DISCLOSURE TO SELLER REGARDING
PROPERTY CONDITION DISCLOSURE STATEMENT
As the seller of residential real property, you are required
by law to complete and sign a Property Condition Disclosure Statement as
prescribed by Real Property Law §462(2) 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 the buyer and the seller must be
attached to the real estate purchase contract.
If you acquire knowledge which renders materially inaccurate a Property
Condition Disclosure Statement previously
provided, you must deliver a revised Property Condition Disclosure Statement
to the buyer as soon as practicable. In no event, however, will you be
required to provide a revised Property Condition Disclosure Statement after
the transfer of title from you to the buyer or after the buyer has commenced
occupancy of the property. If you fail to deliver a Property Condition
Disclosure Statement to the buyer prior to the buyer signing a binding
contract of sale, the buyer will be entitled to a credit in the amount of
$500.00 against the purchase price of the
property upon the transfer of title.
The statement reads as follows:
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. IN THE EVENT A SELLER FAILS TO PERFORM THE DUTY PRESCRIBED IN THIS ARTICLE
TO DELIVER A DISCLOSURE 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 FIVE
HUNDRED DOLLARS AGAINST THE AGREED UPON PURCHASE PRICE OF THE RESIDENTIAL REAL 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.
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 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 and pool chemicals and products containing mercury and lead.
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))
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 transferable warrantee on the roof in effect now?
Yes No UNKN NA (if yes, explain below)
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 amperage? __________________________________________________
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 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
__________
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