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SELLER’S STATEMENT OF EXCLUSION FROM COMPLETING THE PROPERTY CONDITION DISCLOSURE STATEMENT (PCDS)

SELLER’S STATEMENT OF EXCLUSION FROM COMPLETING THE
PROPERTY CONDITION DISCLOSURE STATEMENT (PCDS)

In accordance with Sections 89-1-501 through 89-1-527 of the Mississippi Code of 1954, as amended, a TRANSFEROR (SELLER) of residential real property consisting of not less than one (1) nor more than four (4) dwelling units shall provide a Property Condition Disclosure Statement when the transfer is by, or with the aid of, a duly licensed real estate broker or salesperson. The required Property Condition Disclosure Statement shall be in the form promulgated by the Mississippi Real Estate Commission (MREC) or on another form that contains the identical information. The Property Condition Disclosure Statement may not be personalized in any fashion. All “Forms” which have been promulgated and approved by the Real Estate Commission for use by licensees in real estate transactions may be found at www.mrec.ms.gov.

DUTY OF LICENSEE AND CONSEQUENCES OF FAILURE TO FULFILL SUCH DUTIES:

The Mississippi Statute requires real estate licensees to personally inform clients of the duties and rights associated with the Property Condition Disclosure Statement. The failure of any licensee to inform their client of those responsibilities could subject the licensee (salesperson and broker) to censure, suspension, or revocation of their respective real estate licenses.

WHEN IS A FULLY COMPLETED PCDS REQUIRED:

Typically, a Transferor/Seller’s statutory obligation to furnish a fully completed PCDS applies to the transfer of any interest in applicable residential real property, whether by sale, exchange, installment land contract, lease with an option to purchase, option to purchase or ground lease coupled with improvements. Additionally, the state statute REQUIRES a Transferor/Seller to disclose all personal knowledge about a residential property which would be material to a buyer deciding to purchase the property.

However, the following transfers are EXCLUDED (in part) from the requirement to provide a fully completed PCDS.

1. Transfers pursuant to a court order, to include:

a. Transfer by order of a probate court in the administration of an estate.

b. Transfer pursuant to a writ of execution.

c. Transfer by any foreclosure sale.

d. Transfer by a Trustee in Bankruptcy.

e. Transfer by an eminent domain proceeding.

f. Transfer from a decree of specific performance.

g. Transfer by a fiduciary in the administration of an estate or trust.

2. Transfers by a Mortgagor who is in default to the Mortgagee. a. Transfer to a beneficiary of a deed of trust.

b. Transfer by a foreclosure sale after default on a Mortgage

c. Transfer by a Mortgagee or a beneficiary following a foreclosure.

d. Transfer by a deed in lieu of foreclosure.

3. Transfer from one co-owner to one or more co-owners.

4. Transfers to a spouse of a person in the lineal line of consanguinity.

5. Transfers to or from any governmental entity.

6. Transfers of real property on which no dwelling is located.

7. Transfers involving transactions described in §89-1-527 of the Real Estate Brokers Act.

EXCLUSIONS: In accordance with §89-1-501 of the Mississippi Code, Annotated and the Mississippi Legislature, the SELLER of the residential property located at _______________________________in ____________________________, Mississippi, is excluded/exempt from the requirement to provide a fully completed PCDS based on Item #_________ listed above (Example: #1).
___________________________________ SELLER (SIGN) (DATE)
___________________________________ (NAME-REAL ESTATE BROKERAGE)
_______________________________________ SELLER (SIGN) (DATE)
_______________________________________ REAL ESTATE LICENSEE

INFORMATIONAL STATEMENT FOR MISSISSIPPI PROPERTY CONDITION DISCLOSURE STATEMENT (PCDS)

INFORMATIONAL STATEMENT FOR MISSISSIPPI PROPERTY CONDITION
DISCLOSURE STATEMENT (PCDS)

In accordance with Sections 89-1-501 through 89-1-527 of the Mississippi Code of 1954, as amended,

A TRANSFEROR/SELLER of real property consisting of not less than one (1) nor more than four (4) dwelling units shall provide a Property Condition Disclosure Statement when the transfer is by, or with the aid of, a duly licensed real estate broker or salesperson.

