Seller’s Disclosure Statement
Property Address: Street City, Village or Township
c tanks/drain fields: Condition, if known:
6. Heating system: Type/approximate age:
7. Plumbing system: Type: copper_____ galvanized______ other______
Any known problems?
8. Electrical system: Any known problems?
9. History of Infestation, if any: (termites, carpenter ants, etc.)
10. Environmental problems: Are you aware of any substances, materials or products that may be an environmental hazard such as, but not limited to, asbestos, radon
gas, formaldehyde, lead-based paint, fuel or chemical storage tanks and contaminated soil on property.
Unknown________ yes no
es, please explain:
11. Flood Insurance: Do you have flood insurance on the property? unknown yes no
12. Mineral Rights: Do you own the mineral rights? unknown yes no
r Items: Are you aware of any of the following:
1. Features of property shared in common with the adjoining landowners, such as walls, fences, roads and driveways, or other features whose use or responsibility
for maintenance may have an effect on the property? unknown yes no
2. Any encroachments, easements, zoning violations or nonconforming uses? unknown yes no
3. Any “common areas” (facilities like pools, tennis courts, walkways, or other areas co-owned with others) or a homeowners’ association that has any authority over
the property? unknown yes no
4. Structural modifications, alterations, or repairs made without necessary permits or licensed contractors?
unknown yes no
5. Settling, flooding, drainage, structural, or grading problems? unknown yes no
6. Major damage to the property from fire, wind, floods, or landslides? unknown yes no
7. Any underground storage tanks? unknown yes no
8. Farm or farm operation in the vicinity; or proximity to a landfill, airport, shooting range, etc.?
unknown yes no
9. Any outstanding utility assessments or fees, including any natural gas main extension surcharge?
unknown yes no
10. Any outstanding municipal assessments or fees? unknown yes no
11. Any pending litigation that could affect the property or the Seller’s right to convey the property?
unknown yes no
If the answer to any of these questions is yes, please explain. Attach additional sheets, if necessary:
The Seller has lived in the residence on the property from (date) to (date).
The Seller has owned the property since (date).
The Seller has indicated above the conditions of all the items based on information known to the Seller. If any changes occur in the structural/mechanical/appliance
systems of this property from the date of this form to the date of closing, Seller will immediately disclose the changes to Buyer. In no event shall the parties hold the
Broker liable for any representations not directly made by the Broker or Broker’s Agent.
Seller certifies that the information in this statement is true and correct to the best of Seller’s knowledge as of the date of Seller’s signature.
BUYER SHOULD OBTAIN PROFESSIONAL ADVICE AND INSPECTIONS OF THE PROPERTY TO MORE FULLY DETERMINE THE CONDITION OF THE
PROPERTY. THESE INSPECTIONS SHOULD TAKE INDOOR AIR AND WATER QUALITY INTO ACCOUNT, AS WELL AS ANY EVIDENCE OF
UNUSUALLY HIGH LEVELS OF POTENTIAL ALLERGENS INCLUDING, BUT NOT LIMITED TO, HOUSEHOLD MOLD, MILDEW AND BACTERIA.
BUYERS ARE ADVISED THAT CERTAIN INFORMATION COMPILED PURSUANT TO THE SEX OFFENDERS REGISTRATION ACT, 1994 PA 295, MCL
28,721 TO 28.732 IS AVAILABLE TO THE PUBLIC BUYERS SEEKING SUCH INFORMATION SHOULD CONTACT THE APPROPRIATE LOCAL LAW
ENFORCEMENT AGENCY OR SHERIFF’S DEPARTMENT DIRECTLY.
BUYER IS ADVISED THAT THE STATE EQUALIZED VALUE OF THE PROPERTY, PRINCIPAL RESIDENCE EXEMPTION INFORMATION, AND
OTHER REAL PROPERTY TAX INFORMATION IS AVAILABLE FROM THE APPROPRIATE LOCAL ASSESSOR’S OFFICE. BUYER SHOULD NOT
ASSUME THAT BUYER’S FUTURE TAX BILLS ON THE PROPERTY WILL BE THE SAME AS THE SELLER’S PRESENT TAX BILLS. UNDER
MICHIGAN LAW, REAL PROPERTY TAX OBLIGATIONS CAN CHANGE SIGNIFICANTLY WHEN PROPERTY IS TRANSFERRED.
r has read and acknowledges receipt of this statement.
Buyer Date: Time
r Date: Time
laimer: This form is provided as a service of Michigan Realtors®. Please review both the form and details of the particu
lar transaction to
ensure that each section is appropriate for the transaction. Michigan Realtors® is no
t responsible for use or misuse of form for
misrepresentation or for warranties made in connection with the form.
FORM H JUN/06