Legislation
SECTION 462
Property condition disclosure statement
Real Property (RPP) CHAPTER 50, ARTICLE 14
§ 462. Property condition disclosure statement. 1. Except as is
provided in section four hundred sixty-three of this article, every
seller of residential real property pursuant to a real estate purchase
contract shall complete and sign a property condition disclosure
statement as prescribed by subdivision two of this section and cause it,
or a copy thereof, to be delivered to a buyer or buyer's agent prior to
the signing by the buyer of a binding contract of sale. A copy of the
property condition disclosure statement containing the signatures of
both seller and buyer shall be attached to the real estate purchase
contract. Nothing contained in this article or this disclosure statement
is intended to prevent the parties to a contract of sale from entering
into agreements of any kind or nature with respect to the physical
condition of the property to be sold, including, but not limited to,
agreements for the sale of real property "as is".
* 2. The following shall be the disclosure form:
PROPERTY CONDITION DISCLOSURE STATEMENT
NAME OF SELLER OR SELLERS:
PROPERTY ADDRESS:
THE PROPERTY CONDITION DISCLOSURE ACT REQUIRES THE SELLER OF
RESIDENTIAL REAL PROPERTY TO CAUSE THIS DISCLOSURE STATEMENT OR A COPY
THEREOF TO BE DELIVERED TO A BUYER OR BUYER'S AGENT PRIOR TO THE SIGNING
BY THE BUYER OF A BINDING CONTRACT OF SALE.
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.
A KNOWINGLY FALSE OR INCOMPLETE STATEMENT BY THE SELLER ON THIS FORM
MAY SUBJECT THE SELLER TO CLAIMS BY THE BUYER PRIOR TO OR AFTER THE
TRANSFER OF TITLE.
"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.
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-APPLICABLE). 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
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.
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 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
EXTENSIONS, 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
REGARDING 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,
PESTICIDES 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, POOL CHEMICALS, 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 FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA) DESIGNATED FLOODPLAIN? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
11. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN THE
SPECIAL FLOOD HAZARD AREA ("SFHA"; "100-YEAR FLOODPLAIN")
ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY'S (FEMA'S)
CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
12. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN A
MODERATE RISK FLOOD HAZARD AREA ("500-YEAR FLOODPLAIN") ACCORDING
TO FEMA'S CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
13. IS THE PROPERTY SUBJECT TO ANY REQUIREMENT UNDER FEDERAL LAW TO
OBTAIN AND MAINTAIN FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN
NA (IF YES, EXPLAIN BELOW)
HOMES IN THE SPECIAL FLOOD HAZARD AREA, ALSO KNOWN AS HIGH RISK
FLOOD ZONES, ON FEMA'S FLOOD INSURANCE RATE MAPS WITH MORTGAGES
FROM FEDERALLY REGULATED OR INSURED LENDERS ARE REQUIRED TO OBTAIN
AND MAINTAIN FLOOD INSURANCE. EVEN WHEN NOT REQUIRED, FEMA
ENCOURAGES HOMEOWNERS IN HIGH RISK, MODERATE RISK, AND LOW RISK
FLOOD ZONES TO PURCHASE FLOOD INSURANCE THAT COVERS THE
STRUCTURE(S) AND THE PERSONAL PROPERTY WITHIN THE STRUCTURE(S).
ALSO NOTE THAT HOMES IN COASTAL AREAS MAY BE SUBJECT TO INCREASED
RISK OF FLOODING OVER TIME DUE TO PROJECTED SEA LEVEL RISE AND
INCREASED EXTREME STORMS CAUSED BY CLIMATE CHANGE WHICH MAY NOT BE
REFLECTED IN CURRENT FLOOD INSURANCE RATE MAPS.
14. HAVE YOU EVER RECEIVED ASSISTANCE, OR ARE YOU AWARE OF ANY
PREVIOUS OWNERS RECEIVING ASSISTANCE, FROM THE FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA), THE U.S. SMALL BUSINESS ADMINISTRATION
(SBA), OR ANY OTHER FEDERAL DISASTER FLOOD ASSISTANCE FOR FLOOD
DAMAGE TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW) FOR
PROPERTIES THAT HAVE RECEIVED FEDERAL DISASTER ASSISTANCE, THE
REQUIREMENT TO OBTAIN FLOOD INSURANCE PASSES DOWN TO ALL FUTURE
OWNERS. FAILURE TO OBTAIN AND MAINTAIN FLOOD INSURANCE CAN RESULT
IN AN INDIVIDUAL BEING INELIGIBLE FOR FUTURE ASSISTANCE.
15. IS THERE FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN NA (IF YES,
ATTACH A COPY OF THE POLICY)
A STANDARD HOMEOWNER'S INSURANCE POLICY TYPICALLY DOES NOT COVER
FLOOD DAMAGE. YOU ARE ENCOURAGED TO EXAMINE YOUR POLICY TO
DETERMINE WHETHER YOU ARE COVERED.