The required Property Condition Disclosure Statement shall be in the form promulgated by the Mississippi Real Estate Commission (MREC) or on another form that contains the identical information.

The Property Condition Disclosure Statement may not be personalized in any fashion.

All “Forms” which have been promulgated and approved by the Real Estate Commission for use by licensees in real estate transactions may be found at www.mrec.ms.gov.

PURCHASER RIGHTS & CONSEQUENCES OF FAILURE TO DISCLOSE:

If the PCDS is delivered after the Transferee/Buyer has made an offer, the transferee may terminate any resulting real estate contract or withdraw any offer for a time period of three (3) days after the delivery in person or five (5) days after the delivery by deposit in mail.

This termination or withdrawal will always be without penalty to the Transferee and any deposit or earnest money must be promptly returned to the prospective purchaser (despite any agreement to the contrary).

LICENSEE DUTIES & CONSEQUENCES OF FAILURE TO FULFILL DUTIES:

The Mississippi Statute requires real estate licensees to inform their clients of those clients’ duties and rights in association with the completion of the Property Condition Disclosure Statement.

The failure of any licensee to inform their client of the clients’ responsibilities could subject the licensee (salesperson and broker) to censure, suspension, or revocation of their respective real estate licenses.

The licensee is not liable for any error, inaccuracy or omission in a Property Condition Disclosure Statement UNLESS the licensee has actual knowledge of the error, inaccuracy or omission by the Transferor/Seller.

IMPORTANT PROVISIONS OF THE LAW:

**The PCDS shall not be considered as a warranty by the Transferor/Seller.

**The PCDS is for “disclosure” purposes only and should NOT be included or become a
part of any contract between the Transferor/Seller and the Transferee/Buyer.

**The PCDS may not be used as a substitute for a home inspection by a Mississippi Licensed Home Inspector or for the issuance of any Home Warranty Policy that the
Transferor/Seller or Transferee/Buyer may obtain.

**The purchase or sale of any Appliances or items considered Personal Property should
be negotiated by the Parties as part of the Contract of Sale and the ownership interest(s) should be transferred by a Bill of Sale.

LIMITATION TO EXCLUSIONS/EXEMPTIONS:

If, during the period of ownership, the Transferor/Seller has requested or authorized any repairs, has replaced or repaired any of the mechanical equipment, has initiated any action or activity which could be documented on the PCDS or has actual knowledge of information which might impact a transferee’s/buyer’s decision to purchase the residence, Transferors/Sellers are obligated to complete those specific portions of the PCDS which are applicable to that information.

A known (material) defect is a condition found within the property that was known by the Transferor/Seller at the time of the listing or was discovered prior to a transaction being finalized and the defect results in one of the following:

(a) The defect has an adverse effect on the market value or marketability of the residence.

(b) The defect significantly impairs the health or safety of future occupants of the residence.

(c) If not repaired/removed/replaced, the defect shortens the expected normal life of the residence.

The Transferor/Seller is REQUIRED to sign the Property Condition Disclosure Statement when the transaction is finalized in order to verify and confirm that there have been no material changes to the residence since the original Disclosure Statement was executed by the seller(s).

CONFIRMATION OF UNDERSTANDING:
_______________________________________ SELLER (UPON LISTING) DATE
_______________________________________ SELLER (UPON LISTING) DATE
_______________________________________ REPRESENTING THE SELLER(S)
__________________________________________ BUYER (BEFORE OFFER) DATE
___________________________________________ BUYER (BEFORE OFFER) DATE
___________________________________________ REPRESENTING THE BUYER(S)

PROPERTY CONDITION DISCLOSURE STATEMENT (PCDS)

PROPERTY CONDITION DISCLOSURE STATEMENT (PCDS)
THIS FORM MAY BE DUPLICATED BUT IT MAY NOT BE ALTERED OR PERSONALIZED BY THE SELLER(S), ANY BROKERAGE FIRM OR LICENSEE.

