Fillable Form 2013: RESIDENTIAL PROPERTY DISCLOSURE FORM (Guernsey-Muskingum Valley Association of Realtors)

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Form 2013: RESIDENTIAL PROPERTY DISCLOSURE FORM (Guernsey-Muskingum Valley Association of Realtors)

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STATE OF OHIO
2013
DEPARTMENT OF COMMERCE
RESIDENTIAL PROPERTY DISCLOSURE FORM
Purpose of Disclosure Form: This is a statement of certain conditions and information concerning the property actually
known by the owner. An owner may or may not have lived at the property and unless the potential purchaser is informed
in writing, the owner has no more information about the property than could be obtained by a careful inspection of the
property by a potential purchaser. Unless the potential purchaser is otherwise informed, the owner has not conducted any
inspection of generally inaccessible areas of the property. This form is required by Ohio Revised Code Section 5302.30.
THIS FORM IS NOT A WARRANTY OF ANY KIND BY THE OWNER OR BY ANY AGENT OR
SUBAGENT REPRESENTING THE OWNER. THIS FORM IS NOT A SUBSTITUTE FOR ANY
INSPECTIONS. POTENTIAL PURCHASERS ARE ENCOURAGED TO OBTAIN THEIR OWN
PROFESSIONAL INSPECTION(S).
Owner’s Statement: The statements contained in this form are made by the owner and are not the statements of the
owner’s agent or subagent. The statements contained in this form are provided by the owner only to potential purchasers
in a transfer made by the owner. The statements are not for 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 statute or law to be disclosed in the transfer of residential real estate.
OWNER INSTRUCTIONS
Instructions to Owner: (1) Answer ALL questions. (2) Report known conditions affecting the property. (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.
Owner’s Initials
Owner’s Initials
Date
Date
(Page 1 of 5)
Purchaser’s Initials
Purchaser’s Initials
Date
Date
Owner’s Initials
Owner’s Initials
Date
Date
Purchaser’s Initials
Purchaser’s Initials
Date
Date
(Page 2 of 5)
STATE OF OHIO DEPARTMENT
OF COMMERCE
RESIDENTIAL PROPERTY DISCLOSURE FORM
2013
Pursuant to section 5302.30 of the Revised Code and rule 1301:5-6-10 of the Administrative Code.
TO BE COMPLETED BY OWNER (Please Print)
Property Address:
Owners Name(s):
Date:
, 20
Owner is is not occupying the property. If owner is occupying the property, since what date:
If owner is not occupying the property, since what date:
THE FOLLOWING STATEMENTS OF THE OWNER ARE BASED ON OWNER’S ACTUAL KNOWLEDGE
A) WATER SUPPLY: The source of water supply to the property is (check appropriate boxes):
Public Water Service
Holding Tank
Private Water Service
Cistern
Private Well
Spring
Shared Well
Pond
Do you know of any current leaks, backups or other material problems with the water supply system or quality of the water? Yes
No
If
“Yes”,
please
describe
and
indicate
any
repairs
completed
(but
not
longer
than
the
past
5
years):
Is the quantity of water sufficient for your household use? (NOTE: water usage will vary from household to household) Yes No
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:
Inspected By:
Do you know of any previous or current leaks, backups or other material problems with the sewer system servicing the property?
Yes
No
If
“Yes”,
please
describe
and
indicate
any
repairs
completed
(but
not
longer
than
the
past
5
years):_
Information on the operation and maintenance of the type of sewage system serving the property is available from the
department of health or the board of health of the health district in which the property is located.
