Dsc 8000 Form – Fill Out and Use This PDF

Reference (e.g., Seller & Property)

Seller’s Disclosure Statement for Residential Property

Note: The following is a disclosure statement made by Seller concerning the Property commonly described as

(list address)(the “Property”). This disclosure statement may assist a Buyer in evaluating the Property, but it is not a warranty of any kind by Seller or any broker or licensee in this transaction, and is not a substitute for any inspection or warranties a Buyer may wish to obtain. Real estate brokers and licensees involved in the sale do not inspect the Property for defects or guarantee the accuracy of the information provided in this form.

TO THE SELLER: Please complete the following form, including past history or problems if known. Do not leave any spaces blank. If the condition is not applicable to your Property (or unknown), mark “N/A” (or “Unknown”) in the blank. The following are representations made by the Seller and are not representations of any broker or licensee. Complete and truthful disclosure of the history and condition of the Property gives you the best protection against future charges that you violated a legal disclosure obligation to a Buyer. Your answers or the answers you fail to provide, either way, may have legal consequences, even after the closing of the sale. This questionnaire should help you meet your disclosure obligations, but it may not cover all aspects of the Property. If you know of or suspect some condition which may negatively affect the value of the Property or impair the health or safety of future occupants (e.g., environmental hazards, physical condition or material defects in the Property or title thereto), then you may use the space at the end of this form to further describe that condition and/or attach additional pages if additional space is required.

TO THE BUYER: Since these disclosures are based on the Seller’s knowledge, you cannot be sure that there are, in fact, no problems with the Property simply because the Seller is not aware of them. The answers given by the Seller are not warranties of the condition of the Property. Thus, you may want to condition your offer on a professional inspection(s) of the Property. You may also wish to obtain a home protection plan/warranty. Conditions of the Property that you can see on a reasonable inspection and/or that are disclosed herein should either be taken into account in the purchase price or you should make the correction of these conditions by the Seller a requirement of the sale contract. IF YOU SIGN A SALE CONTRACT TO PURCHASE THE PROPERTY, THAT CONTRACT, AND NOT THIS DISCLOSURE STATEMENT, WILL PROVIDE FOR WHAT IS TO BE INCLUDED IN THE SALE. IF YOU EXPECT CERTAIN ITEMS, APPLIANCES OR EQUIPMENT TO BE INCLUDED, THEY MUST BE SPECIFIED AS INCLUDED IN THE SALE CONTRACT.

1.

SUBDIVISION

(a)

Name:

Assessment: $

per

month

quarter

half-year

year.

(b)

Assessment includes (check all that apply):

street maintenance

clubhouse

pool

tennis court

entrance sign/structure

other common facility(ies):

(c)

Are you aware of any existing or proposed special assessments?

Yes

No

(d)

Are you aware of any written subdivision restrictions, rules, or regulations?

Yes

No

(e)

Are you aware of any violation of subdivision restrictions, rules or regulations by yourself or others?

Yes

No

(f)

Are you aware of any condition or claim which may cause an increase in assessments or fees?

Yes

No

Please explain any “yes” answers you gave in this section (attach additional pages if needed):

2. CONDOMINIUM, CO-OP OR SHARED COST DEVELOPMENT (if applicable)

(a)Name:

(b)Type: Condominium Co-Op Other shared cost development (explain):

(c)

Assessment: $

per

month

quarter

half-year

year.

(d)

Assessment includes (check all that apply):

water

cooling

heating

sewer

trash removal

snow

removal

doorman

street maintenance

assigned parking space(s)

(number)

garage

security

landscaping

clubhouse

real estate taxes

insurance on building

pool

tennis court

exercise area

reception facility

other common facility:

(e)Exterior maintenance: fully covered by assessment partly covered by assessment. Area(s) excluded:

(f)Are you aware of any existing or proposed special assessments? Yes No

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(g)Are you aware of any material defects in your building or other shared elements? Yes No

(h)Are you aware of any written condominium, co-op or other shared cost development agreements, restrictions, rules or regulations? Yes No