The following is a Property Condition Disclosure Statement (PCDS) required by §89-1-507 through §89-1-527 of the Mississippi Real Estate Brokers Act of 1954, as Amended, and made by the SELLER(S) concerning the condition of the RESIDENTIAL PROPERTY (1 TO 4 UNITS) located at: _____________________________________________________________________.

SELLER(S): _________________________________________________________

Approximate Age of the Residence______

This document is a disclosure of the condition of real property known by the SELLER on the date that this statement is signed and it is based on their actual knowledge of the property. It is NOT a warranty of any kind by the Seller or any Real Estate Licensee representing a principal in this transaction and this PCDS is not a substitute for any home inspection(s) or warranties the purchaser(s) may wish to obtain. However, the purchaser(s) may rely on the information contained herein when deciding to negotiate the terms for the purchase of the residential real property. This statement may be made available to other parties and is to be attached to the Listing Agreement and signed by the SELLER(S). This statement is NOT intended to be part of any contract between the seller and the purchaser.

IF THE RESIDENCE IS NEW (NEVER OCCUPIED) OR PROPOSED RESIDENTIAL CONSTRUCTION and a real estate licensee is involved in the transaction, the BUILDER/OWNER/SELLER must complete the PCDS in its entirety and should reference specific plans/specifications, building material lists and/or change orders.

DO NOT LEAVE ANY QUESTIONS UNANSWERED AND DO NOT LEAVE BLANK SPACES. THE SELLER(S) MAY ATTACH ADDITIONAL PAGES IF NECESSARY TO FULLY EXPLAIN A PROPERTY’S CONDITION. THE ACRONYM “N/A” MAY BE USED FOR “NOT APPLICABLE” AND “UNK” MAY BE USED FOR “UNKNOWN”.

A. GENERAL INFORMATION:

1. Does the Transferor/Seller currently have a deeded title to the residence? Yes _____ No _____. If “YES”, when did the current Seller receive the title to the property? _________________________________________________________________________.

2. Does the Transferor/Seller currently occupy the residence? Yes _____ No _____.

If “NO”, has the current seller ever occupied the residence? Yes _____ No _____.

If “YES”, what were the dates of Occupancy? ____________________________________.

3. Is the site improved with a Factory Built (Manufactured Housing Unit) or a Modular Home constructed on a permanent foundation? Yes _____ No _____.

If “YES”, indicate the Home Identification number on the Data Plate ___________________.

4. Was the residence built in conformity with an approved building code? Yes _____ No _____ Unknown _______.

If “YES”, was a PERMIT secured from the City/County Building Authority? Yes _____ No _____ Unknown _______.

5. Do you have a Home Inspection Report which was completed for you? Yes _____ No _____.

If “YES”, is the report available for review by a prospective purchaser? Yes_____ No _____.

B. STRUCTURAL ITEMS & SOILS:

1. Are you aware of any settlement/heaving of soils, any collapsible or expansive soils or poorly compacted fill on the Property? Yes _____ No _____ Unknown _____.

If “YES”, please describe, to your knowledge, the nature and location of any settlement or heaving _________________________________________________________________________________________________.
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2. Are you aware of any past or present movement, shifting, deterioration or other problems with the walls (interior or exterior) or the foundation of the Property? Yes _____ No _____ Unknown _____.

If “YES”, please describe, to your knowledge, the nature and location of any such problems ____________________________________________________________________________.

3. Are you aware of any tests to determine the composition/compaction of the soil or the presence of any “expandable soils” being present on the Property? Yes_____ No _____.

If “YES”, please provide copies of the results if they are available.

