|
YES |
NO |
N/A |
|
| 1. |
___ |
___ |
___ |
Seller has occupied the
property within the last 12 months. (No explanation is needed). |
| 2. |
___ |
___ |
___ |
I am aware of flooding
or recurring leakage problems in the crawlspace or basement. |
| 3. |
___ |
___ |
___ |
I am aware that the
property is located in a flood plain or that I currently have
flood hazard insurance on the property. |
| 4. |
___ |
___ |
___ |
I am aware of material
defects in the basement or foundation (including cracks and
bulges). |
| 5. |
___ |
___ |
___ |
I am aware of leaks or
material defects in the roof, ceilings or chimney. |
| 6. |
___ |
___ |
___ |
I am aware of material
defects in the walls or floors. |
| 7. |
___ |
___ |
___ |
I am aware of material
defects in the electrical system. |
| 8. |
___ |
___ |
___ |
I am aware of material
defects in the plumbing system (includes such things as water
heater, sump pump, water treatment system, sprinkler system, and
swimming pool). |
| 9. |
___ |
___ |
___ |
I am aware of material
defects in the well or well equipment. |
| 10. |
___ |
___ |
___ |
I am aware of unsafe
conditions in the drinking water. |
| 11. |
___ |
___ |
___ |
I am aware of material
defects in the heating, air conditioning, or ventilating
systems. |
| 12. |
___ |
___ |
___ |
I am aware of material
defects in the fireplace or wood burning stove. |
| 13. |
___ |
___ |
___ |
I am aware of
material defects in the septic, sanitary sewer, or other
disposal system. |
| 14. |
___ |
___ |
___ |
I am aware of unsafe
concentrations of radon on the premises. |
| 15. |
___ |
___ |
___ |
I am aware of unsafe
concentrations or unsafe conditions relating to asbestos on the
premises. |
| 16. |
___ |
___ |
___ |
I am aware of unsafe
concentrations of or unsafe conditions relating to lead paint,
lead water pipes, lead plumbing pipes or lead in the soil on the
premises. |
| 17. |
___ |
___ |
___ |
I am aware of mine
subsidence, underground pits, settlement, sliding, upheaval, or
other earth stability defects on the premises. |
| 18. |
___ |
___ |
___ |
I am aware of current
infestations of termites or other wood boring insects. |
| 19. |
___ |
___ |
___ |
I am aware of structural
defect caused by previous infestations of termites or other wood
boring insects. |
| 20. |
___ |
___ |
___ |
I am aware of
underground fuel storage tanks on the property. |
| 21. |
___ |
___ |
___ |
I am aware of boundary
or lot line disputes. |
| 22. |
___ |
___ |
___ |
I have received notice
of violation of local, state or federal laws or regulations
relating to this property, which violation has not been
corrected. |