Disclosure Form

SELLER'S DISCLOSURE OF PROPERTY CONDITION CONCERNING THE PROPERTY AT:_____________________________________________________ (Street Address and City)

THIS NOTICE IS A DISCLOSURE OF SELLER'S KNOWLEDGE OF THE CONDITION OF THE PROPERTY AS OF THE DATE SIGNED BY SELLER AND IS NOT A SUBSTITUTE FOR ANY INSPECTIONS OR WARRANTIES THE PURCHASER MAY WISH TO OBTAIN. IT IS NOT A WARRANTY OF ANY KIND BY SELLER OR SELLER'S AGENTS. Seller is is not occupying the Property. If unoccupied, how long since Seller has occupied the Property? 1. The Property has the items checked below [Write Yes (Y), No (N), or Unknown (U): __Range __Oven __Microwave __Dishwasher __Trash Compactor __Disposal __Washer/Dryer Hookups __Window Screens __Rain Gutters __Security System __Fire Detection Equipment __Intercom System __TV Antenna __Cable __TV Wiring __Satellite Dish __Ceiling Fan(s) __Attic Fan(s) __Exhaust Fan(s) __Central A/C __Central Heating __Wall/Window Air Conditioning __Plumbing System __Septic System __Public Sewer System __Patio/Decking __Outdoor Grill __Fences __Pool Sauna __Spa Hot Tub __Pool Equipment__ Pool Heater __Automatic Lawn Sprinkler System __Fireplace(s) & __Chimney (Mock) __Gas Lines (Nat./LP) __Chimney(Woodburning) __Gas Fixtures Garage: __Attached Carport __Not Attached __Garage Door Opener(s): __Electronic Control(s) __Water Heater: __Gas Electric __Water Supply: __City Well __MUD Co-op __Roof Type: ______Age: (approx) Are you (Seller) aware of any of the above items that are not in working condition, that have known defects, or that are in need of repair? Yes No Unknown. If yes, then describe. (Attach additional sheets if necessary): 2. Are you (Seller) aware of any known defects/malfunctions in any of the following? Write Yes (Y) if you are aware, write No (N) if you are not aware. __Interior Walls Ceilings Floors __Exterior Walls Doors Windows __Roof Foundation/Slab(s) Basement __Walls/Fences Driveways Sidewalks __Plumbing/Sewers/Septics Electrical Systems Lighting Fixtures __Other Structural Components (Describe)

Seller Signature ___________________________ Date _________________ Seller Signature ___________________________ Date _________________ Buyer Signature ___________________________Date __________________ Buyer Signature ___________________________Date __________________