4. Are you aware of any foundation repairs made in the past? Yes _____ No _____.

If “Yes”, is there a written report which will indicate the foundation repairs? Explain _______________________________________________________________________.

5. If foundation repairs were completed is there a Warranty which can be transferred to a new owner? Yes _____ No _____.

6. To your knowledge, are any foundation repairs currently needed? Yes _____ No _____ Unknown _____.

If “YES”, please explain in detail ___________________________________________________________________________________________.

7. Except for “Cosmetic Upgrades” (carpet, paint, wallpaper, etc) have you remodeled, made any room additions, made structural modifications or other alterations or improvements to the Property?

If “YES”, please describe, to your knowledge, the nature of all such remodels/alterations_________________________________________________________________________________.

8. To your knowledge, were all necessary work PERMITS and approvals secured in compliance with local/city/county building codes? Yes _____ No _____ Unknown _____.

If “YES”, please indicate the name of the Licensed Contractor who completed the work and the dates of the work _______________________________________________________________________________.

C. ROOF:

1. Has all or any portion of the roof been repaired or replaced during your ownership? Yes ____ No ____.

If “YES”, please indicate the dates of the roof work (if known) and describe, to the best of your knowledge, the nature of any roof repairs or replacements. ____________________________________________________________________________________________.

2. To your knowledge, are there any written warranties presently in place for the roof? Yes _____ No _____.

If “YES”, please attach copies of any warranties in your possession.

3. Are you aware of any current leaks or defects with the roof such as structural issues, dry rot, water backups, moisture issues, wind damage or hail damage? Yes ____ No _____.

If “YES”, please describe, to your knowledge, the nature of the defects and their location_____________________________________________________________________________________________.

4. How long have you known about the current problems with the roof? ______________________________________________.

5. The roof is _____ years old.

D. HISTORY OF INFESTATION: TERMITES, CARPENTER ANTS, ETC:

1. Are you aware of any ongoing, recurring or habitual problems with termites, dry rot, mildew, vermin, rodents or other pests which affect the Property? Yes _____ No _____.

If “YES”, please describe, to your knowledge, the nature of the problem and the location of the problem _____________________________________________________________________________________.

2. Are you aware of any DAMAGE to the Property which was caused by termites, dry rot, mildew, vermin, rodents or other pests? Yes _____ No _____.

If “YES”, please describe, to your knowledge, the location of such damage and what efforts were taken to mitigate and/or repair the damage ____________________________________________________________________________.

3. If a Wood Destroying Insect Treatment was required for the residence, which Pest Control Company treated the Property for the problem? ________________________________________________________________________________________________.

4. If DAMAGE to the residence was actually mitigated/repaired, who was the contractor who repaired the DAMAGE to the Property? ________________________________________________________________________________________________.

5. To your knowledge, are there any written warranties or other termite or pest control coverage(s) presently in place for the Property? Yes ____ No ____.

If “YES”, please attach copies of such warranties in your possession.

E. STRUCTURE/FLOOR/WALLS/CEILINGS/WINDOWS/FEATURES:

1. During your ownership, has there been DAMAGE to any portion of the physical structure resulting from fire, windstorm, hail, tornados, hurricane or any other natural disaster? Yes ___ No ___

If “YES”, please describe, to your best knowledge, the cause of the damage, in detail, and supply the dates of the losses ___________________________________________________________.

2. Are you aware of any past or present problems, malfunctions or defects with the windows (including storm windows and screens), the flooring (hardwood, marble, stone, tile or carpeting), fireplace/chimneys, ceilings, walls (interior), jetted bathtub, hot tub, sauna, skylights, shower or wet bar; including any modifications to them? Yes _____ No _____.

If “YES”, please describe, to your knowledge, the nature of any such problem; for example, the skylight leaked or the motor which operates the jetted bathtub had to be replaced, etc. _____________________________________________________________________________________.