16. IS THERE A FEMA ELEVATION CERTIFICATE AVAILABLE FOR THE PROPERTY?
YES NO UNKN NA (IF YES, ATTACH A COPY OF THE CERTIFICATE)
AN ELEVATION CERTIFICATE IS A FEMA FORM, COMPLETED BY A LICENSED
SURVEYOR OR ENGINEER. THE FORM PROVIDES CRITICAL INFORMATION ABOUT
THE FLOOD RISK OF THE PROPERTY AND IS USED BY FLOOD INSURANCE
PROVIDERS UNDER THE NATIONAL FLOOD INSURANCE PROGRAM (NFIP) TO
HELP DETERMINE THE APPROPRIATE FLOOD INSURANCE RATING FOR THE
PROPERTY. A BUYER MAY BE ABLE TO USE THE ELEVATION CERTIFICATE
FROM A PREVIOUS OWNER FOR THEIR FLOOD INSURANCE POLICY.
17. HAVE YOU EVER FILED A CLAIM FOR FLOOD DAMAGE TO THE PROPERTY WITH
ANY INSURANCE PROVIDER, INCLUDING THE NATIONAL FLOOD INSURANCE
PROGRAM (NFIP)? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
18. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED WETLAND?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
19. IS THE PROPERTY LOCATED IN AN AGRICULTURAL DISTRICT? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
20. WAS THE PROPERTY EVER THE SITE OF A LANDFILL? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
21. 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)
22. IS THERE ASBESTOS IN THE STRUCTURE? YES NO UNKN NA (IF YES, STATE
LOCATION OR LOCATIONS BELOW)
23. IS LEAD PLUMBING PRESENT? YES NO UNKN NA (IF YES, STATE LOCATION
OR LOCATIONS BELOW)
24. HAS A RADON TEST BEEN DONE? YES NO UNKN NA (IF YES, ATTACH A COPY
OF THE REPORT)
25. 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)
26. 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))
27. HAS THE PROPERTY BEEN TESTED FOR INDOOR MOLD? YES NO UNKN (IF YES,
ATTACH A COPY OF THE REPORT)
STRUCTURAL
28. IS THERE ANY ROT OR WATER DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
29. IS THERE ANY FIRE OR SMOKE DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
30. IS THERE ANY TERMITE, INSECT, RODENT OR PEST INFESTATION OR
DAMAGE? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
31. HAS THE PROPERTY BEEN TESTED FOR TERMITE, INSECT, RODENT OR PEST
INFESTATION OR DAMAGE? YES NO UNKN NA (IF YES, PLEASE ATTACH
REPORT(S))
32. WHAT IS THE TYPE OF ROOF/ROOF COVERING (SLATE, ASPHALT, OTHER.)?
ANY KNOWN MATERIAL DEFECTS? HOW OLD IS THE ROOF? IS THERE A
TRANSFERABLE WARRANTY ON THE ROOF IN EFFECT NOW? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
33. 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
34. WHAT IS THE WATER SOURCE (CIRCLE ALL THAT APPLY - WELL, PRIVATE,
MUNICIPAL, OTHER)? IF MUNICIPAL, IS IT METERED? YES NO UNKN NA
35. HAS THE WATER QUALITY AND/OR FLOW RATE BEEN TESTED? YES NO UNKN NA
(IF YES, DESCRIBE BELOW)
36. 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)
37. WHO IS YOUR ELECTRIC SERVICE PROVIDER? ________ WHAT IS THE
AMPERAGE? ________ DOES IT HAVE CIRCUIT BREAKERS OR FUSES?
________ PRIVATE OR PUBLIC POLES? ________ ANY KNOWN MATERIAL
DEFECTS? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
38. 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)
39. HAS THE STRUCTURE(S) EXPERIENCED ANY WATER PENETRATION OR DAMAGE
DUE TO SEEPAGE OR A NATURAL FLOOD EVENT, SUCH AS FROM HEAVY
RAINFALL, COASTAL STORM SURGE, TIDAL INUNDATION OR RIVER OVERFLOW?
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.):
40. PLUMBING SYSTEM? YES NO UNKN NA
41. SECURITY SYSTEM? YES NO UNKN NA
42. CARBON MONOXIDE DETECTOR? YES NO UNKN NA
43. SMOKE DETECTOR? YES NO UNKN NA
44. FIRE SPRINKLER SYSTEM? YES NO UNKN NA
45. SUMP PUMP? YES NO UNKN NA
46. FOUNDATION/SLAB? YES NO UNKN NA
47. INTERIOR WALLS/CEILINGS? YES NO UNKN NA
48. EXTERIOR WALLS OR SIDING? YES NO UNKN NA
49. FLOORS? YES NO UNKN NA
50. CHIMNEY/FIREPLACE OR STOVE? YES NO UNKN NA
51. PATIO/DECK? YES NO UNKN NA
52. DRIVEWAY? YES NO UNKN NA
53. AIR CONDITIONER? YES NO UNKN NA
54. HEATING SYSTEM? YES NO UNKN NA
55. HOT WATER HEATER? YES NO UNKN NA
56. 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 FEMA'S CURRENT FLOOD
INSURANCE RATE MAPS AND ELEVATION CERTIFICATES)
THE SELLER SHOULD USE THIS AREA TO FURTHER EXPLAIN ANY ITEM ABOVE. IF
NECESSARY, ATTACH ADDITIONAL PAGES AND INDICATE HERE THE NUMBER OF
ADDITIONAL PAGES ATTACHED.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
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
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
CONDITION 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 _________
* NB Effective until July 1, 2025
* 2. The following shall be the disclosure form:
PROPERTY CONDITION DISCLOSURE STATEMENT
NAME OF SELLER OR SELLERS:
PROPERTY ADDRESS:
THE PROPERTY CONDITION DISCLOSURE ACT REQUIRES THE SELLER OF
RESIDENTIAL REAL PROPERTY TO CAUSE THIS DISCLOSURE STATEMENT OR A COPY
THEREOF TO BE DELIVERED TO A BUYER OR BUYER'S AGENT PRIOR TO THE SIGNING
BY THE BUYER OF A BINDING CONTRACT OF SALE.
