Pa Form Disclosure – Fill Out and Use This PDF

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1.SELLER'S EXPERTISE

(A)Does Seller possess expertise in contracting, engineering, architecture, environmental assessment or other areas related to the construction and conditions of the property and its improvements?

(B)Is Seller the landlord for the property?

(C)Is Seller a real estate licensee?

Explain any "yes" answers in section 1:

2.OWNERSHIP/OCCUPANCY

(A)Occupation

1.When was the property most recently occupied?

2.Was the Seller the most recent occupant? If "no," when did the Seller most recently occupy the property?

3.How many persons most recently occupied the property?

(B)Role of Individual Completing This Disclosure. Is the individual completing this form:

1.The owner

2.The executor

3.The administrator

4.The trustee

5.An individual holding power of attorney

(C)When was the property purchased?

(D)Are you aware of any pets having lived in the house or other structures during your ownership? Explain section 2 (if needed):

3.CONDOMINIUMS/PLANNED COMMUNITIES/OTHER HOMEOWNERS ASSOCIATIONS

(A)Type. Is the Property part of a(n):

1.Condominium

2.Homeowners association or planned community

3.Cooperative

4.Other type of association or community

(C)If "yes," are there any community services or systems that the association or community is responsible for supporting or maintaining? Explain:

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Yes No Unk N/A

(D) How much is the capital contribution/initiation fee? $

Notice to Buyer: A buyer of a resale unit in a condominium, cooperative, or planned community must receive a copy of the declaration (other than the plats and plans), the by-laws, the rules or regulations, and a certificate of resale issued by the association in the condominium, cooperative, or planned community. Buyers may be respon- sible for capital contributions, initiation fees or similar one-time fees in addition to regular monthly maintenance fees. The buyer will have the option of canceling the agreement with the return of all deposit monies until the cer- tificate has been provided to the buyer and for five days thereafter or until conveyance, whichever occurs first.

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4.ROOF

(A)Installation

1.When was the roof installed?

2.Do you have documentation (invoice, work order, warranty, etc.)?

(B)Repair

1.Has the roof or any portion of it been replaced or repaired during your ownership?

2.If it has been replaced or repaired, was the existing roofing material removed?

(C)Issues

1.Has the roof ever leaked during your ownership?

2.Are you aware of any current/past problems with the roof, gutters, flashing or downspouts? Explain any "yes" answers in section 4, including the location and extent of any problem(s) and any repair or remediation efforts:

5.BASEMENTS AND CRAWL SPACES

(A)Sump Pump

1.Does the property have a sump pit? If yes, how many?

2.Does the property have a sump pump? If yes, how many?

3.If it has a sump pump, has it ever run?

4 If it has a sump pump, is the sump pump in working order?

(B)Water Infiltration

1. Are you aware of any water leakage, accumulation, or dampness within the basement or crawl space?

2. Do you know of any repairs or other attempts to control any water or dampness problem in the basement or crawl space?

3. Are the downspouts or gutters connected to a public system?

Explain any "yes" answers in this section, including the location and extent of any problem(s) and any repair or remediation efforts:

6.TERMITES/WOOD-DESTROYING INSECTS, DRYROT, PESTS

(A)Status

1.Are you aware of any termites/wood-destroying insects, dryrot, or pests affecting the property?

2.Are you aware of any damage caused by termites/wood-destroying insects, dryrot, or pests?

(B)Treatment

1.Is your property currently under contract by a licensed pest control company?

2.Are you aware of any termite/pest control reports or treatments for the property?

Explain any "yes" answers in section 6, including the name of any service/treatment provider, if applicable:

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Yes No Unk N/A 7. STRUCTURAL ITEMS

(A)Are you aware of any past or present movement, shifting, deterioration, or other problems with walls, foundations, or other structural components?

(B)Are you aware of any past or present problems with driveways, walkways, patios, or retaining walls on the property?

(C)Are you aware of any past or present water infiltration in the house or other structures, other

than the roof, basement or crawl spaces?

(D) Stucco and Exterior Synthetic Finishing Systems

1.Is your property constructed with stucco?

2.Is your property constructed with an Exterior Insulating Finishing System (EIFS), such as

Dryvit or synthetic stucco, synthetic brick or synthetic stone?

3. If "yes," when was it installed?

(E) Are you aware of any fire, storm, water or ice damage to the property?

(F) Are you aware of any defects (including stains) in flooring or floor coverings?

Explain any "yes" answers in section 7, including the location and extent of any problem(s) and any repair or remediation efforts:

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No Unk N/A

8.ADDITIONS/ALTERATIONS

(A)Have any additions, structural changes, or other alterations been made to the property during your ownership? Itemize and date all additions/alterations below.

(B)Are you aware of any private or public architectural review control of the property other than zoning codes?