3. Are you aware of any past or present problems, malfunctions or defects with the lawn sprinkler system, swimming pool, hot tub, rain gutters, tile drains (French drains), driveway, patio, storage building, gazebo, outdoor fireplace, or outdoor kitchen appliances (which are remaining with the property)? Yes _____ No _____.

If “YES”, please describe, to your knowledge, the nature of such problems; for example, the French drains are clogged and do not remove rain water or the timer for the sprinkler system is not functioning properly, etc. ___________________________________________________________________________________.

4. During your ownership, have there been any notices concerning safety issues with a swimming pool or other improvements to the property? Yes _____ No _____.

If “YES”. Please describe, to the best of your knowledge, those safety issue in detail. ________________________________________________________________________________________________________.

5. Except for regular maintenance of the exterior surfaces of the Property (painting, staining, etc) are you aware of any past or present problems, malfunctions or defects with any portion of the exterior walls, fascias, soffits, stucco, windows, doors or trim? Yes_____ No _____.

If “YES”, please describe, to your knowledge, the nature of the problems. (for example, there is moisture damage behind the stucco) __________________________________________________________________________________.

F. LAND AND SITE DATA:

1. Is there an engineer’s survey or a recorded plat of the Property available? Yes _____ No _____.

If “YES”, please attach a copy of the survey (if available).

If “YES”, please indicate by whom the survey was completed _____________________ and the Date the survey was completed____________________.

2. Are you aware of the existence of any of the following, to wit:
Encroachments: Easements:
Soil Problems: Land Fill:
Yes ___ No ___ Unknown ___ Yes ___ No ___ Unknown ___ Yes ___ No ___ Unknown ___ Yes ___ No ___ Unknown ___
Boundary Dispute: Soil/Erosion: Standing Water: Drainage Problems:
Yes ___ No ___ Unknown ____ Yes ___ No ___ Unknown ____ Yes ___ No ___ Unknown_____ Yes ___ No ___ Unknown_____

3. Are you aware of any current pending litigation, foreclosure, zoning regulations, restrictive covenants. building code violations, mechanics liens, judgments, special assessments or any other type of restriction which could negatively affect your Property?
Yes ____ No ____

If “YES”, please explain ____________________________________________________________________.

4. Other than the utility easements, are you aware of any easement which impacts the residence? Yes ____ No ____.

5. Are there any rights-of-way, easements, eminent domain proceedings or similar matters which may negatively impact your ownership interest in the Property? Yes _____ No _____

If “YES”, please explain ______________________________________.

6. Are you aware if any portion of the Property (including a part of the site) is currently located in or near a FEMA Designated Flood Hazard Zone? Yes _____ No _____ Unknown _____.

If “YES”, please indicate the source of your information and the current Map Number used to determine the Flood Zone ___________________________________________________________.

7. Is Flood Insurance currently required on the Property? Yes _____ No _____.

If “YES”, please indicate the amount of the premium currently being paid and when the premium was last adjusted _______________________________________________.

8. Are you aware if any portion of the Property (Site) is currently designated as being located within a WETLANDS area and is subject to specific restrictive uses? Yes _____ No _____.

If “YES”, please explain in detail _____________________________.

9. Are you aware if the Property has ever had standing water in the front, rear or side yards for more than forty-eight (48) hours following a heavy rain? Yes _____ No _____.

If “YES”, please describe, to your knowledge, any unusual circumstances causing the problem ______________________________________________________________________________________________.

10. Are you aware, FOR ANY REASON, in the past or present of water penetration problems in the walls, windows, doors, crawl space, basement or attic? Yes ____ No ____.

If “YES”, please describe, to your knowledge, the nature of the problem and what steps were taken to remedy the problem ________________________________________________________________________.

11. FOR ANY REASON, past or present, has any portion of the interior of the Property ever suffered water damage or moisture related damage which was caused by flooding, lot drainage, moisture seepage, condensation, sewer overflow, sewer backup, leaking or broken water pipes (during or after construction) pipe fittings, plumbing fixtures, leaking appliances, fixtures or equipment? Yes _____ No _____.

