Are you looking for a comprehensive obstetric and gynecological care in the Kingsdale area? Look no further than Kingsdale Gyno Form. Our experienced team of practitioners provide personalized services to ensure that our patients remain both healthy and informed about their treatment options. From well-woman checkups to pregnancy care, we strive to make healthcare easy, convenient and affordable for all of our patients. Read on to find out more about the benefits of choosing Kingsdale Gyno Form as your primary women's health provider!
| Question | Answer |
|---|---|
| Form Name | Kingsdale Gyno Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | wasatch front form printable, wasatch front b res, HOA, MLS |
Wasatch Front Regional MLS Listing Input Form
Single Family, Condo, Mobile, Recreational, P.U.D.
ReS
Fields marked with an * are requiredPrevious MLS# _________________________
PRoPeRty LocatIon
Pricing Information |
address Information |
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List Price* $ |
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House Number* |
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o N o S o E o W |
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Short Sale* |
Street Name or Number * |
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o N o S o E o W |
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o Not Short Sale |
Street Type |
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Unit Number |
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o Price Subject to 3rd Party Approval |
Quadrant* o NW o NE |
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North / South |
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o Price Previously Approved by 3rd Party |
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o SW o SE |
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East / West |
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o Offer Under 3rd Party Review |
Zip* |
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City* |
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County* |
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State* |
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Project / Subdivion |
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Zoning |
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School Information |
Hoa Information |
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School District* |
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HOA Fee / Month* |
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Elementary School* |
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HOA Contact |
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Junior High School* |
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HOA Contact Phone |
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o Voice o TDD |
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High School* |
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o Project Restrictions |
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Private School |
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o Senior Community |
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Other School |
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o Maintenance Fee |
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SIte LocatIon
tax / Parcel Information |
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Construction Status* o Built/Standing o Under Construction o To Be Built |
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o Assigned Parcel # |
OR* |
Taxes $ |
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Water Shares |
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Tax Parcel Number* |
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Parking |
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o P.U.D. |
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Garage Parking Carport |
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Capacity |
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Property Type* o Single Family |
o Condominium |
o Mobile (w/o land) |
Parking Capacity |
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o Recreational |
o Townhouse |
o Twin |
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R.V. Parking Height |
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R.V. Parking Length |
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Style* o |
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o Basement |
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Lot Dimensions |
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o Bungalow/Cottage |
o Cabin |
o Manufactured |
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Acres* |
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Frontage |
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o Mobile |
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o Rambler/Ranch |
o |
Frontage Facing o N o S o E o W o NE o SE o NW o SW |
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o |
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o Tudor |
o Victorian |
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Side |
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Back |
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o Irregular Shape |
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o Condo, High Rise |
o Condo, Main Level |
o Condo, Middle Level |
Deck |
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Patio |
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Basement Information |
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o Condo, Top Level |
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o Townhouse, |
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Basement Type* o None/Crawl Space |
o Daylight o Entrance |
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o Full o Partial o Shelf |
o Slab |
o Walkout o See Remarks |
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Year Built* |
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Effective Year Built |
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Basement Finished* |
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APPROXIMATE SQ FT |
BEDROOMS (MASTER) |
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BATH |
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FAMILY |
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DEN |
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FORMAL |
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KITCHEN/DINING |
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LAUNDRY |
FIREPLACE |
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F T H |
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LIVING ROOM |