Note to Buyer: The PA Construction Code Act, 35 P.S. §7210.101 et seq. (effective 2004), and local codes establish standards for building and altering properties. Buyers should check with the municipality to deter- mine if permits and/or approvals were necessary for disclosed work and if so, whether they were obtained. Where required permits were not obtained, the municipality might require the current owner to upgrade or remove changes made by prior owners. Buyers can have the property inspected by an expert in codes com- pliance to determine if issues exist. Expanded title insurance policies may be available for Buyers to cover the risk of work done to the property by previous owners without a permit or approval.

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A sheet describing other additions and alterations is attached.

9.WATER SUPPLY

(A)Source. Is the source of your drinking water (check all that apply):

1.Public

2.A well on the property

3.Community water

4.A holding tank

5.A cistern

6.A spring

7.Other

8.No water service (explain):

(B)Bypass Valve (for properties with multiple sources of water)

1.Does your water source have a bypass valve?

2.If "yes," is the bypass valve working?

(C)Well

1.Has your well ever run dry?

2.Depth of Well

4.Is there a well used for something other than the primary source of drinking water?

5.If there is an unused well, is it capped?

(D)Pumping and Treatment

1.If your drinking water source is not public, is the pumping system in working order? If "no," explain:

2.Do you have a softener, filter, or other treatment system?

3.Is the softener, filter, or other treatment system leased? From whom?

(E)General

PROPERTY

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(F)Issues

1.Are you aware of any leaks or other problems, past or present, relating to the water supply, pumping system, and related items?

2.Have you ever had a problem with your water supply?

Explain any "yes" answers in section 9, including the location and extent of any problem(s) and any repair or remediation efforts:

10.SEWAGE SYSTEM

(A)General

1.Is your property served by a sewage system (public, private or community)?

2.If no, is it due to availability or permit limitations?

3.When was the sewage system installed (or date of connection, if public)?

(B)Type Is your property served by:

1.Public (if "yes," continue to E, F and G below)

2.Community (non-public)

3.An individual on-lot sewage disposal system

4.Other, explain:

(C)Individual On-lot Sewage Disposal System. Is your sewage system (check all that apply):

1.Within 100 feet of a well

2.Subject to a ten-acre permit exemption

3.A holding tank

4.A drainfield

5.Supported by a backup or alternate drainfield, sandmound, etc.

6.A cesspool

7.Shared

8.Other, explain:

(D)Tanks and Service

1.Are there any metal/steel septic tanks on the Property?

2.Are there any cement/concrete septic tanks on the Property?

3.Are there any fiberglass septic tanks on the Property?

4.Are there any other types of septic tanks on the Property?

5.Where are the septic tanks located?

6.How often is the on-lot sewage disposal system serviced?

7.When was the on-lot sewage disposal system last serviced?

(E)Abandoned Individual On-lot Sewage Disposal Systems and Septic

1.Are you aware of any abandoned septic systems or cesspools on your property?

2.Have these systems or cesspools been closed in accordance with the municipality’s ordinance?

(F)Sewage Pumps

1.Are there any sewage pumps located on the property?

2.What type(s) of pump(s)?

3.Are pump(s) in working order?

4.Who is responsible for maintenance of sewage pumps?

(G)Issues

1.Is any waste water piping not connected to the septic/sewer system?

2.Are you aware of any past or present leaks, backups, or other problems relating to the sewage system and related items?

Explain any "yes" answers in section 10, including the location and extent of any problem(s) and any repair or remediation efforts:

11.PLUMBING SYSTEM

(A)Material(s). Are the plumbing materials (check all that apply):

1.Copper

2.Galvanized

3.Lead

4.PVC

5.Polybutylene pipe (PB)

6.Cross-linked polyethyline (PEX)

7.Other

(B)Are you aware of any problems with any of your plumbing fixtures (e.g., including but not lim- ited to: kitchen, laundry, or bathroom fixtures; wet bars; exterior faucets; etc.)?

If "yes," explain:

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12.DOMESTIC WATER HEATING

1.Electric

2.Natural gas

3.Fuel oil

4.Propane

5.Solar

6.Geothermal

7.Other

8.Is your water heating a summer-winter hook-up (integral system, hot water from the boiler, etc.)?

3. Fireplace types(s) (wood, gas, electric, etc.):

4.Were the fireplace(s) installed by a professional contractor or manufacturer’s representative?

7.Are the chimney(s) working? If "no," explain:

(E) List any areas of the house that are not heated:

(F) Heating and Fuel Tanks

1. Are you aware of any heating fuel tank(s) on the property?

2. Location(s), including underground tank(s):

3. If you do not own the tank(s), explain:

Are you aware of any problems or repairs needed regarding any item in section 13? If "yes," explain:

14.AIR CONDITIONING SYSTEM

1.Central air

2.Wall units

3.Window units

4.Other

5.None

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1.When was the central air conditioning system installed?