C) ROOF: Do you know of any previous or current leaks or other material problems with the roof or rain gutters? Yes No
If
“Yes”,
please
describe
and
indicate
any
repairs
completed
(but
not
longer
than
the
past
5
years):
D) WATER INTRUSION: Do you know of any previous or current water leakage, water accumulation, excess moisture or other
defects to the property, including but not limited to any area below grade, basement or crawl space? Yes No
If
“Yes”,
please
describe
and
indicate
any
repairs
completed:
Property Address_
Do you know of any water or moisture related damage to floors, walls or ceilings as a result of flooding; moisture seepage; moisture
Owner’s Initials
Owner’s Initials
Date
Date
Purchaser’s Initials
Purchaser’s Initials
Date
Date
(Page 3 of 5)
condensation; ice damming; sewer overflow/backup; or leaking pipes, plumbing fixtures, or appliances? Yes No
If
“Yes”,
please
describe
and
indicate
any
repairs
completed:
Have you ever had the property inspected for mold by a qualified inspector? Yes No
If
“Yes”,
please
describe
and
indicate
whether
you
have
an
inspection
report
and
any
remediation
undertaken:
Purchaser is advised that every home contains mold. Some people are more sensitive to mold than others. If concerned about
this issue, purchaser is encouraged to have a mold inspection done by a qualified inspector.
E) STRUCTURAL COMPONENTS (FOUNDATION,
BASEMENT/CRAWL
SPACE, FLOORS, INTERIOR AND
EXTERIOR WALLS): Do you know of any previous or current movement, shifting, deterioration, material cracks/settling (other
than visible minor cracks or blemishes) or other material problems with the foundation, basement/crawl space, floors, or
interior/exterior walls?
Yes No If “Yes”, please describe and indicate any repairs, alterations or modifications to control the cause or effect of any
problem
identified
(but
not
longer
than
the
past
5
years):
Do you know of any previous or current fire or smoke damage to the property? Yes No
If
“Yes”,
please
describe
and
indicate
any
repairs
completed:
F) WOOD DESTROYING INSECTS/TERMITES: Do you know of any previous/current presence of any wood destroying
insects/termites in or on the property or any existing damage to the property caused by wood destroying insects/termites? Yes No
If
“Yes”,
please
describe
and
indicate
any
inspection
or
treatment
(but
not
longer
than
the
past
5
years):
G) MECHANICAL SYSTEMS: Do you know of any previous or current problems or defects with the following existing
mechanical systems? If your property does not have the mechanical system, mark N/A (Not Applicable).
YES NO N/A YES NO N/A
1) Electrical 8) Water softener
2) Plumbing (pipes) a. Is water softener leased?
3) Central heating 9) Security System
4) Central Air conditioning a. Is security system leased?
5) Sump pump 10) Central vacuum
6) Fireplace/chimney 11) Built in appliances
7) Lawn sprinkler 12) Other mechanical systems
If the answer to any of the above questions is “Yes”, please describe and indicate any repairs to the mechanical system (but not longer
than
the
past
5
years):
H) PRESENCE OF HAZARDOUS MATERIALS: Do you know of the previous or current presence of any of the below
identified hazardous materials on the property?
1) Lead-Based Paint
2) Asbestos
3) Urea-Formaldehyde Foam Insulation
4) Radon Gas
a. If “Yes”, indicate level of gas if known
5) Other toxic or hazardous substances
Yes No Unknown
If the answer to any of the above questions is “Yes”, please describe and indicate any repairs, remediation or mitigation to the
property:
Owner’s Initials
Owner’s Initials
Date
Date
Purchaser’s Initials
Purchaser’s Initials
Date
Date
(Page 4 of 5)
Property
Address_
I) UNDERGROUND STORAGE TANKS/WELLS: Do you know of any underground storage tanks (existing or removed), oil or
natural gas wells (plugged or unplugged), or abandoned water wells on the property? Yes No
If
“Yes”,
please
describe:
Do you know of any oil, gas, or other mineral right leases on the property? Yes No
Purchaser should exercise whatever due diligence purchaser deems necessary with respect to oil, gas, and other mineral rights.
Information may be obtained from records contained within the recorder’s office in the county where the property is located.
J) FLOOD PLAIN/LAKE ERIE COASTAL EROSION AREA: Yes No Unknown
Is the property located in a designated flood plain?