K |
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LEVEL 4 |
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( ❏ ) |
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(4th Floor) |
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LEVEL 3 |
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( |
❏ |
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(3rd Floor) |
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LEVEL 2 |
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( ❏ ) |
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(2nd Floor) |
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LEVEL 1 |
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( |
❏ |
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(Main Floor) |
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BASEMENT |
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( ❏ ) |
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TOTALS |
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(System Entered) |
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LIStIng oFFIce LocatIon |
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Listing Date* |
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Expiration Date* |
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Compensation Offered* BAC |
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BAC Based on* o Gross o NET |
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Owner Name |
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Possession |
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o REO / Foreclosure / Bank Owned |
o HUD Owned |
o Owner / Agent |
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o Publicly Searchable |
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Contact Type o Agent |
o Owner o Secretary |
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Contact for Appointments & Access |
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Listing agent Information |
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Contact Phone 1 |
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o Voice o TDD |
Agent Public ID* |
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Contact Phone 2 |
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o Voice o TDD |
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Agent Name |
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Listing Type* o EAL |
o ERS |
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Photo Instructions* o Under Construction o I Will Provide |
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Ofice License ID# |
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o To Be Built |
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Ofice Name |
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Dual/VAR Rate* o Yes o No |
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The information in gray will be supplied by the WFR Membership Database (Completion Optional) |
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Seller’s Initials |
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Date |
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Seller’s Initials |
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Date |
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REV 06/11 GSW |
FORM B - RES PAGE 1 OF 4 |
accessibility Features
Recommended Maximum 8*
o 32" wide doorways o 36" wide hallways
o Access to elec. Outlets o Audible alerts
o Ceiling lift system
oElevator
o
oFully accessible
oGrab bars
oGround level
oModiied kitchen
o
oPorch lift
oRamp
o
oSingle level living
oStair lift
oUniversal design
oVisible alerts
oVisitable
oWheelchair access
oSee remarks
air conditioning
Recommended Maximum 2*
o Central Air, Electric
o Central Air, Gas
o Evap. Cooler, Roof
o Evap. Cooler, Window
oGeothermal
oHeat Pump
oNatural Ventilation
oRefrig. Air, Window
oSeer 16 Or Higher
oSolar - Active
oSolar - Passive
oSee Remarks
amenities
Recommended Maximum 5*
o Cable TV Available o Cable TV Wired
oClubhouse
oElectric Dryer Hookup
oExercise Room
oGas Dryer Hookup
oGated Community
oHome Warranty
oPark / Playground
oSauna / Steam Room
oSwimming Pool
oTennis Court
oWorkshop
oSee Remarks
animals
Pick Only 1
oNone
oPets < 20 Lbs.
oPets 20 - 75 Lbs.
oPets > 75 Lbs.
oLivestock
oSee Remarks
Seller’s Initials
Driveway / access
Recommended Maximum 2*
oAsphalt
oCircular
oCommon Drive
oConcrete
oDirt
oGravel
oSee Remarks
environmental certs
Recommended Maximum 3*
o Built Green
o Energy Star
o Home Energy Rating
oLeed
oSee Remarks
exterior
Recommended Maximum 3*
o Aluminum / Vinyl
o Asbestos Shingles
o Asphalt Shingles
oBrick
oCedar / Redwood
oCement Board
oCinder Block
oClapboard / Masonite
oComposition
oConcrete / Glass
oContainer
oFrame
oInsulated Concrete Forms
oLog
oSips Panel
oStone
oStraw Bale
oStucco
oSee Remarks
exterior Special Features
Recommended Maximum 10*
oAtrium
oAttic Fan
oAwnings
oBalcony
oBarn
oBasement Entrance
oBay Box Windows
oDeck, Covered
oDouble Pane Windows
oEntry (Foyer)
oGreenhouse Windows
oHorse Property
oOut Buildings
oOutdoor Lighting
oPatio, Covered
oPorch, Open
oPorch, Screened
oSecured Building
oSecured Parking
oSkylights
oSliding Glass Doors
oStained Glass Windows
oStorm Doors
oStorm Windows
oTriple Pane Windows
oWalk Out
oSee Remarks
Date
Floor coverings
Recommended Maximum 3*
oBamboo
oCarpet
oCork
oHardwood
oLaminate
oLinoleum
oMarble
oNatural Rock
oSlate
oTile
oTravertine
oVinyl
oSee Remarks
garage / Parking
Recommended Maximum 4*
o 2 Car Deep (Tandem)
oAttached
o
oDetached
oExtra Height
oExtra Length
oExtra Width
oHeated
oOpener
oParking, Covered
oParking, Uncovered
oRV Parking
oStorage Above
oWorkbench
oWorkshop
oSee Remarks
Heating
Recommended Maximum 3*
o95% Eficiency Or Higher
oElectric
oElectric, Baseboard
oElectric, Radiant
oForced Air
oGas, Central
oGas, Radiant
oGas, Stove
oGeothermal
oGravity Heater
oHeat Pump
oHeat Recovery
oHot Water
oHydronic
oOil
oPropane
oSolar - Active
oSolar - Passive
oSpace Heater
oSteam
oWall Heater
oWood Burning
oSee Remarks
Seller’s Initials
Inclusions / exclusions
Pick Up To 10*
Include Exclude
oo Alarm System
oo Basketball Standard
oo Ceiling Fan
oo Compactor
oo Dishwasher, Portable
oo Dog Run
oo Dryer
oo Electric Air Cleaner
oo Fireplace Equipment
oo Fireplace Insert
oo Freezer
oo Gas Grill / BBQ
oo Gazebo
oo Hot Tub
oo Humidiier
oo Microwave
oo Play Gym
oo Projector
oo Range
oo Range Hood
oo Refrigerator
oo Satellite Equipment
oo Satellite Dish
oo Storage Sheds
oo Swing Set
oo Trampoline
oo TV Antenna
oo Washer
oo Water Softener, Own
oo Water Softener, Rent
oo Window Coverings
oo Wood Stove
oo Workbench
oo See Remarks
Date
REV 06/11 GSW |
FORM B - RES PAGE 2 OF 4 |
Interior Special Features |
Lot Facts |