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.
A KNOWINGLY FALSE OR INCOMPLETE STATEMENT BY THE SELLER ON THIS FORM
MAY SUBJECT THE SELLER TO CLAIMS BY THE BUYER PRIOR TO OR AFTER THE
TRANSFER OF TITLE.
"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.
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-APPLICABLE). 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
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.
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 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
EXTENSIONS, 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
REGARDING 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,
PESTICIDES 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, POOL CHEMICALS, 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 FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA) DESIGNATED FLOODPLAIN? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
11. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN THE
SPECIAL FLOOD HAZARD AREA ("SFHA"; "100-YEAR FLOODPLAIN")
ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY'S (FEMA'S)
CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
12. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN A
MODERATE RISK FLOOD HAZARD AREA ("500-YEAR FLOODPLAIN") ACCORDING
TO FEMA'S CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
13. IS THE PROPERTY SUBJECT TO ANY REQUIREMENT UNDER FEDERAL LAW TO
OBTAIN AND MAINTAIN FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN
NA (IF YES, EXPLAIN BELOW)
HOMES IN THE SPECIAL FLOOD HAZARD AREA, ALSO KNOWN AS HIGH RISK
FLOOD ZONES, ON FEMA'S FLOOD INSURANCE RATE MAPS WITH MORTGAGES
FROM FEDERALLY REGULATED OR INSURED LENDERS ARE REQUIRED TO OBTAIN
AND MAINTAIN FLOOD INSURANCE. EVEN WHEN NOT REQUIRED, FEMA
ENCOURAGES HOMEOWNERS IN HIGH RISK, MODERATE RISK, AND LOW RISK
FLOOD ZONES TO PURCHASE FLOOD INSURANCE THAT COVERS THE
STRUCTURE(S) AND THE PERSONAL PROPERTY WITHIN THE STRUCTURE(S).
ALSO NOTE THAT HOMES IN COASTAL AREAS MAY BE SUBJECT TO INCREASED
RISK OF FLOODING OVER TIME DUE TO PROJECTED SEA LEVEL RISE AND
INCREASED EXTREME STORMS CAUSED BY CLIMATE CHANGE WHICH MAY NOT BE
REFLECTED IN CURRENT FLOOD INSURANCE RATE MAPS.
14. HAVE YOU EVER RECEIVED ASSISTANCE, OR ARE YOU AWARE OF ANY
PREVIOUS OWNERS RECEIVING ASSISTANCE, FROM THE FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA), THE U.S. SMALL BUSINESS ADMINISTRATION
(SBA), OR ANY OTHER FEDERAL DISASTER FLOOD ASSISTANCE FOR FLOOD
DAMAGE TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW) FOR
PROPERTIES THAT HAVE RECEIVED FEDERAL DISASTER ASSISTANCE, THE
REQUIREMENT TO OBTAIN FLOOD INSURANCE PASSES DOWN TO ALL FUTURE
OWNERS. FAILURE TO OBTAIN AND MAINTAIN FLOOD INSURANCE CAN RESULT
IN AN INDIVIDUAL BEING INELIGIBLE FOR FUTURE ASSISTANCE.
15. IS THERE FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN NA (IF YES,
ATTACH A COPY OF THE POLICY)
A STANDARD HOMEOWNER'S INSURANCE POLICY TYPICALLY DOES NOT COVER
FLOOD DAMAGE. YOU ARE ENCOURAGED TO EXAMINE YOUR POLICY TO
DETERMINE WHETHER YOU ARE COVERED.
16. IS THERE A FEMA ELEVATION CERTIFICATE AVAILABLE FOR THE PROPERTY?
YES NO UNKN NA (IF YES, ATTACH A COPY OF THE CERTIFICATE)
AN ELEVATION CERTIFICATE IS A FEMA FORM, COMPLETED BY A LICENSED
SURVEYOR OR ENGINEER. THE FORM PROVIDES CRITICAL INFORMATION ABOUT
THE FLOOD RISK OF THE PROPERTY AND IS USED BY FLOOD INSURANCE
PROVIDERS UNDER THE NATIONAL FLOOD INSURANCE PROGRAM (NFIP) TO
HELP DETERMINE THE APPROPRIATE FLOOD INSURANCE RATING FOR THE
PROPERTY. A BUYER MAY BE ABLE TO USE THE ELEVATION CERTIFICATE
FROM A PREVIOUS OWNER FOR THEIR FLOOD INSURANCE POLICY.
