FSBO Property Disclosures .pdf

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Original filename: FSBO - Property Disclosures.pdf
Author: The Rock Foundation

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SELLER'S PROPERTY DISCLOSURES
Under Maine Law, certain information must be made available to buyers prior to or during preperation of an offer. This statement has been
put together by the seller to serve this purpose.

PROPERTY ADDRESS:
WATER SUPPLY
TYPE OF SYSTEM:

(circle)

Public

Private

Drilled

Dug

Seasonal

MALFUNCTIONS:
Pump:
Quality:

Are you aware of or have you experienced any malfunctions with the water system?

WATER TEST:

Have you had the water tested? (circle Yes or No)

Yes

No

N/A

Yes

No

Unkown

Quantity:

Yes

YES

Other

Unknown

No

Unkown

YES

NO

NO

Date of Most Recent Test:
Are Test Results Available?:

Yes

No

Any Results Unsatisfactory?:

Yes

No

Steps Taken To Remedy?:

IF PRIVATE:
Location:

Installed By:

Date Installed:
What is the source of your information?:
How many people currently use the system?:
How many households does this supply water for?:

Comments: (Please explain any YES answers from above)

WASTE WATER DISPOSAL
TYPE OF SYSTEM:

(circle)

Public

Private

Quasi-Pub

Unknown

If Private (circle)
Tank:

Septic

Holding

Cesspool

Tank Location:

Size:

500Gal

1000Gal

Unknown

Date Installed:

Type:

Concrete

Metal

Unknown

Date Last Pumped:

YES

NO

Unknown

Leach Field Location:

Leach Field?

Date of Installation:

Installed By:

Last Serviced:

Service Company:

Does the seller have record of septic designs indicating the # of bedrooms the system is designed for?
Is the system located in a shoreland zone?

YES

NO

Is the system located in a coastal shoreland zone?

YES

NO

Who or What is the source of this information?
Have you experienced any malfunctions in the Waste Disposal System?

YES

NO

If yes, please give detail:

PG1of3

Buyer's Initials:

_______

_______

DESIGNED BY: THE ROCK FOUNDATION

Seller's Initials:

_______

_______
FSBO

PROPERTY ADDRESS:
HAZARDOUS MATERIALS
UNDERGROUND STORAGE TANKS:
YES

NO

YES

NO

Unknown

YES

NO

Unknown

YES

NO

Unknown

YES

NO

Unknown

Are you aware of Underground Storage Tanks currently or previously used on your property?
If Yes:
Location of Storage Tanks?

Age?

Size?

Material Stored in Tanks?
Experienced Leakage?

YES

Are Tanks Registered with the D.E.P.?

NO
YES

NO

Comments:

ASBESTOS:
Are you aware of Asbestos currently or previously being present in this property?
If Yes - Please give detail as to location, condition, and if it has been removed or remedied:

RADON AIR:
Are you aware of Radon Air currently or previously being present in this property?
If Yes - Please give detail as to location, condition, and if it has been removed or remedied:

RADON WATER:
Are you aware of Radon Water currently or previously being present in this property?
If Yes - Please give detail as to location, condition, and if it has been removed or remedied:

LEAD BASED PAINT:
Are you aware of Lead Paintr currently or previously being present in this property?
If Yes - Please give detail as to location, condition, and if it has been removed or remedied:

HEATING SYSTEM
SYSTEM 1

SYSTEM 2

SYSTEM 3

SYSTEM 4

System Type
System Age
Service Company
Date Last Serviced
Annual Consumption
Malfunctions (2 yrs)
Other
Buried Oil Supply Line?

YES

NO

Unknown

Sleeved?

Chimney Lined?

YES

NO

Unknown

Chimney Fire?

Chimney Inspected?

YES

NO

Unknown

Chimney Last Cleaned?

Multi HeatSource Flues?

YES

NO

Unknown

Chimney Age?

_______

_______

PG2of3

Buyer's Initials:

DESIGNED BY: THE ROCK FOUNDATION

Seller's Initials:

YES

_______

NO

Unknown

YES

NO

_______
FSBO

PROPERTY ADDRESS:
GENERAL INFORMATION
Is the property subject to or have the benefit of any encroachments, easements, right-of-ways, leases, rights of first refusal,
life estates, private way, private road/homeowner associations or restrictive covenants?
YES

NO

Unknown

If Yes, Explain:
Source of Info?:

Are there any Tax Exemptions for Tree Growth, Open Space & Farmland, Veteran's, Homestead, Blind, Working Waterfront?
YES

NO

Unknown

If Yes, Explain:

Leased Equipment? (i.e. propane tank, hot water heater, satellite dish, etc)?:
Year Principle Structure Built:
Year Seller Purchased Property:
ROOF: Year Built - Structure:
Shingles/Roofing Installed:
Any Moisture or Leakage in Roof?:
FOUNDATION/BASEMENT:
YES
NO
Unknown
Comments:
Sump Pump?
YES
NO
Unknown
Comments:
Moisture or Leakage?
YES
NO
Unknown
Comments:
Prior Issues?
YES
NO
Unknown
MOLD: Has the property been tested for Mold?
YES
If Yes, are tests available?
Fuses
Breakers
ELECTRICAL (circle):
SURVEY: Has the property been surveyed?:

NO
Other
YES

Unknown
NO

Unknown

YES
NO
If Yes, is survey available?
Mobile Home:
YES
NO
Manufactured Home:
YES
NO
MANUFACTURED HOME:
DEFECTS: Please explain any other known material defects to the physical condition of or value of the property:

SELLER IS RESPONSIBLE AND LIABLE FOR ANY FAILURE TO PROVIDE KNOWN INFORMATION REGARDING KNOWN MATERIAL DEFECTS TO THE BUYER.

Are there any attachments included with the disclosures:

YES

NO

ADDITIONAL INFORMATION

By signing below the seller represents that all information provided is correct. To the best of the sellers knowledge, all systems and
equipment (unless otherwise noted) is operational. The seller makes no representation as to the applicability of, or compliance with, any
codes of any sort, whether state, municipal, federal, or any other, including but not limited to fire, life safety, building, electrical, or
plumbing.

SELLER

DATE

SELLER

DATE

Buyer has received copies of the disclosures and understands that they should seek professional assistance if they have any questions or
concerns:
BUYER
PG3of3

DATE
DATE

BUYER
DESIGNED BY: THE ROCK FOUNDATION

FSBO


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