LBD07725-01-1
A. 3714 2
"RESIDENTIAL REAL PROPERTY" MEANS REAL PROPERTY IMPROVED BY A ONE TO
FOUR FAMILY DWELLING USED OR OCCUPIED, OR INTENDED TO BE USED OR OCCU-
PIED, 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.
INSTRUCTIONS TO THE SELLER:
(a) ANSWER ALL QUESTIONS BASED UPON YOUR ACTUAL KNOWLEDGE.
(b) ATTACH ADDITIONAL PAGES WITH YOUR SIGNATURE IF ADDITIONAL SPACE IS
REQUIRED.
(c) COMPLETE THIS FORM YOURSELF.
(d) IF SOME ITEMS DO NOT APPLY TO YOUR PROPERTY, CHECK "NA" (NON-AP-
PLICABLE). IF YOU DO NOT KNOW THE ANSWER CHECK "UNKN" (UNKNOWN).
SELLER'S STATEMENT: THE SELLER MAKES THE FOLLOWING REPRESENTATIONS TO
THE BUYER BASED UPON THE SELLER'S ACTUAL KNOWLEDGE AT THE TIME OF SIGN-
ING THIS DOCUMENT. THE SELLER AUTHORIZES HIS OR HER AGENT, IF ANY, TO
PROVIDE A COPY OF THIS STATEMENT TO A PROSPECTIVE BUYER OF THE RESIDEN-
TIAL REAL PROPERTY. THE FOLLOWING ARE REPRESENTATIONS MADE BY THE SELLER
AND ARE NOT THE REPRESENTATIONS OF THE SELLER'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 INVESTI-
GATE FOR THE PRESENCE OF LEAD BASED PAINT.
4. DOES ANYBODY OTHER THAN YOURSELF HAVE A LEASE, EASEMENT OR ANY
OTHER RIGHT TO USE OR OCCUPY ANY PART OF YOUR PROPERTY OTHER THAN
THOSE STATED IN DOCUMENTS AVAILABLE IN THE PUBLIC RECORD, SUCH AS
RIGHTS TO USE A ROAD OR PATH OR CUT TREES OR CROPS. YES NO UNKN NA
5. DOES ANYBODY ELSE CLAIM TO OWN ANY PART OF YOUR PROPERTY? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
6. HAS ANYONE DENIED YOU ACCESS TO THE PROPERTY OR MADE A FORMAL LEGAL
CLAIM CHALLENGING YOUR TITLE TO THE PROPERTY? YES NO UNKN NA (IF
YES, EXPLAIN BELOW)
7. ARE THERE ANY FEATURES OF THE PROPERTY SHARED IN COMMON WITH
ADJOINING LAND OWNERS OR A HOMEOWNERS ASSOCIATION, SUCH AS WALLS,
FENCES OR DRIVEWAYS? YES NO UNKN NA (IF YES DESCRIBE BELOW)
8. ARE THERE ANY ELECTRIC OR GAS UTILITY SURCHARGES FOR LINE EXTEN-
SIONS, SPECIAL ASSESSMENTS OR HOMEOWNER OR OTHER ASSOCIATION FEES
THAT APPLY TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
9. ARE THERE CERTIFICATES OF OCCUPANCY RELATED TO THE PROPERTY? YES
NO UNKN NA (IF NO, EXPLAIN BELOW)
ENVIRONMENTAL
NOTE TO SELLER - IN THIS SECTION, YOU WILL BE ASKED QUESTIONS REGARD-
ING PETROLEUM PRODUCTS AND HAZARDOUS OR TOXIC SUBSTANCES THAT YOU KNOW
TO HAVE BEEN SPILLED, LEAKED OR OTHERWISE BEEN RELEASED ON THE PROPERTY
OR FROM THE PROPERTY ONTO ANY OTHER PROPERTY. PETROLEUM PRODUCTS MAY
INCLUDE, BUT ARE NOT LIMITED TO, GASOLINE, DIESEL FUEL, HOME HEATING
FUEL, AND LUBRICANTS. HAZARDOUS OR TOXIC SUBSTANCES ARE PRODUCTS OR
OTHER MATERIAL THAT COULD POSE SHORT- OR LONG-TERM DANGER TO PERSONAL
HEALTH OR THE ENVIRONMENT IF THEY ARE NOT PROPERLY DISPOSED OF, APPLIED
OR STORED. THESE INCLUDE, BUT ARE NOT LIMITED TO, FERTILIZERS, PESTI-
A. 3714 3
CIDES AND INSECTICIDES, PAINT INCLUDING PAINT THINNER, VARNISH REMOVER
AND WOOD PRESERVATIVES, TREATED WOOD, CONSTRUCTION MATERIALS SUCH AS
ASPHALT AND ROOFING MATERIALS, ANTIFREEZE AND OTHER AUTOMOTIVE PRODUCTS,
BATTERIES, CLEANING SOLVENTS INCLUDING SEPTIC TANK CLEANERS, HOUSEHOLD
CLEANERS [AND], POOL CHEMICALS [AND], PRODUCTS CONTAINING MERCURY AND
LEAD AND INDOOR MOLD.
