Property Condition Disclosure Statement -New York
DOS-1614 (Re v. 8/06) PAGE 1 OF 6
NYS Department of State
Division of Licensing Se rvices
P.O. Box 22 0 01
Alba ny, NY 12201-2001
(518) 474-4429
www.dos.state.ny.us
Property Condition Disclosure Statement
N ame of Se lle r o r Se lle rs:
Property Address:
G eneral I nstructions :
The Property Conditi on D isc losure Act requ ires the seller of res i dent ial real p rop erty to caus e this disc losu re s tatement or
a c opy thereof to b e delivered t o a b uyer or b uyer’ s agent prior to the s i gning b y the b uyer of a binding c ontrac t of s ale.
Purpo s e o f St atement:
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 environment al tes ts and also is enc ouraged to check pub lic records pertaining to the property.
A knowingly f alse or inc omp let e s tatement by the s eller on this f orm may sub ject the s eller to c laims b y the b u yer prior to
or after the transfer of title. In the event a seller fails to perform the duty prescribed in this article to deliver a Disclosur e
Statement prior to the signing by the buyer of a binding contract of sale, the buyer shall receive upon the transfer of title a credit
of $500 aga inst the a gr eed upon pur cha se price of the residential rea l pr operty.
“Residential real property” means real property improved by a one to four family dwelling used or occupied, or intended to
b e u sed or oc c upied, wholly or partly, as the home or res i dence of one or more persons, but shall not refer to ( a) unimp roved
real property upon which such dwellings a re to be constructed or (b) condominium units or cooperative apartments or (c)
p roperty on a homeowners’ ass oc i ation that is not owned in f ee simp le b y the s eller.
Inst ructions to the S eller:
a. Answer all ques tions based u pon you r ac tual knowledge.
b . Attac h additi onal pages with your s i gnature if additional spac e is requ ired.
c. Complete this form yourself.
d. If some items do not apply to your property, check “NA” (Non-applicable). If you do not know the answer check “Unkn”
(Unknown).
S eller’s S t atement:
The selle r m akes the following represe ntations to the buyer based upon the seller’s actual knowledge at the time of signing
this doc ument. The s eller au thoriz es his or her agent, if any, to provide a c op y of this statement to a p rosp ective b uyer of the
r esidentia l r ea l p r oper ty. T he following a r e r epr esent a tions ma de by t he s eller a nd are no t the r ep r esent a tions of t he s eller ’s
agent.
GENERAL INFORMATION
1. How long have you owned the property?......................................
2. How long have you occupied the property? ....................................
3. What is the age of the structure or structures? ..................................
Note to buyer – If the structure was built before 1978 you are encouraged to investigate for
the presenc e of l ead based pai nt . .
4 . D oe s anybod y othe r than yours e lf have a leas e, eas e me nt or any othe r right to u se or oc c up y
any part o f your prop erty othe r than those stated in doc u ments available in the p u blic re co rd,
such as rights to use a road or path or cut trees or crops? ..........................
Yes
No
Unkn
NA
5 . Does anybody else clai m to own a ny part of your p roperty? If Yes, explain below ........
Yes
No
Unkn
NA
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