Is the property or any portion of the property included in a Lake Erie Coastal Erosion Area?
K) DRAINAGE/EROSION: Do you know of any previous or current flooding, drainage, settling or grading or erosion problems
affecting the property? Yes No
If “Yes”, please describe and indicate any repairs, modifications or alterations to the property or other attempts to control any
problems
(but
not
longer
than
the
past
5
years):_
L) ZONING/CODE
VIOLATIONS/ASSESSMENTS/HOMEOWNERS’
ASSOCIATION: Do you know of any violations of
building or housing codes, zoning ordinances affecting the property or any nonconforming uses of the property? Yes No
If
“Yes”,
please
describe:
Is the structure on the property designated by any governmental authority as a historic building or as being located in an historic
district? (NOTE: such designation may limit changes or improvements that may be made to the property). Yes No
If
“Yes”,
please
describe:
Do you know of any recent or proposed assessments, fees or abatements, which could affect the property? Yes No
If “Yes”, please describe:
_
List any assessments paid in full (date/amount)
List any current assessments:
monthly fee
Length of payment (years
months )
Do you know of any recent or proposed rules or regulations of, or the payment of any fees or charges associated with this property,
including but not limited to a Community Association, SID, CID, LID, etc. Yes No
If
“Yes”,
please
describe
(amount)
M) BOUNDARY
LINES/ENCROACHMENTS/SHARED
DRIVEWAY/PARTY WALLS: Do you know of any of the
following conditions affecting the property? Yes No Yes No
1)
Boundary Agreement 4) Shared Driveway
2) Boundary Dispute 5) Party Walls
3) Recent Boundary Change 6) Encroachments From or on Adjacent Property
If
the
answer
to
any
of
the
above
questions
is
“Yes”,
please
describe:
N) OTHER KNOWN MATERIAL DEFECTS: The following are other known material defects 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 non-observable physical condition that could inhibit a person’s use of the
property.
Property
Address
CERTIFICATION OF OWNER
Owner certifies that the statements contained in this form are made in good faith and based on his/her actual knowledge as of
the date signed by the Owner. Owner is advised that 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 statute or law or that may exist to
preclude fraud, either by misrepresentation, concealment or nondisclosure in a transaction involving the transfer of
residential real estate.
OWNER:
DATE:
OWNER:
DATE:
RECEIPT AND ACKNOWLEDGEMENT OF POTENTIAL PURCHASERS
Potential purchasers are advised that the owner has no obligation to update this form but may do so according to Revised Code Section
5302.30(G). Pursuant to Ohio Revised Code Section 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 or your agent’s receipt
of this form or an amendment of this form.
Owner makes no representations with respect to any offsite conditions. Purchaser should exercise whatever due diligence
purchaser deems necessary with respect to offsite issues that may affect purchaser’s decision to purchase the property.
Purchaser should exercise whatever due diligence purchaser deems necessary with respect to Ohio’s Sex Offender
Registration and Notification Law (commonly referred to as “Megan’s Law”). This law requires the local Sheriff to provide
written notice to neighbors if a sex offender resides or intends to reside in the area. The notice provided by the Sheriff
i
s a
public record and is open to inspection under Ohio’s Public Records Law. If concerned about this issue, purchaser assumes
responsibility to obtain information from the Sheriff’s office regarding the notices they have provided pursuant to Megan’s
Law.
Purchaser should exercise whatever due diligence purchaser deems necessary with respect to abandoned underground mines.
If concerned about this issue, purchaser assumes responsibility to obtain information from the Ohio Department of Natural
Resources. The Department maintains an online map of known abandoned underground mines on their website at
www.dnr.state.oh.us.
I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS DISCLOSURE FORM AND UNDERSTAND THAT THE
STATEMENTS ARE MADE BASED ON THE OWNERS 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:
(Page 5 of
5)
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Form 2013: RESIDENTIAL PROPERTY DISCLOSURE FORM (Guernsey-Muskingum Valley Association of Realtors)

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Completed 31 January 2021

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