NOTE TO BUYER - IF CONTAMINATION OF THIS PROPERTY FROM PETROLEUM
PRODUCTS AND/OR HAZARDOUS OR TOXIC SUBSTANCES IS A CONCERN TO YOU, YOU
ARE URGED TO CONSIDER SOIL AND GROUNDWATER TESTING OF THIS PROPERTY.
10. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED FLOODPLAIN?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
11. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED WETLAND?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
12. IS THE PROPERTY LOCATED IN AN AGRICULTURAL DISTRICT? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
13. WAS THE PROPERTY EVER THE SITE OF A LANDFILL? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
14. ARE THERE OR HAVE THERE EVER BEEN FUEL STORAGE TANKS ABOVE OR
BELOW THE GROUND ON THE PROPERTY? YES NO UNKN NA IF YES, ARE
THEY CURRENTLY IN USE? YES NO UNKN NA LOCATION(S) ARE THEY LEAKING
OR HAVE THEY EVER LEAKED? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
15. IS THERE ASBESTOS IN THE STRUCTURE? YES NO UNKN NA (IF YES, STATE
LOCATION OR LOCATIONS BELOW)
16. IS LEAD PLUMBING PRESENT? YES NO UNKN NA (IF YES, STATE LOCATION
OR LOCATIONS BELOW)
17. HAS A RADON TEST BEEN DONE? YES NO UNKN NA (IF YES, ATTACH A COPY
OF THE REPORT)
18. HAS MOTOR FUEL, MOTOR OIL, HOME HEATING FUEL, LUBRICATING OIL OR
ANY OTHER PETROLEUM PRODUCT, METHANE GAS, OR ANY HAZARDOUS OR
TOXIC SUBSTANCE SPILLED, LEAKED OR OTHERWISE BEEN RELEASED ON THE
PROPERTY OR FROM THE PROPERTY ONTO ANY OTHER PROPERTY? YES NO
UNKN NA (IF YES, DESCRIBE BELOW)
19. HAS THE PROPERTY BEEN TESTED FOR THE PRESENCE OF MOTOR FUEL, MOTOR
OIL, HOME HEATING FUEL, LUBRICATING OIL, OR ANY OTHER PETROLEUM
PRODUCT, METHANE GAS, OR ANY HAZARDOUS OR TOXIC SUBSTANCE? YES NO
UNKN NA (IF YES, ATTACH REPORT(S))
19-A. HAS THE PROPERTY BEEN TESTED FOR INDOOR MOLD? YES NO UNKN (IF
YES, ATTACH A COPY OF THE REPORT)
STRUCTURAL
20. IS THERE ANY ROT OR WATER DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
21. IS THERE ANY FIRE OR SMOKE DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
22. IS THERE ANY TERMITE, INSECT, RODENT OR PEST INFESTATION OR
DAMAGE? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
23. HAS THE PROPERTY BEEN TESTED FOR TERMITE, INSECT, RODENT OR PEST
INFESTATION OR DAMAGE? YES NO UNKN NA (IF YES, PLEASE ATTACH
REPORT(S))
24. WHAT IS THE TYPE OF ROOF/ROOF COVERING (SLATE, ASPHALT, OTHER.)?
ANY KNOWN MATERIAL DEFECTS? HOW OLD IS THE ROOF? IS THERE A TRANS-
FERABLE WARRANTEE ON THE ROOF IN EFFECT NOW? YES NO UNKN NA (IF
YES, EXPLAIN BELOW)
A. 3714 4
25. ARE THERE ANY KNOWN MATERIAL DEFECTS IN ANY OF THE FOLLOWING
STRUCTURAL SYSTEMS: FOOTINGS, BEAMS, GIRDERS, LINTELS, COLUMNS OR
PARTITIONS. YES NO UNKN NA (IF YES, EXPLAIN BELOW)
MECHANICAL SYSTEMS & SERVICES
26. WHAT IS THE WATER SOURCE (CIRCLE ALL THAT APPLY - WELL, PRIVATE,
MUNICIPAL, OTHER)? IF MUNICIPAL, IS IT METERED? YES NO UNKN NA
27. HAS THE WATER QUALITY AND/OR FLOW RATE BEEN TESTED? YES NO UNKN NA
(IF YES, DESCRIBE BELOW)
28. WHAT IS THE TYPE OF SEWAGE SYSTEM (CIRCLE ALL THAT APPLY - PUBLIC
SEWER, PRIVATE SEWER, SEPTIC OR CESSPOOL)? IF SEPTIC OR CESSPOOL,
AGE? ________ DATE LAST PUMPED? ________ FREQUENCY OF PUMPING?
