Historic Property Disclosure Statement
Property Information
Property Address
Year Built
Historic Designation
Tax Parcel Number
Owner Information
Owner Name(s)
Contact Information
Historic Status
Is the property listed on a historic register?
If yes, which register?
Date of Designation
Modifications / Renovations
List any significant modifications or renovations made to the property
Were appropriate permits and approvals obtained?
Property Condition
Known issues affecting the historic character or structure
Past repairs or restoration work
Restrictions / Easements
Is the property subject to any historic preservation restrictions or easements?
If yes, describe
Additional Disclosures
Other relevant information or disclosures
Certification
I/We certify that the above statements are true and correct to the best of my/our knowledge.
Owner Signature
Date