Question	Answer
Form Name	Real Estate Seller Disclosure Form 17
Form Length	6 pages
Fillable?	Yes
Fillable fields	465
Avg. time to fill out	31 min 31 sec
Other names	mls form 17, form 17 washington, form 17 seller disclosure statement, washington state form 17

Form 17	SELLER DISCLOSURE STATEMENT	©Copyright 2019
Seller Disclosure Statement	IMPROVED PROPERTY	Northwest Multiple Listing Service
Rev. 7/19	IMPROVED PROPERTY	ALL RIGHTS RESERVED
Page 1 of 6
SELLER: ________________________________________________________________________________________________
Seller	Seller

I. SELLER’S DISCLOSURES:							34
If you answer “Yes” to a question with an asterisk (), please explain your answer and attach documents, if available and not							35
otherwise publicly recorded. If necessary, use an attached sheet.							36
1. TITLE			YES	NO	DON’T	N/A	37
1. TITLE					KNOW		38
A. Do you have legal authority to sell the property? If no, please explain							39
*B. Is title to the property subject to any of the following?							40
(1)	First right of refusal						41
(2)	Option						42
(3)	Lease or rental agreement						43
(4)	Life estate?						44
*C. Are there any encroachments, boundary agreements, or boundary disputes?							45
*D. Is there a private road or easement agreement for access to the property?							46
*E. Are there any rights-of-way, easements, or access limitations that may affect the Buyer’s use of							47
the property?							48
*F. Are there any written agreements for joint maintenance of an easement or right-of-way?							49
*G. Is there any study, survey project, or notice that would adversely affect the property?						 50
*H. Are there any pending or existing assessments against the property?							51
________________________________		________________________________

2. WATER						62
A. Household Water						63
(1) The source of water for the property is:  Private or publicly owned water system						64
	 Private well serving only the subject property * Other water system					65
	*If shared, are there any written agreements?					66
*(2)	Is there an easement (recorded or unrecorded) for access to and/or maintenance of the					67
	water source?					68
*(3)	Are there any problems or repairs needed?				 69
(4)	During your ownership, has the source provided an adequate year-round supply of potable water? ..					70
	If no, please explain: ______________________________________________________					71
*(5)	Are there any water treatment systems for the property?					72
	If yes, are they:  Leased  Owned					73
*(6)	Are there any water rights for the property associated with its domestic water supply, such					74
	as a water right permit, certificate, or claim?				 75
	(a) If yes, has the water right permit, certificate, or claim been assigned, transferred, or changed?					76
	*(b) If yes, has all or any portion of the water right not been used for five or more successive years? 					77
*(7)	Are there any defects in the operation of the water system (e.g. pipes, tank, pump, etc.)?					78
B. Irrigation Water						79
(1)	Are there any irrigation water rights for the property, such as a water right permit,					80
	certificate, or claim?					81
	*(a) If yes, has all or any portion of the water right not been used for five or more					82
	successive years?					83
	*(b) If so, is the certificate available? (If yes, please attach a copy.)					84
	*(c) If so, has the water right permit, certificate, or claim been assigned, transferred, or changed? ...					85
*(2)	Does the property receive irrigation water from a ditch company, irrigation district, or other entity?					86
	If so, please identify the entity that supplies water to the property:					87
	_______________________________________________________________________					88
C. Outdoor Sprinkler System						89
(1)	Is there an outdoor sprinkler system for the property?					90
*(2)	If yes, are there any defects in the system?					91
*(3)	If yes, is the sprinkler system connected to irrigation water?					92

4. STRUCTURAL
*A. Has the roof leaked within the last 5 years?				
*B. Has the basement flooded or leaked?				
*C. Have there been any conversions, additions or remodeling?				
*(1) If yes, were all building permits obtained?				
*(2) If yes, were all final inspections obtained?				
D. Do you know the age of the house?				
If yes, year of original construction: _____________________________________________
*E. Has there been any settling, slippage, or sliding of the property or its improvements?				
*F. Are there any defects with the following: (If yes, please check applicable items and explain)				

 Foundations	 Decks	 Exterior Walls
 Chimneys	 Interior Walls	 Fire Alarms
 Doors	 Windows	 Patio
 Ceilings	 Slab Floors	 Driveways
 Pools	 Hot Tub	 Sauna
 Sidewalks	 Outbuildings	 Fireplaces
 Garage Floors	 Walkways	 Siding
 Wood Stoves	 Elevators	 Incline Elevators

*G. Was a structural pest or “whole house” inspection done?				
If yes, when and by whom was the inspection completed?
______________________________________________________________________
H. During your ownership, has the property had any wood destroying organism or pest infestation?				
I. Is the attic insulated?				
J. Is the basement insulated?				