2.When was the central air conditioning system last serviced?

3.How many air conditioning zones are in the property?

(C)List any areas of the house that are not air conditioned:

Are you aware of any problems with any item in section 14? If "yes," explain:

16.OTHER EQUIPMENT AND APPLIANCES

This section must be completed for each item that will, or may, be sold with the property. The fact that an item is listed does not mean it is included in the Agreement of Sale. Terms of the Agreement of Sale negotiated between Buyer and Seller will determine which items, if any, are included in the purchase of the Property.

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Are you aware of any problems or repairs needed regarding any item in section 16? If "yes," explain:

17.LAND/SOILS

(A)Property

1.Are you aware of any fill or expansive soil on the property?

2.Are you aware of any sliding, settling, earth movement, upheaval, subsidence, sinkholes or earth stability problems that have occurred on or affect the property?

3.Are you aware of sewage sludge (other than commercially available fertilizer products) being spread on the property, or have you received written notice of sewage sludge being spread on an adjacent property?

394Yes No Unk N/A

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(B)Boundaries

1.Are you aware of any encroachments, boundary line disputes, or easements affecting the property?

Note to Buyer: Most properties have easements running across them for utility services and other reasons. In many cases, the easements do not restrict the ordinary use of the property, and Seller may not be readily aware of them. Buyers may wish to determine the existence of easements and restrictions by examining the property and ordering an Abstract of Title or searching the records in the Office of the Recorder of Deeds for the county before entering into an agreement of sale.

2.Do you access the property from a private road or lane?

3.If "yes," do you have a recorded right of way or maintenance agreement?

4.Are you aware of any shared or common areas (driveways, bridges, docks, walls, etc.) or maintenance agreements?

Explain any "yes" answers in section 18(B):

PROPERTY

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19.HAZARDOUS SUBSTANCES AND ENVIRONMENTAL ISSUES

(A)Mold and Indoor Air Quality (other than radon)

1.Are you aware of any tests for mold, fungi, or indoor air quality in the property?

2.Other than general household cleaning, have you taken any efforts to control or remediate mold or mold-like substances in the property?

Note to Buyer: Individuals may be affected differently, or not at all, by mold contamination. If mold contamination or indoor air quality is a concern, buyers are encouraged to engage the services of a qualified professional to do testing. Information on this issue is available from the United States Environmental Protection Agency and may be obtained by contacting IAQ INFO, P.O. Box 37133, Washington, D.C. 20013-7133, 1-800-438-4318.

(B)Radon

1.Are you aware of any tests for radon gas that have been performed in any buildings on the property? If "yes," list date, type, and results of all tests below:

Date

Type of Test

Results (picocuries/liter)

Name of Testing Service

2.Are you aware of any radon removal system on the property?

If "yes," list date installed and type of system, and whether it is in working order below:

(C)Lead Paint

If property was constructed, or if construction began, before 1978, you must disclose any knowledge of, and records and reports about, lead-based paint on the property.

1.Are you aware of any lead-based paint or lead-based paint hazards on the property?

2.Are you aware of any reports or records regarding lead-based paint or lead-based paint haz- ards on the property?

(D)Tanks

1.Are you aware of any existing or removed underground tanks? Size:

2.If "yes," have any tanks been removed during your ownership?

(E)Dumping. Are you aware of any dumping on the property?

(F)Other

1.Are you aware of any existing hazardous substances on the property (structure or soil) such as, but not limited to, asbestos or polychlorinated biphenyls (PCBs)?

2.Have you received written notice regarding the presence of an environmental hazard or bio- hazard on your property or any adjacent property?

3.Are you aware of testing on the property for any other hazardous substances or environ- mental concerns?

4.Are you aware of any other hazardous substances or environmental concerns that might

impact upon the property? Explain any "yes" answers in section 19:

20.MISCELLANEOUS

(A)Deeds, Restrictions and Title

1.Are you aware of any deed restrictions that apply to the property?

2.Are you aware of any historic preservation restriction or ordinance or archeological desig- nation associated with the property?

3.Are you aware of any reason, including a defect in title, that would prevent you from giving a warranty deed or conveying title to the property?

4.Are you aware of any insurance claims filed relating to the property?

(B)Financial

1.Are you aware of any public improvement, condominium or homeowner association assess- ments against the property that remain unpaid or of any violations of zoning, housing, build- ing, safety or fire ordinances or other use restriction ordinances that remain uncorrected?

2.Are you aware of any mortgage, judgment, encumbrance, lien, overdue payment on a sup- port obligation, or other debt against this property or Seller that cannot be satisfied by the proceeds of this sale?