17. HAVE YOU EVER FILED A CLAIM FOR FLOOD DAMAGE TO THE PROPERTY WITH
ANY INSURANCE PROVIDER, INCLUDING THE NATIONAL FLOOD INSURANCE
PROGRAM (NFIP)? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
18. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED WETLAND?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
19. IS THE PROPERTY LOCATED IN AN AGRICULTURAL DISTRICT? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
20. WAS THE PROPERTY EVER THE SITE OF A LANDFILL? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
21. 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)
22. IS THERE ASBESTOS IN THE STRUCTURE? YES NO UNKN NA (IF YES, STATE
LOCATION OR LOCATIONS BELOW)
23. IS LEAD PLUMBING PRESENT? YES NO UNKN NA (IF YES, STATE LOCATION
OR LOCATIONS BELOW)
24. HAS A RADON TEST BEEN DONE? YES NO UNKN NA (IF YES, ATTACH A COPY
OF THE REPORT)
25. 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)
26. 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))
27. HAS THE PROPERTY BEEN TESTED FOR INDOOR MOLD? YES NO UNKN (IF YES,
ATTACH A COPY OF THE REPORT)
STRUCTURAL
28. IS THERE ANY ROT OR WATER DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
29. IS THERE ANY FIRE OR SMOKE DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
30. IS THERE ANY TERMITE, INSECT, RODENT OR PEST INFESTATION OR
DAMAGE? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
31. HAS THE PROPERTY BEEN TESTED FOR TERMITE, INSECT, RODENT OR PEST
INFESTATION OR DAMAGE? YES NO UNKN NA (IF YES, PLEASE ATTACH
REPORT(S))
32. WHAT IS THE TYPE OF ROOF/ROOF COVERING (SLATE, ASPHALT, OTHER.)?
ANY KNOWN MATERIAL DEFECTS? HOW OLD IS THE ROOF? IS THERE A
TRANSFERABLE WARRANTY ON THE ROOF IN EFFECT NOW? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
33. 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
34. WHAT IS THE WATER SOURCE (CIRCLE ALL THAT APPLY - WELL, PRIVATE,
MUNICIPAL, OTHER)? IF MUNICIPAL, IS IT METERED? YES NO UNKN NA
35. HAS THE WATER QUALITY AND/OR FLOW RATE BEEN TESTED? YES NO UNKN NA
(IF YES, DESCRIBE BELOW)
36. 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)
More information on "septic system operation and maintenance" can be
found on the NYS Department of Health website in the informational
health pamphlet made available by the Department of Health pursuant to
section 396-s of NYS general business law.
37. WHO IS YOUR ELECTRIC SERVICE PROVIDER? ________ WHAT IS THE
AMPERAGE? ________ DOES IT HAVE CIRCUIT BREAKERS OR FUSES?
________ PRIVATE OR PUBLIC POLES? ________ ANY KNOWN MATERIAL
DEFECTS? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
38. 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)
39. HAS THE STRUCTURE(S) EXPERIENCED ANY WATER PENETRATION OR DAMAGE
DUE TO SEEPAGE OR A NATURAL FLOOD EVENT, SUCH AS FROM HEAVY
RAINFALL, COASTAL STORM SURGE, TIDAL INUNDATION OR RIVER OVERFLOW?
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.):
40. PLUMBING SYSTEM? YES NO UNKN NA
41. SECURITY SYSTEM? YES NO UNKN NA
42. CARBON MONOXIDE DETECTOR? YES NO UNKN NA
43. SMOKE DETECTOR? YES NO UNKN NA
44. FIRE SPRINKLER SYSTEM? YES NO UNKN NA
45. SUMP PUMP? YES NO UNKN NA
46. FOUNDATION/SLAB? YES NO UNKN NA
47. INTERIOR WALLS/CEILINGS? YES NO UNKN NA
48. EXTERIOR WALLS OR SIDING? YES NO UNKN NA
49. FLOORS? YES NO UNKN NA
50. CHIMNEY/FIREPLACE OR STOVE? YES NO UNKN NA
51. PATIO/DECK? YES NO UNKN NA
52. DRIVEWAY? YES NO UNKN NA
53. AIR CONDITIONER? YES NO UNKN NA
54. HEATING SYSTEM? YES NO UNKN NA
55. HOT WATER HEATER? YES NO UNKN NA
56. 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 FEMA'S CURRENT FLOOD
INSURANCE RATE MAPS AND ELEVATION CERTIFICATES)
THE SELLER SHOULD USE THIS AREA TO FURTHER EXPLAIN ANY ITEM ABOVE. IF
NECESSARY, ATTACH ADDITIONAL PAGES AND INDICATE HERE THE NUMBER OF
ADDITIONAL PAGES ATTACHED.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
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
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
CONDITION 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 _________
* NB Effective July 1, 2025
3. Nothing in this article shall require a seller to undertake or
provide for any investigation or inspection of his or her residential
real property or to check any public records.