*A. Did you make any alterations to the home?	 
If yes, please describe the alterations: ________________________________________

*B. Did any previous owner make any alterations to the home?	    227
*C. If alterations were made, were permits or variances for these alterations obtained?	    228
10. FULL DISCLOSURE BY SELLERS	229
A. Other conditions or defects:	230
*Are there any other existing material defects affecting the property that a prospective	231
buyer should know about?	   232

If the answer is “Yes” to any asterisked (*) items, please explain below (use additional sheets if necessary). Please refer to the line	240
number(s) of the question(s).	241
	242

_________________________________________________		____________________________________________________
Seller	Date	Seller	Date

Form 17	SELLER DISCLOSURE STATEMENT	©Copyright 2019
Seller Disclosure Statement	IMPROVED PROPERTY	Northwest Multiple Listing Service
Rev. 7/19	IMPROVED PROPERTY	ALL RIGHTS RESERVED
Page 6 of 6	(Continued)
II. NOTICES TO THE BUYER			255
1. SEX OFFENDER REGISTRATION			256
INFORMATION REGARDING REGISTERED SEX OFFENDERS MAY BE OBTAINED FROM LOCAL LAW ENFORCEMENT			257
AGENCIES. THIS NOTICE IS INTENDED ONLY TO INFORM YOU OF WHERE TO OBTAIN THIS INFORMATION AND IS NOT			258
AN INDICATION OF THE PRESENCE OF REGISTERED SEX OFFENDERS.			259
2. PROXIMITY TO FARMING/WORKING FOREST			260
THIS NOTICE IS TO INFORM YOU THAT THE REAL PROPERTY YOU ARE CONSIDERING FOR PURCHASE MAY LIE IN			261
CLOSE PROXIMITY TO A FARM OR WORKING FOREST. THE OPERATION OF A FARM OR WORKING FOREST			262
INVOLVES USUAL AND CUSTOMARY AGRICULTURAL PRACTICES OR FOREST PRACTICES, WHICH ARE PROTECTED			263
UNDER RCW 7.48.305, THE WASHINGTON RIGHT TO FARM ACT.			264
3. OIL TANK INSURANCE			265
THIS NOTICE IS TO INFORM YOU THAT IF THE REAL PROPERTY YOU ARE CONSIDERING FOR PURCHASE UTILIZES			266
AN OIL TANK FOR HEATING PURPOSES, NO COST INSURANCE MAY BE AVAILABLE FROM THE POLLUTION LIABILITY			267
INSURANCE AGENCY.			268
III. BUYER’S ACKNOWLEDGEMENT			269
1. BUYER HEREBY ACKNOWLEDGES THAT:			270
A. Buyer has a duty to pay diligent attention to any material defects that are known to Buyer or can be known to Buyer by			271
utilizing diligent attention and observation.			272
B. The disclosures set forth in this statement and in any amendments to this statement are made only by the Seller and			273
not by any real estate licensee or other party.			274
C. Buyer acknowledges that, pursuant to RCW 64.06.050(2), real estate licensees are not liable for inaccurate information			275
provided by Seller, except to the extent that real estate licensees know of such inaccurate information.			276
D. This information is for disclosure only and is not intended to be a part of the written agreement between the Buyer and Seller.			277
E. Buyer (which term includes all persons signing the “Buyer’s acceptance” portion of this disclosure statement below) has			278
received a copy of this Disclosure Statement (including attachments, if any) bearing Seller’s signature(s).			279

DISCLOSURES CONTAINED IN THIS DISCLOSURE STATEMENT ARE PROVIDED BY SELLER BASED ON SELLER’S				281
ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME SELLER COMPLETES THIS DISCLOSURE. UNLESS BUYER				282
AND SELLER OTHERWISE AGREE IN WRITING, BUYER SHALL HAVE THREE (3) BUSINESS DAYS FROM THE DAY				283
SELLER OR SELLER’S AGENT DELIVERS THIS DISCLOSURE STATEMENT TO RESCIND THE AGREEMENT BY				284
DELIVERING A SEPARATELY SIGNED WRITTEN STATEMENT OF RESCISSION TO SELLER OR SELLER’S AGENT. YOU				285
MAY WAIVE THE RIGHT TO RESCIND PRIOR TO OR AFTER THE TIME YOU ENTER INTO A SALE AGREEMENT.				286
BUYER HEREBY ACKNOWLEDGES RECEIPT OF A COPY OF THIS DISCLOSURE STATEMENT AND ACKNOWLEDGES				287
THAT THE DISCLOSURES MADE HEREIN ARE THOSE OF THE SELLER ONLY, AND NOT OF ANY REAL ESTATE				288
LICENSEE OR OTHER PARTY.				289
_____________________________________________________		___________________________________________________		290
Buyer	Date	Buyer	Date	291

_____________________________________________________		___________________________________________________
Buyer	Date	Buyer	Date

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