________ ANY KNOWN MATERIAL DEFECTS? YES NO UNKN NA (IF YES,
EXPLAIN BELOW)
29. WHO IS YOUR ELECTRIC SERVICE PROVIDER? ________ WHAT IS THE AMPER-
AGE? ________ DOES IT HAVE CIRCUIT BREAKERS OR FUSES? ________
PRIVATE OR PUBLIC POLES? ________ ANY KNOWN MATERIAL DEFECTS? YES
NO UNKN NA (IF YES, EXPLAIN BELOW)
30. ARE THERE ANY FLOODING, DRAINAGE OR GRADING PROBLEMS THAT RESULTED
IN STANDING WATER ON ANY PORTION OF THE PROPERTY? YES NO UNKN NA
(IF YES, STATE LOCATIONS AND EXPLAIN BELOW)
31. DOES THE BASEMENT HAVE SEEPAGE THAT RESULTS IN STANDING WATER? YES
NO UNKN NA (IF YES, EXPLAIN BELOW)
ARE THERE ANY KNOWN MATERIAL DEFECTS IN ANY OF THE FOLLOWING (IF
YES, EXPLAIN BELOW. USE ADDITIONAL SHEETS IF NECESSARY.):
32. PLUMBING SYSTEM? YES NO UNKN NA
33. SECURITY SYSTEM? YES NO UNKN NA
34. CARBON MONOXIDE DETECTOR? YES NO UNKN NA
35. SMOKE DETECTOR? YES NO UNKN NA
36. FIRE SPRINKLER SYSTEM? YES NO UNKN NA
37. SUMP PUMP? YES NO UNKN NA
38. FOUNDATION/SLAB? YES NO UNKN NA
39. INTERIOR WALLS/CEILINGS? YES NO UNKN NA
40. EXTERIOR WALLS OR SIDING? YES NO UNKN NA
41. FLOORS? YES NO UNKN NA
42. CHIMNEY/FIREPLACE OR STOVE? YES NO UNKN NA
43. PATIO/DECK? YES NO UNKN NA
44. DRIVEWAY? YES NO UNKN NA
45. AIR CONDITIONER? YES NO UNKN NA
46. HEATING SYSTEM? YES NO UNKN NA
47. HOT WATER HEATER? YES NO UNKN NA
48. THE PROPERTY IS LOCATED IN THE FOLLOWING SCHOOL DISTRICT UNKN
NOTE: BUYER IS ENCOURAGED TO CHECK PUBLIC RECORDS CONCERNING THE
PROPERTY (E.G. TAX RECORDS AND WETLAND AND FLOOD PLAIN MAPS)
THE SELLER SHOULD USE THIS AREA TO FURTHER EXPLAIN ANY ITEM ABOVE. IF
NECESSARY, ATTACH ADDITIONAL PAGES AND INDICATE HERE THE NUMBER OF ADDI-
TIONAL PAGES ATTACHED.
______________________________________________________________
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SELLER'S CERTIFICATION: SELLER CERTIFIES THAT THE INFORMATION IN THIS
PROPERTY CONDITION DISCLOSURE STATEMENT IS TRUE AND COMPLETE TO THE
SELLER'S ACTUAL KNOWLEDGE AS OF THE DATE SIGNED BY THE SELLER. IF A
SELLER OF RESIDENTIAL REAL PROPERTY ACQUIRES KNOWLEDGE WHICH RENDERS
MATERIALLY INACCURATE A PROPERTY CONDITION DISCLOSURE STATEMENT PROVIDED
A. 3714 5
PREVIOUSLY, THE SELLER SHALL DELIVER A REVISED PROPERTY CONDITION
DISCLOSURE STATEMENT TO THE BUYER AS SOON AS PRACTICABLE. IN NO EVENT,
HOWEVER, SHALL A SELLER BE REQUIRED TO PROVIDE A REVISED PROPERTY CONDI-
TION DISCLOSURE STATEMENT AFTER THE TRANSFER OF TITLE FROM THE SELLER TO
THE BUYER OR OCCUPANCY BY THE BUYER, WHICHEVER IS EARLIER.
SELLER__________ DATE___________
SELLER__________ DATE___________
BUYER'S ACKNOWLEDGMENT: BUYER ACKNOWLEDGES RECEIPT OF A COPY OF THIS
STATEMENT AND BUYER UNDERSTANDS THAT THIS INFORMATION IS A STATEMENT OF
CERTAIN CONDITIONS AND INFORMATION CONCERNING THE PROPERTY KNOWN TO THE
SELLER. IT IS NOT A WARRANTY OF ANY KIND BY THE SELLER OR SELLER'S AGENT
AND IS NOT A SUBSTITUTE FOR ANY HOME, PEST, RADON OR OTHER INSPECTIONS
OR TESTING OF THE PROPERTY OR INSPECTION OF THE PUBLIC RECORDS.
BUYER__________ DATE__________
BUYER__________ DATE _________
§ 2. This act shall take effect on the one hundred eightieth day
after it shall have become a law; provided, however, that this act shall
apply to contracts of sale for real property entered into on or after
such effective date.