Seller's Residential Disclosure

Important NoticeSeller states that the information contained in this Disclosure is correct to the best of Seller’s CURRENT ACTUAL KNOWLEDGE as of the date signed. This disclosure is not a warranty by the owner or the owner’s agent and may not be used as a substitute for any inspections or warranties that the prospective buyer may obtain.

Property Information

Property Address *

Disclosure Date *

Seller Name(s) *

Seller Email *

Seller Phone

1A. Appliances

Definition of “Defect”A condition that would have a significant adverse effect on the value of the property, significantly impair the health or safety of future occupants, or if not repaired, removed, or replaced would significantly shorten or adversely affect the expected normal life of the premises.

Item	None / Not Included	Defective	Not Defective	Do Not Know

1B. Electrical System

Item	None / Not Included	Defective	Not Defective	Do Not Know

Amp Service

1C. Water & Sewer System

Item	None / Not Included	Defective	Not Defective	Do Not Know

Question	Yes	No	Do Not Know
Are the structures connected to a public water system?
Are the structures connected to a public sewer system?
Are the improvements connected to a private/community water system?
Are the improvements connected to a private/community sewer system?
Are there any additions that may require improvements to the sewage disposal system?
If yes, have the improvements been completed?

1D. Heating & Cooling System

Item	None / Not Included	Defective	Not Defective	Do Not Know

2. Roof

Age of Roof (if known)

Question	Yes	No	Do Not Know
Does the roof leak?
Is there present damage to the roof?
Is there more than one layer of shingles?

If yes, how many layers?

3. Hazardous Conditions

Question	Yes	No	DNK
Have there been or are there any hazardous conditions on the property (methane gas, lead paint, radon, radioactive material, landfill, mineshaft, expansive soil, toxic materials, mold, biological contaminants, asbestos, PCBs)?
Is there contamination caused by manufacture of a controlled substance not certified as decontaminated (IC 13-14-1-15)?
Has there been manufacture of methamphetamine or dumping of waste from manufacture of methamphetamine?

4. Other Disclosures

Question	Yes	No	DNK

Additional Comments

Additional comments or explanations

Signatures

The seller(s) certify the above information is true and correct to the best of their current actual knowledge. The buyer(s) acknowledge receipt of this disclosure.

Seller Signatures

Seller 1 *

Sign here

Date

Seller 2 (optional)

Sign here

Date

Buyer Signatures (At Closing)

Buyer 1

Sign here

Date

Buyer 2

Sign here

Date

Your form will be emailed to Tina Browning with a copy sent to your email address.

Seller’s Residential Disclosure

Property Information

1A. Appliances

1B. Electrical System

1C. Water & Sewer System

1D. Heating & Cooling System

2. Roof

3. Hazardous Conditions

4. Other Disclosures

Additional Comments

Signatures

Seller Signatures

Seller 1 *

Seller 2 (optional)

Buyer Signatures (At Closing)

Buyer 1

Buyer 2