If “YES”, please describe, to your knowledge, the nature of the problems and what steps were taken to remedy the problems ________________________________________________________________________________.

12. Are you aware, FOR ANY REASON, of any leaks, back-ups, or other problems relating to any of the plumbing, water, sewage, or related items during your ownership? Yes ____ No ____.

If “YES”, please describe, to your best knowledge, the problem you experienced and how it was mitigated _______________________________________________________________.

G. APPLIANCES/MECHANICAL EQUIPMENT:

Following is a list of appliances and mechanical systems which may or may not be present in the residence. Please complete the information to the best of your knowledge.

You may use the “Item Blanks” at the bottom of the page for additional items.
Page 3

APPLIANCES/ITEMS/SYSTEMS REMAINING WITH THE PROPERTY:

ITEMS
YES/ #ITEMS
NO GAS/ N/A ELECTRIC
REPAIRS COMPLETED IN LAST TWO YEARS
AGE
BUILT-IN COOKTOP
BUILT-IN OVEN(S)
BUILT-IN DISHW ASHER
GARBAGE DISPOSAL
ICE-MAKER (STAND ALONE)
MICROWAVE OVEN
TRASH COMPACTOR
KITCHEN VENT FAN(S)
CENTRAL AIR SYSTEM(S)
CENTRAL HEATING SYSTEM(S)
HUMIDIFIERS OR EVAPORATORS
AIR PURIFIERS
WATER HEATER(S)
TANKLESS WATER HEATER(S)
CEILING FAN(S)
ATTIC FANS
BATHROOM VENT FAN(S)
GARAGE DOOR OPENER(S)
SMOKE/MONOXIDE DETECTORS
SECURITY SYSTEM
INTERCOM/SOUND SYSTEM
REFRIGERATOR
FREE STANDING STOVE
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H. OTHER:

1. Are you aware of any past or present hazardous conditions, substances or materials on the Property such as asbestos or asbestos components, lead-based paint, urea-formaldehyde insulation, the presence of Chinese dry-wall, methane gas, radon gas, underground storage tanks and lines or any past industrial uses occurring on the premises? Yes ___ No ___

If “YES”, please describe, to your best knowledge, the nature of any such hazardous conditions and any attempts to mitigate any such hazardous condition(s) ______________________________________________________________________________________________.

2. Are you aware of any past or present contaminations which have resulted from the storing or the manufacturing of methamphetamines? Yes _____ No _____.

If “YES”, please describe ________________________________________________.

3. Are you aware if there are currently, or have previously been, any inspections by qualified experts or orders issued on the property by any governmental authority requiring the remediation of MOLD or any other public health nuisance on the Property? Yes _____ No _____.

If “YES”, please describe, to your best knowledge, any attempts to mitigate such condition(s) ________________________________________________________________________________________________________.

4. Are you aware of any problems or conditions that affect the desirability or functionality of the Heating, Cooling, Electrical, Plumbing, or Mechanical Systems? Yes ____ No ____.

If “YES”, please described, to your best knowledge, all known problems in complete detail _________________________________________________________________________________________.

5. The water supply is: Public _____ Private ____ On-site Well ____ Neighbor’s Well ____ Community______

6. If your drinking water is from a well, when was the water quality last checked for safety, what were the results of the test and who was the qualified entity who conducted the test? _____________________________________________________________.

7. Is the water supply equipped with a water softener? Yes _____ No _____ Unknown _____

8. The Sewage System is: Public ____ Private ____ Septic ____ Cesspool ____ Treatment Plant ____ Other _____

9. If the sewer service is by an individual system, has it been inspected by the proper state/county Health Department officials? Yes _____ No _____.

If “YES”, please give complete details _______________________________________________________.