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Recommended Maximum 10* |
Recommended Maximum 10* |
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o Accessory Apartment |
o Additional Land Available |
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o Alarm, Fire |
o Adjacent to Golf Course |
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o Alarm, Security |
o Corner Lot |
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o Bar, Dry |
o |
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o Bar, Wet |
o Curb & Gutter |
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o Basement Apartment |
o Drip Irrigation, |
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o Bath, Master |
o Drip Irrigation, |
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o Bath, Sep. Tub / Shower |
o Drip Irrigation, |
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o Central Vacuum |
o Drip Irrigation, |
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o Closet, |
o Fenced, Full |
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o Den / Ofice |
o Fenced, Part |
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o Dishwasher, |
o Greywater Collection |
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o Disposal |
o Pervious Paving |
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o Floor Drains |
o Private |
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o French Doors |
o Rainwater Collection |
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o Gas Log |
o Road, Paved |
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o Granite Countertops |
o Road, Unpaved |
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o Great Room |
o Secluded Yard |
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o Instantaneous Hot Water |
o Sidewalks |
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o Intercom |
o Sprinkler, |
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o Jetted Tub |
o Sprinkler, |
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o Kitchen, Second |
o Sprinkler, |
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o Kitchen, Updated |
o Sprinkler, |
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o Laundry Chute |
o Terrain, Flat |
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o Low Voc Finishes |
o Terrain, Grad Slope |
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o |
o Terrain, Hilly |
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o Oven, Double |
o Terrain, Mountain |
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o Oven, Gas |
o Terrain, Steep Slope |
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o Oven, Wall |
o View, Lake |
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o Range, Countertop |
o View, Mountain |
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o Range, Down Vent |
o View, Valley |
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o Range, Gas |
o Wooded |
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o Range / Oven, |
o See Remarks |
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o Range / Oven, Free Stdng. |
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o Silestone Countertops |
Pool Features |
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o Theater Room |
Recommended Maximum 3* |
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o Above Ground |
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o Vaulted Ceilings |
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o Concrete / Gunite |
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o See Remarks |
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o Electronic Cover |
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Landscaping |
o Fenced |
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o Fiberglass / Vinyl |
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Recommended Maximum 5* |
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o Fruit Trees |
o Heated |
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o Landscaping, Full |
o In Ground |
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o Landscaping, Part |
o Indoor |
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o Mature Trees |
o With Spa |
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o Pines |
o See Remarks |
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o Scrub Oak |
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o Stream |
Roof |
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o Terraced Yard |
Recommended Maximum 2* |
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o Aluminum |
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o Vegetable Garden |
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o Asbestos Shingles |
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o Waterfall |
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o Asphalt Shingles |
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o Xeriscaped |
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o Bitumen |
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o See Remarks |
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o Composition |
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o Fiberglass |
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|
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o Flat |
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o Metal |
||
|
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o Pitched |
||
|
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o PVC |
||
|
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o |
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o Rubber (Epdm) |
||
|
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o Stone |
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|
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o Tar / Gravel |
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o Tile |
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o Wood Shake Shingles |
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o See Remarks |
||
Seller’s Initials |
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Date |
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Show Instructions
Recommended Maximum 3*
o Agent Has Key
o Appt / Use Key Box o Call / Use Key Box o Call Agent / Appt o Call Owner / Appt o Call Tenant / Appt
oKey At List Ofice
oKey Box, Electronic
oKey Box, Mechanical
oKnock / Use Key Box
oVacant
oSee Agent Remarks
Storage
Recommended Maximum 3*
oBasement
oCarport
oGarage
oPatio
oShed
oSee Remarks
telecommunications
Recommended Maximum 4*
o Broadband Cable
oDSL
oEthernet, Wired
oFiber Optics
oISDN
oMultiple Phone Lines
o
oWireless Broadband
oSee Remarks
terms
Recommended Maximum 10*
o Assumption, Qualify
o Assumption, Simple
o Available T
oRent
oCash
oCommercial Fin. Req.