(i)Are you aware of any violation of any such restrictions, rules or regulations by yourself or others? Yes No

(j)Are you aware of any condition or claim which may cause an increase in assessments or fees? Yes No

Please explain any “yes” answer you gave in this section (attach additional pages if needed) :

3. BOAT DOCKS, SLIPS, LIFTS (Sale Contract will control as to items actually included in sale)

(a) Does the Property include or is there available to it any boat docks, slips, lifts or similar features?						Yes	No
If yes, check all that apply:	dock	slip	lift	other

If any of the above are checked and are not owned by Seller, please further specify if it or they are leased or otherwise transferable. If so, please provide a copy of the lease, permit or other such written agreement, if available, and also identify the name and available contact information for the actual owner, landlord, transferor):

(b)	Assessment $ ________________________________ per		month	quarter	half-year		year
(c)	Assessment includes (check all that apply): permits/license fees			storage	maintenance		insurance	other:
	(explain):
(d)	Are you aware of any written agreements regarding the subject matter of this section?					Yes	No If yes, please
	explain below and provide a copy if available.
(e)	Are you aware of any violation of any such agreement(s) by you or anyone else?				Yes	No
(f)	Are you aware of any condition or claim which may cause an increase in assessments or fees?						Yes	No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

4.HEATING, COOLING AND VENTILATING (Sale Contract will control as to items actually included in sale)

(a)

Air Conditioning System:

Central electric

Central gas

Window/Wall (number of window units:

)

Other:

Age of system:

(b)

Heating System:

Electric

Natural Gas

Propane

Fuel Oil

Other:

If any tanks, indicate whether:		owned	leased From whom purchased/leased?:
(c) Type of heating equipment:		Forced air	Heat pump	Hot water radiators		Steam radiators		Radiant
Baseboard Other					Age of system:

(d)Area(s) of house not served by central heating/cooling:

(e)Fireplace: Wood burning Gas Other:

(f) Additional:		Humidifier	Wood burning stove	Electronic air filter	Attic fan	Ceiling fan(s)
Other:

(g)Insulation: Known Unknown (Describe if known, including R-Factor): _________________________________

(h)Are you aware of any problems or repairs needed with any item in this section? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

5.	ELECTRICAL
(a)	Electrical System:		110V		220V	AMPS:
(b)	Type of service panel:		Fuses		Circuit Breakers.
(c)	Type of wiring:	Copper		Aluminum		Knob and Tube		Unknown.
(d)	Are you aware of any problems or repairs needed in the electrical system? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

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Reference (e.g., Seller & Property)

6. APPLIANCES/FIXTURES/EQUIPMENT (Sale Contract will control as to items actually included in sale.)

Please explain any “Are Not” responses (attach additional pages if necessary):

7.	ROOF, GUTTERS AND DOWNSPOUTS
(a)	What is the approximate age of the roof?		Years. Documented? Yes No
(b)	Has the roof ever leaked during your ownership?		Yes No

Please explain any “yes” answers you gave in this section, including repair history (attach additional pages if needed):

(c)Has the roof or any portion of it been repaired, recovered or replaced during your ownership? Yes No

(d)Are you aware of any problems with the roof, gutters or downspouts? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

8.

PLUMBING SYSTEM, FIXTURES AND EQUIPMENT

(a)

Plumbing System:

Copper

Galvanized

Other:

(b)

Water Heater:

Gas

Electric

Other:

Age of System/Size:

(c)

Hot tub/Whirlpool/Jacuzzi?

Yes

No

(d)

Lawn Sprinkler System:

Yes No If “yes”, date of last backflow device inspection or certificate:

Unknown.

(e)

Are you aware of any problems or repairs needed in the plumbing systems?

Yes

No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

9.

WATER

(a)

Water Systems/Source:

Public

Well

Other:

If “well,” specify type of well and approximate depth:

Has well been tested?

Yes

No If “yes,” identify date of report and explain results below or provide copy.

(b)

Do you have a softener, filter or other purification system?

