Seller’s Disclosure Statement
Property Address: ____ MICHIGAN
Street City, Village or Township
Purpose of Statement: This statement is a disclosure of the condition of the property in compliance with the Seller Disclosure Act. This statement is a disclosure of the
condition and information concerning the property, known by the Seller. Unless otherwise advised, the Seller does not possess any expertise in construction,
architecture, engineering or any other specific area related to the construction or condition of the improvements on the property or the land. Also, unless otherwise
advised, the Seller has not conducted any inspection of generally inaccessible areas such as the foundation or roof. This statement is not a warranty of any kind by
the Seller or by any Agent representing the Seller in this transaction, and is not a substitution for any inspections or warranties the Buyer may wish to obtain.
Seller’s Disclosure: The Seller discloses the following information with the knowledge that even though this is not a warranty, the Seller specifically makes the
following representations based on the Seller’s knowledge at the signing of this document. Upon receiving this statement from the Seller, the Seller’s Agent is required
to provide a copy to the Buyer or the Agent of the Buyer. The Seller authorizes its Agent(s) to provide a copy of this statement to any prospective Buyer in connection
with any actual or anticipated sale of property. The following are representations made solely by the Seller and are not the representations of the Seller’s Agent(s), if
any. THIS INFORMATION IS A DISCLOSURE ONLY AND IS NOT INTENDED TO BE A PART OF ANY CONTRACT BETWEEN BUYER AND
SELLER.
Instructions to the Seller. (1) Answer ALL questions. (2) Report known conditio
ns affecting the property. (3) Attach additional pages with your signature if additional
space is required. (4) Complete this form yourself. (5) If some items do not apply to your property, check NOT AVAILABLE. If you do not know the facts, check
UNKNOWN. FAILURE TO PROVIDE A PURCHASER WITH A SIGNED DISCLOSURE STATEMENT WILL ENABLE A PURCHASER TO TERMINATE AN
OTHERWISE BINDING PURCHASE AGREEMENT.
Appliances/Systems/Services: The items below are in working order. (The items listed below are included in the sale of the property only if the purchase agreement so
provides.)
Yes No Unknown Not Yes No Unknown Not
Available Available
Range/oven
Lawn sprinkler system
Dishwasher
Water heater
Refrigerator
Plumbing system
Water softener/conditioner
Hood/fan
Disposal
TV antenna, TV rotor controls
Well & pump
Septic tank & drainfield
Sump pump
Electric system
City water system
Alarm System
City sewer system
Inte
rcom Central air conditioning
Central vacuum Central heating system
Attic fan Wall furnace
Pool
heater, wall liner Humidifier
Electronic air filter
Solar heating system
& equipment
Microwave
Trash compactor
Fireplace & chimney
Ceiling fan Wood burning system
Sauna/hot tub Dryer
Washer
Expl
anations (attach additional sheets if necessary):
_______________________________________________________________________________________________________________________________________
UNLESS OTHERWISE AGREED, ALL HOUSEHOLD APPLIANCES ARE SOLD IN WORKING ORDER EXCEPT AS NOTED WITHOUT WARRANTY
BEYOND DATE OF CLOSING.
Property conditions, improvements & additional information:
1. Basement/Crawlspace: Has there been evidence of water? yes no
If yes, please explain: ____________________________________________________________________________________________________________
2. Insulation: Describe, if known: ____________________________________________________________________________________________________
Urea Formaldehyde Foam Insulation (UFFI) is installed? unknown yes no
3. Roof: Leaks? yes no
Approximate age if known:
4. Well: Type of well (depth/diameter, age and repair history, if known):
Has the water been tested? yes no
If yes, date of last report/results:
BUYER’S INITIALS
SELLER’S INITIALS
PAGE 1 OF 2
FORM
H JUN/06
Garage door opener & remote
Seller’s Disclosure Statement
Property Address: Street City, Village or Township
5. Septi
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
If y
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
Othe
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.
Seller Date:
Sell
er Date:
Buye
r has read and acknowledges receipt of this statement.
Buyer Date: Time
Buye
r Date: Time
Disc
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.
PAGE 2
OF 2
FORM H JUN/06
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