provided in section four hundred sixty-three of this article, every
seller of residential real property pursuant to a real estate purchase
contract shall complete and sign a property condition disclosure
statement as prescribed by subdivision two of this section and cause it,
or a copy thereof, to be delivered to a buyer or buyer's agent prior to
the signing by the buyer of a binding contract of sale. A copy of the
property condition disclosure statement containing the signatures of
both seller and buyer shall be attached to the real estate purchase
contract. Nothing contained in this article or this disclosure statement
is intended to prevent the parties to a contract of sale from entering
into agreements of any kind or nature with respect to the physical
condition of the property to be sold, including, but not limited to,
agreements for the sale of real property "as is".
* 2. The following shall be the disclosure form:
PROPERTY CONDITION DISCLOSURE STATEMENT
NAME OF SELLER OR SELLERS:
PROPERTY ADDRESS:
THE PROPERTY CONDITION DISCLOSURE ACT REQUIRES THE SELLER OF
RESIDENTIAL REAL PROPERTY TO CAUSE THIS DISCLOSURE STATEMENT OR A COPY
THEREOF TO BE DELIVERED TO A BUYER OR BUYER'S AGENT PRIOR TO THE SIGNING
BY THE BUYER OF A BINDING CONTRACT OF SALE.
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.
A KNOWINGLY FALSE OR INCOMPLETE STATEMENT BY THE SELLER ON THIS FORM
MAY SUBJECT THE SELLER TO CLAIMS BY THE BUYER PRIOR TO OR AFTER THE
TRANSFER OF TITLE.
"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.
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-APPLICABLE). 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
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.
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 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
EXTENSIONS, 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
REGARDING 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,
PESTICIDES 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, POOL CHEMICALS, 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 FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA) DESIGNATED FLOODPLAIN? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
11. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN THE
SPECIAL FLOOD HAZARD AREA ("SFHA"; "100-YEAR FLOODPLAIN")
ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY'S (FEMA'S)
CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
12. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN A
MODERATE RISK FLOOD HAZARD AREA ("500-YEAR FLOODPLAIN") ACCORDING
TO FEMA'S CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
13. IS THE PROPERTY SUBJECT TO ANY REQUIREMENT UNDER FEDERAL LAW TO
OBTAIN AND MAINTAIN FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN
NA (IF YES, EXPLAIN BELOW)
HOMES IN THE SPECIAL FLOOD HAZARD AREA, ALSO KNOWN AS HIGH RISK
FLOOD ZONES, ON FEMA'S FLOOD INSURANCE RATE MAPS WITH MORTGAGES
FROM FEDERALLY REGULATED OR INSURED LENDERS ARE REQUIRED TO OBTAIN
AND MAINTAIN FLOOD INSURANCE. EVEN WHEN NOT REQUIRED, FEMA
ENCOURAGES HOMEOWNERS IN HIGH RISK, MODERATE RISK, AND LOW RISK
FLOOD ZONES TO PURCHASE FLOOD INSURANCE THAT COVERS THE
STRUCTURE(S) AND THE PERSONAL PROPERTY WITHIN THE STRUCTURE(S).
ALSO NOTE THAT HOMES IN COASTAL AREAS MAY BE SUBJECT TO INCREASED
RISK OF FLOODING OVER TIME DUE TO PROJECTED SEA LEVEL RISE AND
INCREASED EXTREME STORMS CAUSED BY CLIMATE CHANGE WHICH MAY NOT BE
REFLECTED IN CURRENT FLOOD INSURANCE RATE MAPS.
14. HAVE YOU EVER RECEIVED ASSISTANCE, OR ARE YOU AWARE OF ANY
PREVIOUS OWNERS RECEIVING ASSISTANCE, FROM THE FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA), THE U.S. SMALL BUSINESS ADMINISTRATION
(SBA), OR ANY OTHER FEDERAL DISASTER FLOOD ASSISTANCE FOR FLOOD
DAMAGE TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW) FOR
PROPERTIES THAT HAVE RECEIVED FEDERAL DISASTER ASSISTANCE, THE
REQUIREMENT TO OBTAIN FLOOD INSURANCE PASSES DOWN TO ALL FUTURE
OWNERS. FAILURE TO OBTAIN AND MAINTAIN FLOOD INSURANCE CAN RESULT
IN AN INDIVIDUAL BEING INELIGIBLE FOR FUTURE ASSISTANCE.
15. IS THERE FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN NA (IF YES,
ATTACH A COPY OF THE POLICY)
A STANDARD HOMEOWNER'S INSURANCE POLICY TYPICALLY DOES NOT COVER
FLOOD DAMAGE. YOU ARE ENCOURAGED TO EXAMINE YOUR POLICY TO
DETERMINE WHETHER YOU ARE COVERED.