oConventional
oDown Payment Assist.
oExchange
$Equity For Exchange Only o FHA
o Lease Option o Monthly o Yearly
o Owner 2nd
o Seller Finance
o Seller Will Subordinate o VA
o See Remarks
Seller’s Initials
Utilities
Recommended Maximum 5*
o Gas, Available
o Gas, Connected
o Gas, Not Available
o Gas, Not Connected
oPower, Available
oPower, Connected
oPower, Not Available
oPower, Not Connected
oSewer, Available
oSewer, Connected
oSewer, Not Available
oSewer, Not Connected
oSewer, Private
oSewer, Public
oSewer, Septic Tank
oWater, Available
oWater, Connected
oWater, Not Available
oWater, Not Connected
oSee Remarks
Water
Recommended Maximum 3*
oCulinary
oIrrigation
oIrrigation, Pressure
oPrivate
oRights, Owned
oRights, Rented
oSecondary
oShares
oSpring
oWell
oSee Remarks
Window coverings
Recommended Maximum 3*
oBlinds
oDraperies
oFull
oNone
oPart
oPlantation Shutters
oShades
oSee Remarks
Zoning
Recommended Maximum 3*
oAgricultural
oCommercial
oIndust. / Manufact.
oRes. - Multi Family
oRes. - Single Family
oSee Remarks
Date
REV 06/11 GSW |
FORM B - RES PAGE 3 OF 4 |
Remarks
agent Remarks
Directions /
exclusions Remarks
Hoa Remarks
The Undersigned is the owner of the real property described in this Listing Input Form (“Owner”) and hereby acknowledges receipt of completed copies of this document, (Form B, 4 pages) and the Exclusive Right to Sell Listing Agreement.
Owner acknowledges that Wasatch Front Regional Multiple Listing Service, Inc. (“WFRMLS”) maintains a multiple listing service database for bro- kers and agents, and others (the “MLS Database”), and a database of listings which is available to the public (the “IDX Database”). Owner consents
to WFRMLS including all of the information included in this Listing Input Form (the “Listing”) in the MLS Database and the IDX Database, and any modiications of the MLS Database and IDX Database, the licensing of the MLS Database and IDX Database to any third party, disclosure and public display of the Listing, and any other lawful use of the Listing by WFRMLS. Owner hereby irrevocably assigns and transfers to WFRMLS all right, title,
and interest in and to any copyright rights and other intellectual property rights, and any actions and causes of action related to the foregoing, and any damages, proits and other recoveries related thereto, which Owner may have or acquire in and to the Listing and any and all photographs, images, graphics, video recordings, virtual tours, drawings, written descriptions, remarks, narratives, pricing information, and other copyrightable elements
relating to the property that are associated with the Listing and any changes thereto (“Listing Content”).
Owner represents and warrants to WFRMLS that the information contained herein is correct and that the Listing, Listing Content, and the assignment of rights to WFRMLS set forth above does not violate or infringe upon the rights, including any intellectual property rights, of any person or entity. Owner agrees to indemnify and hold harmless WFRMLS against all damages, costs and liabilities, including reasonable attorney fees, arising from any claim that the Listing, Listing Content, or any portion thereof infringes the rights of any third party.
Owner’s Signature |
Owner’s Signature |
REV 06/11 GSW |
FORM B - RES PAGE 4 OF 4 |