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Seller's Disclosure StatementProperty Address: _______________________________________________________ Street _________________________________________________________,Michigan City, Village, or Township Purpose of Statement: This statement is a disclosure of the condition of the property in compliance with the seller disclosure act. This statement is a disclosure of the condition and information concerning the property, known by the seller. Unless otherwise advised, the seller does not possess any expertise in construction, architecture, engineering, or any other specific area related to the construction or condition of the improvements on the property or the land. Also, unless otherwise advised, the seller has not conducted any inspection of generally inaccessible areas such as the foundation or roof. This statement is not a warranty of any kind by the seller or by any agent representing the seller in this transaction, and is not a substitute for any inspections or warranties the buyer may wish to obtain. Seller's Disclosure: The seller discloses the following information with the knowledge that even though this is not a warranty, the seller specifically makes the following representations based on the seller's knowledge at the signing of this document. Upon receiving this statement from the seller, the seller's agent is required to provide a copy to the buyer or the agent of the buyer. The seller authorizes its agent(s) to provide a copy of this statement to any prospective buyer in connection with any actual or anticipated sale of property. The following are representations made solely by the seller and are not the representations of the seller's agent(s), if any. This information is a disclosure only and is not intended to be a part of any contract between buyer and seller. Instructions to seller: (1) Answer ALL questions. (2) Report known conditions affecting the property. (3) Attach additional pages with your signature if additional space is required. (4) Complete this form yourself. (5) If some items do not apply to your property check N/A (nonapplicable). If you do not know the facts, check UNKNOWN. FAILURE TO PROVIDE A PURCHASER WITH A SIGNED DISCLOSURE STATEMENT WILL ENABLE A PURCHASER TO TERMINATE AN OTHERWISE BINDING PURCHASE AGREEMENT. Appliances/Systems/Services: The items below are in working order: Yes No Unknown N/A (Does not apply) Range/Oven ___________ ___________ ___________ ___________ Dishwasher ___________ ___________ ___________ ___________ Refrigerator ___________ ___________ ___________ ___________ Hood/Fan ___________ ___________ ___________ ___________ Disposal ___________ ___________ ___________ ___________ TV Antenna, TV rotor & controls ___________ ___________ ___________ ___________ Electrical System ___________ ___________ ___________ ___________ Garage door opener & remote control ___________ ___________ ___________ ___________ Alarm system ___________ ___________ ___________ ___________ Intercom ___________ ___________ ___________ ___________ Central Vac ___________ ___________ ___________ ___________ Attic fan ___________ ___________ ___________ ___________ Pool heater, Wall liner & Equipment ___________ ___________ ___________ ___________ Microwave ___________ ___________ ___________ ___________ Trash Comp ___________ ___________ ___________ ___________ Ceiling fan ___________ ___________ ___________ __________ Sauna/HotTb ___________ ___________ ___________ ___________ Lawn sprinkler ___________ ___________ ___________ ___________ Water heater ___________ ___________ ___________ ___________ Plumbing Sys ___________ ___________ ___________ ___________ Water softener / conditioner ___________ ___________ ___________ ___________ Well & Pump ___________ ___________ ___________ ___________ Septic tank & drain field ___________ ___________ ___________ ___________ Sump pump ___________ ___________ ___________ ___________ City Water ___________ ___________ ___________ ___________ City Sewer ___________ ___________ ___________ ___________ Central Air ___________ ___________ ___________ ___________ Central Heat ___________ ___________ ___________ ___________ Furnace ___________ ___________ ___________ ___________ Humidifier ___________ ___________ ___________ ___________ Air filter ___________ ___________ ___________ ___________ SolarHeating ___________ ___________ ___________ ___________ Fireplace ___________ ___________ ___________ ___________ Wood burning system ___________ ___________ ___________ ___________ Explanations (attach additional sheets if necessary): --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- UNLESS OTHERWISE AGREED, ALL HOUSEHOLD APPLIANCES ARE SOLD IN WORKING ORDER EXCEPT AS NOTED, WITHOUT WARRANTY BEYOND DATE OF CLOSING. Property conditions, improvements & additional information: 1. Basement: Has there been evidence of water? If yes, please explain: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Insulation: Describe, if known _________________________________ Urea Formaldehyde Foam Insulation (UFFI) is installed? 3. Roof: Leaks? Approximate age if known _____________________________ 4. Well: Type of well (depth/diameter, age and repair history, if known ___________________________________________________________ Has the water been tested? 5. Septic tanks/drain fields: Condition, if known ____________________ ______________________________________________________________________ 6. Heating system: Type/approximate age: _____________________________ 7. Plumbing system: Type: copper _____ galvanized _____ other _____ Any known problems? ______________________________________________________ 8. Electrical system: Any known problems?_____________________________ ______________________________________________________________________ 9. History of infestation, if any: (termites, carpenter ants, etc.) __ ______________________________________________________________________ 10. Environmental Problems: Substances, materials or products that may be an environmental hazard such as, but not limited to, asbestos, radon gas, formaldehyde, lead-based paint, fuel or chemical storage tanks and contaminated soil on the property. If yes, please explain:_____________ _______________________________________________________________________ _______________________________________________________________________ Other Items: Are you aware of any of the following: 1. Features of the property shared in common with the adjoining landowners, such as walls, fences, roads and driveways, or other features whose use or responsibility for maintenance may have an effect on the property? 2. Any encroachments, easements, zoning violations, or nonconforming uses? 3. Any "common areas" (facilities like pools, tennis courts, walkways, or other areas co-owned with others), or a homeowners' association that has any authority over the property? 4. Structural modifications, alterations, or repairs made without necessary permits or licensed contractors? 5. Settling, flooding, drainage, structural, or grading problems? 6. Major damage to the property from fire, wind, floods, or landslides? 7. Any underground storage tanks? 8. Any area environmental concerns (i.e., proximity to a landfill, airport, shooting range, etc.)? If the answer to any of these questions is yes, please explain. Attach additional sheets, if necessary: --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- The most recent state equalized valuation of the property provided by the local taxing unit to the seller was $___________ as of _____________ (date). The seller has lived in the residence on the property from __________ (date) to __________ (date). The seller has owned the property since _________ (date) and makes representation only since that date. The seller has indicated above the history and condition of all the items based on that information known to the seller. If any changes occur in the structural/mechanical/appliance systems of this property from the date of this form to the date of closing, seller will immediately disclose the changes to buyer. In no event shall the parties hold the broker liable for any representations not directly made by the broker or broker's agent. Seller certifies that the information in this statement is true and correct to the best of seller's knowledge as of the date of seller's signature. BUYER SHOULD OBTAIN PROFESSIONAL ADVICE AND INSPECTIONS OF THE PROPERTY TO MORE FULLY DETERMINE THE CONDITION OF THE PROPERTY Seller ______________________________________________ Date _____________ Seller ______________________________________________ Date _____________ Buyer has read and acknowledges receipt of this statement. Buyer _______________________________________________ Date _____________ Buyer _______________________________________________ Date _____________ |
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