Yes

No If “yes”,

Owned

Leased

(c)

Are you aware of any problems relating to the water system, including quality or source of water?

Yes

No

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Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

________________________________

10. SEWAGE

(a)What is the type of sewage system to which the house is connected? Public Private Septic Aerator

tanks/laterals/drain fields Other:

(b) Is there a sewage lift system?

Yes

No If “yes,” is it in good working condition?

Yes

No

(c)When was the septic/aerator system last serviced?

(d)Are you aware of any leaks, backups or other problems relating to the sewage system? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

11. CONSTRUCTION

(a)Are you aware of any problems with the footings, foundation, sub-floor, interior or exterior walls, roof construction, decks/porches or other load bearing or structural components? Yes No

(b)Are you aware of any repairs or replacements relating to any items listed in (a) above? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

14. TERMITES/WOOD DESTROYING INSECTS, PESTS

(a)Are you aware of any termites/wood destroying insects or pests affecting the Property? Yes No

(b)Are you aware of any uncorrected damage to the Property caused by any of the above? Yes No

(c)Is Property under a warranty contract by a pest control company? Yes No If “yes”, transferable? Yes No

(d)Are you aware of any termite/pest control reports for or treatment of the Property? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

____________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

15. SOIL AND DRAINAGE

(a)Are you aware of any fill, expansive soil or sinkholes on the Property? Yes No

(b)Are you aware of any soil, earth movement, flood, drainage or grading problems? Yes No

(c)Are you aware of any past, present or proposed mining, strip-mining, or any other excavations that affect or might affect the Property? Yes No

Please explain any “yes” answer you gave in this section, including repair history (attach additional pages if needed) :

_________________________________________________________________________________________________

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Reference (e.g., Seller & Property)

16. HAZARDOUS SUBSTANCES/OTHER ENVIRONMENTAL CONCERNS

(a)Lead

(1)Are you aware of the presence of any lead hazards (e.g., paint, water supply lines, etc.) on the Property?

Yes No (Note: Production of lead based paint was banned in 1978. MAR Form DSC-2000 may need to be completed in connection with this form).

(2)Are you aware of the presence of any lead in the soils? Yes No

(3)Are you aware if lead has ever been covered or removed? Yes No

(4)Are you aware if the Property has been tested for lead? Yes No

(b)Asbestos Materials

(1)Are you aware of the presence of asbestos materials on the Property, such as roof shingles, siding, insulation,

ceiling, flooring, pipe wrap, etc.?	Yes	No
(2) Are you aware of any asbestos material that has been encapsulated or removed?			Yes	No

(3)Are you aware if the Property has been tested for the presence of asbestos? Yes No

(c)Mold

(1)Are you aware of the presence of any mold on the Property? Yes No

(2)Are you aware if anything with mold on the Property has ever been covered or removed? Yes No

(3)Are you aware if the Property has ever been tested for the presence of mold? Yes No

(4)Are you aware if the Property has ever been treated for the presence of mold? Yes No

(d)Radon

(1)Are you aware if the Property has been tested for radon gas? Yes No

(2)Are you aware if the Property has ever been treated or mitigated for radon gas? Yes No

(e)Methamphetamine

Are you aware if the Property is or was used as a site for methamphetamine production or the place of residence of a person convicted of a crime involving any controlled substance related thereto?

Yes No If “yes,” MAR Form DSC-5000 must be filled out in conjunction with this form.

(f)Other Environmental Concerns

Are you aware of any other environmental concerns that may affect the Property such as polychlorinated biphenyls (PCB’s), electro-magnetic fields (EMF’s), underground fuel tanks, discoloration of soil or vegetation, oil sheens in wet areas, unused septic or storage tanks, uses of the Property other than residential (e.g., commercial, farming, landfill, dumping site), etc.? Yes No

Please explain any “yes” answer you gave in this section, including repair history, date(s) performed, type of tests or treatment and results, and name of person/company who did the testing or mitigation (attach additional pages if needed):

17.	INSURANCE
(a)	Are you aware of any claims that have been filed for damages to the Property in the last 5 years?			Yes	No If
	“yes,” please explain and include the following: Date of claim, description of claim, repairs and/or replacements
	completed:
					______
(b)	Are you aware that any insurance application or prior coverage regarding any part of the Property has been rejected
	or will not be renewed? Yes		No

(c) Are you aware that any existing insurance coverage will be subjected to increased rates? Yes No

18. ROADS, STREETS & ALLEYS

(a)The roads, streets and/or alleys serving the Property are public private?

