Property Address:__________________________________________
Owners Name(s):____________________________________________
Date:______________________________________,19______
Owner (___ is, ___is not) occupying the property. If owner is occupying the property, since what date________________.
Purpose of Disclosure Form: This is a statement of the condition of the property and of information concerning the property actually known by the owner as required by Ohio Revised Code Section 5302.30. Unless otherwise advised in writing by the owner, other than having lived at or owning the property, possesses no greater knowledge than that which could be obtained by a careful inspection of the property by a potential purchaser. Unless otherwise advised, owner has not conducted any inspection of generally inaccessible areas of the property. THIS STATEMENT IS NOT A WARRANTY OF ANY KIND BY THE OWNER OR BY ANY AGENT OR SUBAGENT REPRESENTING THE OWNER OF THE PROPERTY. THIS STATEMENT IS NOT A SUBSTITUTE FOR ANY INSPECTIONS. POTENTIAL PURCHASERS ARE ENCOURAGED TO OBTAIN THEIR OWN PROFESSIONAL INSPECTION.
Owner's Statement: The representations contained on this form are made by the owner and are not the representations of the owner's agent or subagent. This form and the representations contained in it are provided by the owner exclusively to potential purchasers in a transfer made by the owner, and are not made to purchasers in any subsequent transfers. The information contained in this disclosure form does not limit the obligation of the owner to disclose an item of information that is required by any other statue or law to be disclosed in the transfer of residential real estate.
Instructions to Owner: (1) Answer ALL questions. (2) Identify any material matters in the property that are actually known. (3) Attach additional pages with your signature if additional space is needed. (4) Complete this form yourself. (5) If some items do not apply to your property, write NA (not applicable). If the item to be disclosed is not within your actual knowledge, indicate unknown.
_____Public Water Service _____Private Water Service _____Well _____Holding Tank _____Cistern _____Spring _____Pond _____Unknown _____Other____________________________________
If owner knows of any current leaks, backups or other material problems with the water supply system or quality of the water, please describe:
B) SEWER SYSTEM: The nature of the sanitary sewer system servicing the property is (check appropriate boxes):
______Public Sewer ______Private Sewer _____Septic Tank
______Leach Field ______Aeration Tank _____Filtration Bed
______Unknown ______Other_____________________________
If not a public or private sewer, date of last inspection
_______________________.
If owner knows of any current leaks, backups or other material problems with the sewer system servicing the property, please describe:
C) ROOF: Do you know of any current leaks or other material
problems with the roof or rain gutter?
____Yes ______No
If "YES", Please describe:
If owner known of any leaks or other material problems with the roof or rain gutters since owning the property (but no longer than the past 5 years) please describe and indicate any repairs completed:
D) BASEMENT/CRAWL SPACE: Do you know of any current water
leakage, water accumulation, excess dampness or other defects
with the basement/crawl space? _____Yes _____No
If "YES", Please describe:
If owner knows of any repairs, alterations or modifications to the property or other attempts to control any water or dampness problems in the basement or crawl space since owning the property (but not longer than the past 5 years) please describe:
FOUNDATION, FLOORS, INTERIOR AND EXTERIOR WALLS: Do you known of any movements, shifting, deterioration, material cracks (other than visible minor cracks or blemishes) or other material problems with the foundations, floors, or interior/exterior walls? _____Yes _____No
If "YES", please describe
If you know of any repairs, alterations or modifications to control the cause or effect of any problems identified above, since owning the property (but no longer than the past 5 years), please describe:
F) MECHANICAL SYSTEMS: Do you know of any current problems or defects with the mechanical systems? _____Yes _____No
If "YES", Please describe:
F) MECHANICAL SYSTEMS: For purposes of this section, mechanical systems include electrical, plumbing (pipes), central heating and air conditioning, sump pump, fireplace/chimney, lawn sprinkler, water softner, security system, central vacuum, or other mechanical systems that exist on the property.
G) WOOD BORING INSECTS/TERMITES: Do you know of the presence
of any wood boring insects/termites in or on the property or
any existing damage to the property caused by wood boring
insects/termites? ______Yes _____No
If "YES", please describe:
If owner knows of any inspection or treatment for wood boring insects/termites since owning the property (but no longer than the past 5 years) please describe:
H) PRESENCE OF HAZARDOUS MATERIALS: Do you have actual knowledge of the presence of any of the below identified hazardous materials on the property?
YES NO unknown
1) Lead Based paint ____ ____ _____
2) Asbestos ____ ____ _____
3) Urea-Formaldehyde Foam Insulation ____ ____ _____
4) Radon Gas ____ ____ _____
4a) If "YES" indicate level of Gas if known ___________
5) Other toxic substances _____ ____ ____
If the answer to any of the above questions is "YES", please describe:
I) DRAINAGE:Do you know of any current flooding, drainage, settling or grading problems affecting the property? _____ Yes ______ No
If "YES", please describe:
If owner knows of any repairs, modifications or alterations to the property or other attempts to control any flooding, drainage, settling or grading problems since owning the property (but no longer than the past 5 years), please describe:
J) CODE VIOLATIONS: Have you received notice of any building or housing code violations currently affecting the use of the property? _______Yes _______No
If "YES", please describe:
K) UNDERGROUND STORAGE TANKS/WELLS:Do you know of any underground storage tanks, oil or natural gas wells (plugged or unplugged), or abandoned water wells on the property? _______Yes _______No
If "YES", Please describe:
L) OTHER KNOWN MATERIAL DEFECTS: The following are other known material defects currently in or on the property:
For purposes of this section, material defects would include any non-observable physical condition existing on the property that could be dangerous to anyone occupying the property or any nonobservable physical condition that would inhibit a person's use of the property.
Owner represents that the statements contained in this form are made in good faith based on his/her actual knowledge as of the date signed by the Owner.
OWNER___________________________________ DATE:_____________ OWNER___________________________________ DATE:_____________
RECEIPT AND ACKNOWLEDGEMENT OF POTENTIAL PURCHASERS
Potential purchasers are advised that the owner has no obligations to update this form but may do so according to Revised Code Section 5302.30(G). Pursuant to Ohio Revised Code 5302.30(K), if this form is not provided to you prior to the time you enter into a purchase contract for the property, you may rescind the purchase contract by delivering a signed and dated document of rescission to Owner or Owner's Agent, provided the document of rescission is delivered prior to all three of the following dates: (1) the date of closing; (2) 30 days after the owner accepted your offer; and (3) within 3 business days following your receipt of your agent's receipt of this form or an amendment of this form.
I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS DISCLOSURE FORM AND UNDERSTAND THAT THE STATEMENTS ARE MADE BASED ON the OWNER'S ACTUAL KNOWLEDGE AS OF THE DATE SIGNED BY THE OWNER.
My/Our Signature below does not constitute approval of any disclosed condition as represented herein by the owner.
PURCHASER:__________________________ DATE:_________________ PURCHASER:__________________________ DATE:__________________