Property Information

Property Address

City

State

Zip Code

Seller Information

Seller Name(s)

Phone Number(s)

General Condition of Property

Describe the general condition of the property

Appliances & Systems

Heating Air Conditioning Plumbing Electrical Water Heater Other

Any Known Issues or Malfunctions?

Structural & Other Issues

Are there any known structural problems (foundation, roof, walls, etc.)? Have there been any water leaks or flooding? Any pest infestations or environmental hazards?

Legal & Regulatory Disclosures

Are there any legal or regulatory issues affecting the property? Are there any liens, assessments, or encroachments?

Additional Disclosures or Comments

Seller Certification

I/we certify that the information provided in this disclosure statement is true and complete to the best of my/our knowledge as of the date signed below.

Seller Signature

Date

Seller Signature (if applicable)