(b)Is there a recorded road/street/alley maintenance agreement? Yes No

(c)Are you aware of any right of way, unrecorded easement or similar matter which affect the Property? Yes No Please explain any “yes” answer you gave in this section, including repair history and identify maintenance provider and costs below (attach additional pages if needed)

______

19.	MISCELLANEOUS
(a)	The approximate age of the residence is		years

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Seller has been the owner of the Property for				years
Seller has continuously occupied the Property for				years
If ever vacant, when and how long?

(b)Is the Property located in an area that requires an occupancy (code compliance) inspection? Yes No

(c)Is the Property designated as a historical home or located in a historic district? Yes No

(d)Do you have a survey that includes all existing improvements on the Property? Yes No

(e)Are you aware of any pets ever having been kept in the home at the Property? Yes No

(f)Are you aware of any pets ever having been kept on the Property? Yes No

(g)Is the Buyer being offered a protection plan/home warranty at closing at Seller’s expense? Yes No

(h)Are you aware of any:

Inoperable windows? Yes No inoperable doors? Yes No broken thermal seals? Yes No

(i)Are you aware if carpet has been laid over a damaged wood floor? Yes No

(j)Is any portion of the Property located within the 100 year flood hazard area (flood plain)? Yes No

(k)Are you aware of any:

Shared or common features with adjoining properties, (e.g., walls, wells, sewers, fences, roads, etc.)?							Yes	No
Encroachments which affect the Property?	Yes	No
Existing or threatened legal action affecting the Property?			Yes	No
Violations of local, state, or federal laws/regulations, including zoning, relating to the Property?						Yes	No
Additions, modifications, or alterations made to the Property without necessary permits?					Yes	No
Consent required of anyone other than the signer(s) of this form to convey title to the Property?						Yes	No

(l)Current Utility Service Providers: Electric Company:

Water Service: Cable Service: Sewer:

Telephone:

Gas:

Garbage: Fire District:

Fire Dues Paid with Taxes? Yes No

Please explain any “yes” answer you gave in this section (attach additional pages if needed) :

Additional comments ( please mark if additional pages are attached):

Seller’s Acknowledgement Brokers are hereby authorized to distribute this information to potential buyers for this Property. Seller has carefully examined this statement and acknowledges that the information contained above is true and accurate to the best of Seller’s knowledge. Seller will fully and promptly disclose in writing to Buyer any new information pertaining to the Property that is discovered by or made known to Seller at any time prior to closing or settlement and constitutes an adverse material fact or would make any existing information set forth herein false or materially misleading.

Seller

Date

Seller

Date

Buyer’s Acknowledgement Buyer should verify information contained in this disclosure statement and is urged to carefully inspect the Property and, if desired, to have the Property inspected by an independent, professional expert(s). Buyer understands that there are areas of the Property of which Seller may have no knowledge and that this disclosure statement does not encompass those areas and is limited to information of which Seller has knowledge. Buyer also acknowledges having received and read a signed copy of this disclosure statement from Seller or the listing broker and that brokers and licensees are not experts at detecting or repairing physical defects in property.

Buyer

Date

Buyer

Date

Approved by legal counsel for use exclusively by members of the Missouri Association of Realtors, P. O. Box 1327, Columbia, Missouri 65205. No warranty is made or implied as to the legal validity or adequacy of this document, or that it complies in every respect with the law or that its use is appropriate for all situations. Local law, customs and practice, and differing circumstances in each transaction, may each dictate that amendments to this document be made. Last Revised 6/14/06. All previous versions of this document are no longer approved.

©2003 Missouri Association of Realtors

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