16. IS THERE A FEMA ELEVATION CERTIFICATE AVAILABLE FOR THE PROPERTY?
YES NO UNKN NA (IF YES, ATTACH A COPY OF THE CERTIFICATE)
AN ELEVATION CERTIFICATE IS A FEMA FORM, COMPLETED BY A LICENSED
SURVEYOR OR ENGINEER. THE FORM PROVIDES CRITICAL INFORMATION ABOUT
THE FLOOD RISK OF THE PROPERTY AND IS USED BY FLOOD INSURANCE
PROVIDERS UNDER THE NATIONAL FLOOD INSURANCE PROGRAM (NFIP) TO
HELP DETERMINE THE APPROPRIATE FLOOD INSURANCE RATING FOR THE
PROPERTY. A BUYER MAY BE ABLE TO USE THE ELEVATION CERTIFICATE
FROM A PREVIOUS OWNER FOR THEIR FLOOD INSURANCE POLICY.
17. HAVE YOU EVER FILED A CLAIM FOR FLOOD DAMAGE TO THE PROPERTY WITH
ANY INSURANCE PROVIDER, INCLUDING THE NATIONAL FLOOD INSURANCE
PROGRAM (NFIP)? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
18. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED WETLAND?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
19. IS THE PROPERTY LOCATED IN AN AGRICULTURAL DISTRICT? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
20. WAS THE PROPERTY EVER THE SITE OF A LANDFILL? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
21. 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)
22. IS THERE ASBESTOS IN THE STRUCTURE? YES NO UNKN NA (IF YES, STATE
LOCATION OR LOCATIONS BELOW)
23. IS LEAD PLUMBING PRESENT? YES NO UNKN NA (IF YES, STATE LOCATION
OR LOCATIONS BELOW)
24. HAS A RADON TEST BEEN DONE? YES NO UNKN NA (IF YES, ATTACH A COPY
OF THE REPORT)
25. 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)
26. 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))
27. HAS THE PROPERTY BEEN TESTED FOR INDOOR MOLD? YES NO UNKN (IF YES,
ATTACH A COPY OF THE REPORT)
STRUCTURAL
28. IS THERE ANY ROT OR WATER DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
29. IS THERE ANY FIRE OR SMOKE DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
30. IS THERE ANY TERMITE, INSECT, RODENT OR PEST INFESTATION OR
DAMAGE? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
31. HAS THE PROPERTY BEEN TESTED FOR TERMITE, INSECT, RODENT OR PEST
INFESTATION OR DAMAGE? YES NO UNKN NA (IF YES, PLEASE ATTACH
REPORT(S))
32. WHAT IS THE TYPE OF ROOF/ROOF COVERING (SLATE, ASPHALT, OTHER.)?
ANY KNOWN MATERIAL DEFECTS? HOW OLD IS THE ROOF? IS THERE A
TRANSFERABLE WARRANTY ON THE ROOF IN EFFECT NOW? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
33. 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
34. WHAT IS THE WATER SOURCE (CIRCLE ALL THAT APPLY - WELL, PRIVATE,
MUNICIPAL, OTHER)? IF MUNICIPAL, IS IT METERED? YES NO UNKN NA
35. HAS THE WATER QUALITY AND/OR FLOW RATE BEEN TESTED? YES NO UNKN NA
(IF YES, DESCRIBE BELOW)
36. 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)
37. WHO IS YOUR ELECTRIC SERVICE PROVIDER? ________ WHAT IS THE
AMPERAGE? ________ DOES IT HAVE CIRCUIT BREAKERS OR FUSES?
________ PRIVATE OR PUBLIC POLES? ________ ANY KNOWN MATERIAL
DEFECTS? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
38. 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)
39. HAS THE STRUCTURE(S) EXPERIENCED ANY WATER PENETRATION OR DAMAGE
DUE TO SEEPAGE OR A NATURAL FLOOD EVENT, SUCH AS FROM HEAVY
RAINFALL, COASTAL STORM SURGE, TIDAL INUNDATION OR RIVER OVERFLOW?
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.):
40. PLUMBING SYSTEM? YES NO UNKN NA
41. SECURITY SYSTEM? YES NO UNKN NA
42. CARBON MONOXIDE DETECTOR? YES NO UNKN NA
43. SMOKE DETECTOR? YES NO UNKN NA
44. FIRE SPRINKLER SYSTEM? YES NO UNKN NA
45. SUMP PUMP? YES NO UNKN NA
46. FOUNDATION/SLAB? YES NO UNKN NA
47. INTERIOR WALLS/CEILINGS? YES NO UNKN NA
48. EXTERIOR WALLS OR SIDING? YES NO UNKN NA
49. FLOORS? YES NO UNKN NA
50. CHIMNEY/FIREPLACE OR STOVE? YES NO UNKN NA
51. PATIO/DECK? YES NO UNKN NA
52. DRIVEWAY? YES NO UNKN NA
53. AIR CONDITIONER? YES NO UNKN NA
54. HEATING SYSTEM? YES NO UNKN NA
55. HOT WATER HEATER? YES NO UNKN NA
56. 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 FEMA'S CURRENT FLOOD
INSURANCE RATE MAPS AND ELEVATION CERTIFICATES)
THE SELLER SHOULD USE THIS AREA TO FURTHER EXPLAIN ANY ITEM ABOVE. IF
NECESSARY, ATTACH ADDITIONAL PAGES AND INDICATE HERE THE NUMBER OF
ADDITIONAL PAGES ATTACHED.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
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
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
CONDITION 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 _________
* NB Effective until July 1, 2025
* 2. The following shall be the disclosure form:
PROPERTY CONDITION DISCLOSURE STATEMENT
NAME OF SELLER OR SELLERS:
PROPERTY ADDRESS:
THE PROPERTY CONDITION DISCLOSURE ACT REQUIRES THE SELLER OF
RESIDENTIAL REAL PROPERTY TO CAUSE THIS DISCLOSURE STATEMENT OR A COPY
THEREOF TO BE DELIVERED TO A BUYER OR BUYER'S AGENT PRIOR TO THE SIGNING
BY THE BUYER OF A BINDING CONTRACT OF SALE.