10. How many bedrooms are allowed by the Individual Waste Water Permit? _______.

11. Is there a sewage pump installed? Yes ____ No ____ Date of the last Septic Inspection ____________________.

I. MISCELLANEOUS:

1. Is the residence situated on Leasehold or Sixteenth Section land? Yes _____ No _____ Unknown _____.

If “YES”, please indicate the terms of the lease including payments and expiration date ________________________________________________.

2. Are you aware of any hidden defects or needed repairs about which the purchaser should be informed PRIOR to their purchase? Yes _____ No _____.

If “YES”, please describe, to your best knowledge, the problem(s) which need to be disclosed ________________________________________________________________________________________________________.

3. What is the APPROXIMATE SQUARE FOOTAGE of the Heated and Cooled Living Area? _________________________.

4. How was the approximation of the Gross Living Area (square footage) determined? __________________________________.

5. Are there any finished hardwood floors beneath the floor coverings? Yes ____ No ____ Unknown _____.

If “YES”, please indicate, to your best knowledge, the condition and the location of the hardwood floors __________________________________.

6. Are there Homeowner’s Association Fees associated with ownership? Yes ____ No ____ Amount _________(Yr/Mth/Quarter)

7. Does the HOA levy dues or assessments for maintenance of common areas and/or other common expenses? _______________.

8. Are you aware of any HOA, Public (municipal) special improvement district (PID) or other assessments that are presently owing or that have been approved but not yet levied against the Property? Yes _____ No _____.

If “YES”, please indicate the tax (assessing) entity and the amount of the taxes/assessments _________________________________________________________.

9. Please indicate the contact information for the HOA ____________________________________________________________.

10. What is the YEARLY Real Estate Tax Bill? County Taxes _______ City Taxes _______ Special District Taxes _________.

11. Has Homestead Exemption been filed for the current year? Yes _____ No _____ Unknown _____.

12. Are you aware of any additional tax exemptions which accrue to the Property? Yes _____ No _____ Unknown_____.

If “YES”, please describe the exemptions and the amount of the tax ___________________________________________________.

13, What is the average YEARLY Electric Bill? $____________.

What is the average YEARLY Gas Bill? $_______________.

14. Is the residence serviced by Propane (LP) Gas?

If “YES”, what is the average YEARLY Propane Bill? $________________.

15. The Propane Tank is: Owned ______ Leased ______

If Leased, how much is the lease payment? $____________________.

16. Is Cable Television Service available at the site? Yes ____ No ____ Service Provider ________________________________.

17. Is Fiber Optic Cable (Internet) available at the site? Yes _____ No _____ Service Provider ___________________________.

18. List any item remaining with the Property which is financed separately from the mortgages ____________________________.

MECHANICAL EQUIPMENT WHICH IS CONSIDERED PERSONAL PROPERTY AND IS NOT CONVEYED BY DEED AS PART OF THE REAL PROPERTY SHOULD BE NEGOTIATED IN THE CONTRACT OF SALE OR OTHER SUCH INSTRUMENT IF THE ITEMS ARE TO REMAIN WITH THE RESIDENCE.

To the extent of the Seller’s knowledge as a property owner, the Seller(s) acknowledges that the information contained above is true and accurate for those areas of the property listed.

The owner(s) agree to save and hold the Broker harmless from all claims, disputes, litigation and/or judgments arising from any incorrect information supplied by the owner(s) or from any material fact known by the owner(s) which owner(s) fail to disclose except the Broker is not held harmless to the owner(s) in claims, disputes, litigation, or judgments arising from conditions of which the Broker had actual knowledge.
_______________________________________ SELLER (UPON LISTING) DATE
_______________________________________ SELLER (AT CLOSING) DATE
_________________________________________ SELLER (UPON LISTING) DATE
_________________________________________ SELLER (AT CLOSING) DATE
PROSPECTIVE PURCHASER’S SIGNATURE ______________________________________________________________ PURCHASER(S) ACKNOWLEDGE RECEIPT OF REPORT DATE
FORM #0100
EFFECTIVE DATE: April 1, 2017

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