Property Condition Disclosure Statement Page 2
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1
2MECHANICAL ITEMS:
ELECTRICAL SYSTEM/PLUMBING SYSTEM:
Are you aware of any problems or conditions that affect the desirability or functionality of the Heating, Cooling,
Electrical, Plumbing, or Mechanical Systems? Yes ____ No ____ If yes, please explain all known problems in
complete detail _______________________________________________________________________________
WATER, SEWER, & SEPTIC ITEMS:
WATER:
The water supply is: Public _____ Private ____ On-site Well ____ Neighbor’s Well ____ Community______
If your drinking water is from a well, when was the water quality last checked for safety, what were the results of
the test and who conducted the test? ______________________________________________________________
Is the water supply equipped with a water softener? Yes _____ No _____ Unknown _____
The Sewage System is: Public ____ Private ____ Septic ____ Cesspool ____ Treatment Plant ____ Other _____
Is there a sewage pump installed? Yes ____ No ____ Date of the last Septic Inspection ____________________
Are you aware of any leaks, back-ups, or other problems relating to any of the plumbing, water, sewage, or related
items during your ownership? Yes ____ No ____. If yes, please explain ________________________________
OTHER MATTERS/ITEMS:
MISCELLANEOUS:
Is the residence situated on Leasehold or Sixteenth Section land? Yes _____ No _____ Explain ______________
Is there any existing or threatening legal action affecting the property? Yes ____ No ____ Explain____________
Are you aware of any violations of local/state/federal laws/regulations relating to the property? Yes ____ No ____
Are you aware of any hidden defects or needed repairs about which the purchaser should be informed PRIOR to
their purchase? Yes ____ No ___ If yes, please explain in detail _______________________________________
What is the APPROXIMATE SQUARE FOOTAGE of the Heated and Cooled Living Area ________________
How was this approximation of square footage determined? ___________________________________________
Are there any finished wood floors beneath the floor coverings? Yes ____ No ____ Where __________________
Are there any Homeowner’s Association Fees associated with ownership? Yes ____ No ____ Amount _________
If the property is a Condominium, how much is the YEARLY Maintenance Fees $_________________________
What is the YEARLY Real Estate Tax Bill? $__________ Homestead Exemption has been filed for __________
Is the property subject to ANY special real property tax assessments Yes _____ No _____ Explain ____________
Is the property located in a Public Improvement (tax) District (PID) Yes _____ No _____ Unknown _________
What is the average YEARLY Electric Bill? $_______ What is the average YEARLY Gas Bill? $___________
If the residence is serviced by Propane (LP) Gas, what is the average YEARLY Propane Bill? $______________
The Propane Tank is: Owned ______ Leased ______ If Leased, how much is the lease payment? $__________
Is Cable Television Service available at the site? Yes ____ No ____ Service Provider ______________________
Are any items remaining with the residence financed separately from the mortgages? Yes ____ No ___
APPLIANCES/SYSTEMS REMAINING WITH RESIDENCE:
ITEM
YES
NO
GAS/ELECTRIC
AGE
LIST REPAIRS COMPETED
IN LAST TWO (2) YEARS
Cook-top
Dishwasher
Garbage Disposal
Ice-maker
Microwave
Oven(s)
Trash Compactor
Vent-Fan
Other Items
MECHANICAL EQUIPMENT CONSIDERED PERSONAL PROPERTY SHOULD BE NEGOTIATED IN THE
CONTRACT OF SALE OR OTHER SUCH INSTRUMENT IF THE ITEMS REMAIN WITH THE RESIDENCE.
To the extent of the Seller’s knowledge as a property owner, the Seller(s) acknowledges that the information contained
above is true and accurate for those areas of the property listed. The owner(s) agree to save and hold the Broker harmless
from all claims, disputes, litigation and/or judgments arising from any incorrect information supplied by the owner(s) or
from any material fact known by the owner(s) which owner(s) fail to disclose except the Broker is not held harmless to the
owner(s) in claims, disputes, litigation, or judgments arising from conditions of which the Broker had actual knowledge.
_______________________________________
_________________________________________
SELLER (UPON LISTING)
DATE
SELLER (UPON LISTING)
DATE
_______________________________________
_________________________________________
SELLER (AT CLOSING)
DATE
SELLER (AT CLOSING)
DATE
PROSPECTIVE PURCHASER’S SIGNATURE ___________________________________________________________
PURCHASER(S) ACKNOWLEDGE RECEIPT OF REPORT
DATE
MREC FORM #0100
Page 3 of 3
EFFECTIVE DATE: JULY 1, 2008
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