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.
A KNOWINGLY FALSE OR INCOMPLETE STATEMENT BY THE SELLER ON THIS FORM
MAY SUBJECT THE SELLER TO CLAIMS BY THE BUYER PRIOR TO OR AFTER THE
TRANSFER OF TITLE.
"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.
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-APPLICABLE). 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
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.
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 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
EXTENSIONS, 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
REGARDING 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,
PESTICIDES 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, POOL CHEMICALS, 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 FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA) DESIGNATED FLOODPLAIN? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
11. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN THE
SPECIAL FLOOD HAZARD AREA ("SFHA"; "100-YEAR FLOODPLAIN")
ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY'S (FEMA'S)
CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
12. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN A
MODERATE RISK FLOOD HAZARD AREA ("500-YEAR FLOODPLAIN") ACCORDING
TO FEMA'S CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
13. IS THE PROPERTY SUBJECT TO ANY REQUIREMENT UNDER FEDERAL LAW TO
OBTAIN AND MAINTAIN FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN
NA (IF YES, EXPLAIN BELOW)
HOMES IN THE SPECIAL FLOOD HAZARD AREA, ALSO KNOWN AS HIGH RISK
FLOOD ZONES, ON FEMA'S FLOOD INSURANCE RATE MAPS WITH MORTGAGES
FROM FEDERALLY REGULATED OR INSURED LENDERS ARE REQUIRED TO OBTAIN
AND MAINTAIN FLOOD INSURANCE. EVEN WHEN NOT REQUIRED, FEMA
ENCOURAGES HOMEOWNERS IN HIGH RISK, MODERATE RISK, AND LOW RISK
FLOOD ZONES TO PURCHASE FLOOD INSURANCE THAT COVERS THE
STRUCTURE(S) AND THE PERSONAL PROPERTY WITHIN THE STRUCTURE(S).
ALSO NOTE THAT HOMES IN COASTAL AREAS MAY BE SUBJECT TO INCREASED
RISK OF FLOODING OVER TIME DUE TO PROJECTED SEA LEVEL RISE AND
INCREASED EXTREME STORMS CAUSED BY CLIMATE CHANGE WHICH MAY NOT BE
REFLECTED IN CURRENT FLOOD INSURANCE RATE MAPS.
14. HAVE YOU EVER RECEIVED ASSISTANCE, OR ARE YOU AWARE OF ANY
PREVIOUS OWNERS RECEIVING ASSISTANCE, FROM THE FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA), THE U.S. SMALL BUSINESS ADMINISTRATION
(SBA), OR ANY OTHER FEDERAL DISASTER FLOOD ASSISTANCE FOR FLOOD
DAMAGE TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW) FOR
PROPERTIES THAT HAVE RECEIVED FEDERAL DISASTER ASSISTANCE, THE
REQUIREMENT TO OBTAIN FLOOD INSURANCE PASSES DOWN TO ALL FUTURE
OWNERS. FAILURE TO OBTAIN AND MAINTAIN FLOOD INSURANCE CAN RESULT
IN AN INDIVIDUAL BEING INELIGIBLE FOR FUTURE ASSISTANCE.
15. IS THERE FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN NA (IF YES,
ATTACH A COPY OF THE POLICY)
A STANDARD HOMEOWNER'S INSURANCE POLICY TYPICALLY DOES NOT COVER
FLOOD DAMAGE. YOU ARE ENCOURAGED TO EXAMINE YOUR POLICY TO
DETERMINE WHETHER YOU ARE COVERED.
16. IS THERE A FEMA ELEVATION CERTIFICATE AVAILABLE FOR THE PROPERTY?
YES NO UNKN NA (IF YES, ATTACH A COPY OF THE CERTIFICATE)
AN ELEVATION CERTIFICATE IS A FEMA FORM, COMPLETED BY A LICENSED
SURVEYOR OR ENGINEER. THE FORM PROVIDES CRITICAL INFORMATION ABOUT
THE FLOOD RISK OF THE PROPERTY AND IS USED BY FLOOD INSURANCE
PROVIDERS UNDER THE NATIONAL FLOOD INSURANCE PROGRAM (NFIP) TO
HELP DETERMINE THE APPROPRIATE FLOOD INSURANCE RATING FOR THE
PROPERTY. A BUYER MAY BE ABLE TO USE THE ELEVATION CERTIFICATE
FROM A PREVIOUS OWNER FOR THEIR FLOOD INSURANCE POLICY.
