Property Condition Disclosure Statement Form

Property Condition Disclosure Form

Seller(s) Name

Property Address

Purpose of Statement:

This is a statement of certain conditions and information concerning the property known to the seller. This disclosure statement is not a warranty of any kind by the seller

or by any agent representing the seller in this transaction. It is not a substitute for any inspections or tests and the buyer is encouraged to obtain his or her own

independent professional inspections and environmental tests and also is encouraged to check public records pertaining to the property.

“Residential real property” means real property improved by a one to four family dwelling used or occupied, or intended to be used or occupied, wholly or partly, as the

home or residence of one or more persons, but shall not refer to (a) unimproved real property upon which such dwellings are to be constructed or (b) condominium units

or cooperative apartments or (c) property on a homeowners’ association that is not owned in fee simple by the seller.

Seller’s Statement:

The seller makes the following representations to the buyer based upon the seller’s actual knowledge at the time of signing this document. The seller authorizes his or

her agent, if any, to provide a copy of this statement to a prospective buyer of the residential real property. The following are representations made by the seller and are

not the representations of the seller’s agent.

S NO

NOT

KNOWN N/A

General Information

How long have you owned the property?

How long have you occupied the property?

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