest in the residence? Yes _____ No _____ If YES, please explain ________________
FOR ANY REASON, has any portion of the residence ever suffered water damage? Yes _____ No ____ If yes,
please explain in detail ______________. Is the residence currently located in a FEMA Designated Flood Hazard
Zone? Yes ___ No ___ Unknown _____; Is Flood Insurance required? Yes _____ No _____ Unknown _________
Is any portion of the property designated as a WETLANDS AREA? Yes _____ No _____ Unknown__________
F.
ADDITIONS/REMODELS:
During your period of ownership, have there been any additions, remodeling, structural changes or alterations to
the residence? Yes ____ No _____ If YES, please explain _____________________________________________
Name of the Licensed Contractor______________________. Were all work permits and approvals in compliance
with the local building codes? Yes _____ No ____ Please Explain ______________________________________
G.
STRUCTURE/WALLS/ WINDOWS:
Has there been any damage to the structure as a result of fire, windstorm, tornados, hurricane or any other natural
disaster? Yes ___ No ___ If YES, please explain ___________________________________________________
Have you ever experienced ANY problems with walls, siding or windows? Yes ___ No ___ Explain __________
H.
OTHER:
Are you aware of any problems which may exist with the property by virtue of prior usages such as, but not
limited to, Methamphetamine Labs, Hazardous/Toxic waste disposal, the presence of asbestos components,
Lead-Based Paint, Urea-Formaldehyde Insulation, Mold, Radon Gas, Underground Tanks or any past industrial
uses of the premises? Yes ___ No ___ If “YES, please explain _________________________________________
SELLER’S INITIALS __________
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PURCHASER’S INITIALS __________

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