Real Estate Residential
Property Disclosure Form

Please complete this form with accurate and truthful information to the best of your knowledge. This form is required to be filled out by the seller and submitted to our office along with any necessary supporting documentation.

Property Information

Address
Type of Property		Year Built

Ownership

Length of Ownership

Water Supply

Water Supply Source	Public	Private Well	Other
Has the water supply been tested?		Yes	No

If Yes, provide the date of the last test and summarize the results:

Sewage System

Disposal Type	Public Sewer	Septic Tank	Other
Condition/History

Structural Components

1. Describe the foundation condition:

2. Describe the age of roof and condition:

3. Describe history of water intrusion, if applicable:

Plumbing, Heating, and Electrical

1. Condition and any known problems of plumbing system:

2. Type, age, and condition of heating system:

3. Capacity (amps) and any known issues of electrical system:

Homeowner’s Association (HOA)

Is the property part of a HOA?	Yes	No
If Yes, indicate fees and what they cover.

Additional Disclosures

1. Has the property been used for any non-residential purposes?

• Yes, specify what purpose:                               

• No

2. Are there any known legal issues, easements, or zoning violations?

• Yes

• No

If Yes, please explain:

Seller’s Certification

I/We certify that the information provided herein is accurate and complete to the best of my/our knowledge as of the date signed below. I/We understand that any significant changes to the condition of the property after the date of this form will be disclosed to the buyer as soon as they are known.

[Name]

[Date]

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