17. HAVE YOU EVER FILED A CLAIM FOR FLOOD DAMAGE TO THE PROPERTY WITH
ANY INSURANCE PROVIDER, INCLUDING THE NATIONAL FLOOD INSURANCE
PROGRAM (NFIP)? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
18. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED WETLAND?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
19. IS THE PROPERTY LOCATED IN AN AGRICULTURAL DISTRICT? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
20. WAS THE PROPERTY EVER THE SITE OF A LANDFILL? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
21. 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)
22. IS THERE ASBESTOS IN THE STRUCTURE? YES NO UNKN NA (IF YES, STATE
LOCATION OR LOCATIONS BELOW)
23. IS LEAD PLUMBING PRESENT? YES NO UNKN NA (IF YES, STATE LOCATION
OR LOCATIONS BELOW)
24. HAS A RADON TEST BEEN DONE? YES NO UNKN NA (IF YES, ATTACH A COPY
OF THE REPORT)
25. 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)
26. 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))
27. HAS THE PROPERTY BEEN TESTED FOR INDOOR MOLD? YES NO UNKN (IF YES,
ATTACH A COPY OF THE REPORT)
STRUCTURAL
28. IS THERE ANY ROT OR WATER DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
29. IS THERE ANY FIRE OR SMOKE DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
30. IS THERE ANY TERMITE, INSECT, RODENT OR PEST INFESTATION OR
DAMAGE? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
31. HAS THE PROPERTY BEEN TESTED FOR TERMITE, INSECT, RODENT OR PEST
INFESTATION OR DAMAGE? YES NO UNKN NA (IF YES, PLEASE ATTACH
REPORT(S))
32. WHAT IS THE TYPE OF ROOF/ROOF COVERING (SLATE, ASPHALT, OTHER.)?
ANY KNOWN MATERIAL DEFECTS? HOW OLD IS THE ROOF? IS THERE A
TRANSFERABLE WARRANTY ON THE ROOF IN EFFECT NOW? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
33. 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
34. WHAT IS THE WATER SOURCE (CIRCLE ALL THAT APPLY - WELL, PRIVATE,
MUNICIPAL, OTHER)? IF MUNICIPAL, IS IT METERED? YES NO UNKN NA
35. HAS THE WATER QUALITY AND/OR FLOW RATE BEEN TESTED? YES NO UNKN NA
(IF YES, DESCRIBE BELOW)
36. 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)
More information on "septic system operation and maintenance" can be
found on the NYS Department of Health website in the informational
health pamphlet made available by the Department of Health pursuant to
section 396-s of NYS general business law.
37. WHO IS YOUR ELECTRIC SERVICE PROVIDER? ________ WHAT IS THE
AMPERAGE? ________ DOES IT HAVE CIRCUIT BREAKERS OR FUSES?
________ PRIVATE OR PUBLIC POLES? ________ ANY KNOWN MATERIAL
DEFECTS? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
38. 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)
39. HAS THE STRUCTURE(S) EXPERIENCED ANY WATER PENETRATION OR DAMAGE
DUE TO SEEPAGE OR A NATURAL FLOOD EVENT, SUCH AS FROM HEAVY
RAINFALL, COASTAL STORM SURGE, TIDAL INUNDATION OR RIVER OVERFLOW?
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.):
40. PLUMBING SYSTEM? YES NO UNKN NA
41. SECURITY SYSTEM? YES NO UNKN NA
42. CARBON MONOXIDE DETECTOR? YES NO UNKN NA
43. SMOKE DETECTOR? YES NO UNKN NA
44. FIRE SPRINKLER SYSTEM? YES NO UNKN NA
45. SUMP PUMP? YES NO UNKN NA
46. FOUNDATION/SLAB? YES NO UNKN NA
47. INTERIOR WALLS/CEILINGS? YES NO UNKN NA
48. EXTERIOR WALLS OR SIDING? YES NO UNKN NA
49. FLOORS? YES NO UNKN NA
50. CHIMNEY/FIREPLACE OR STOVE? YES NO UNKN NA
51. PATIO/DECK? YES NO UNKN NA
52. DRIVEWAY? YES NO UNKN NA
53. AIR CONDITIONER? YES NO UNKN NA
54. HEATING SYSTEM? YES NO UNKN NA
55. HOT WATER HEATER? YES NO UNKN NA
56. 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 FEMA'S CURRENT FLOOD
INSURANCE RATE MAPS AND ELEVATION CERTIFICATES)
THE SELLER SHOULD USE THIS AREA TO FURTHER EXPLAIN ANY ITEM ABOVE. IF
NECESSARY, ATTACH ADDITIONAL PAGES AND INDICATE HERE THE NUMBER OF
ADDITIONAL 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
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
CONDITION 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 _________
* NB Effective July 1, 2025
3. Nothing in this article shall require a seller to undertake or
provide for any investigation or inspection of his or her residential
real property or to check any public records.