Fillable PROPERTY DISCLOSURE EXEMPTION FORM In accordance with LSA-R.S. (Louisiana Louisiana Real Estate Commission)

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PROPERTY DISCLOSURE EXEMPTION FORM In accordance with LSA-R.S. (Louisiana Louisiana Real Estate Commission)

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Property Description (Address, City, State, Zip)
PROPERTY DISCLOSURE EXEMPTION FORM
In accordance with LSA-R.S. 9:3196-3200, a SELLER of residential real property must furnish BUYERS with a
Property Disclosure Document. A complete copy of these statutes can be found at http://www.legis.la.gov/. The
required Property Disclosure Document may be in the form promulgated by the Louisiana Real Estate
Commission (“Commission”) or in another form that contains substantially the same information. The
Commission form can be found at www.lrec.gov.
WHO IS REQUIRED TO MAKE DISCLOSURE? ALL SELLERS are required to make written disclosure of
known defects regarding a property being transferred. A SELLER’S obligation to furnish a Property
Disclosure Document applies to any transfer of any interest in residential real property, whether by sale,
exchange, bond for deed, lease with option to purchase, etc. The following transfers are exempt from the
requirement to provide a property disclosure document:
1. Transfers ordered by a court, including but not limited to a transfer ordered by a court in the administration
of an estate, a transfer pursuant to a writ of execution, a transfer by any foreclosure sale, a transfer by a
trustee in bankruptcy, a transfer by eminent domain, and any transfer resulting from a decree of specific
performance.
2. Transfers to a mortgagee by a mortgagor or successor in interest who is in default.
3. Transfers by a mortgagee who has acquired the residential real property at a sale conducted pursuant to a
power of sale under a mortgage or a sale pursuant to decree of foreclosure, or who has acquired the
residential property by a deed in lieu of foreclosure.
4. Transfers by a fiduciary in the course of administration of a decedent's estate, guardianship,
conservatorship, or trust.
5. Transfers of newly constructed residential real property, which has never been occupied.
6. Transfers from one or more co-owners solely to one or more of the remaining co-owners.
7. Transfers pursuant to testate or intestate succession.
8. Transfers of residential real property that will be converted by the BUYER into a use other than residential
use.
9. Transfers of residential real property to a spouse or relative in the line of consanguinity (blood line).
10. Transfers between spouses resulting from a judgment of divorce or a judgment of separate maintenance or
from a property settlement agreement incidental to such a judgment.
11. Transfers or exchanges to or from any governmental entity.
12. Transfers from an entity that has acquired title or assignment of a real estate contract to a piece of
residential real property to assist the prior owner in relocating, as long as the entity makes available to the
BUYER a copy of the property disclosure statement, any inspection reports if any furnished to the entity by
the prior owner, or both.
13. Transfers to an inter vivos trust.
14. Acts that, without additional consideration and without changing ownership or ownership interest, confirm,
correct, modify, or supplement a deed or conveyance previously recorded.
Property Description (Address, City, State, Zip)
SELLER claims that he/she is exempt from filling out the Property Disclosure Document and
warrants that SELLER has no knowledge of known defects to the property. SELLER is
claiming exemption number(s) _____________________________________________ above.
SELLER (sign) (print) Date Time
SELLER (sign) (print) Date Time
BUYER (sign) (print) Date Time
BUYER (sign) (print) Date Time
OR
SELLER has reviewed this Exemption page. SELLER does not claim any of the Exemptions
listed on this page. Accordingly, SELLER will complete the Property Disclosure Form.
SELLER (sign)
(print) Date Time
SELLER (sign)
(print) Date Time
BUYER (sign)
(print) Date Time
BUYER (sign) (print) Date Time
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 1 of 7
PROPERTY DISCLOSURE DOCUMENT
In accordance with LSA-R.S. 9:3196-3200, a SELLER of residential real property must furnish BUYERS with a
Property Disclosure Document. A complete copy of these statutes can be found at www.legis.la.gov. The
required Property Disclosure Document may be in the form promulgated by the Louisiana Real Estate
Commission (“Commission”) or in another form that contains substantially the same information. The
Commission form can be found at www.lrec.state.la.us.
RIGHTS OF BUYER AND CONSEQUENCES FOR FAILURE TO DISCLOSE: If the Property Disclosure
Document is delivered after the BUYER makes an offer, the BUYER can terminate any resulting real estate
contract or withdraw the offer for up to 72 hours after receipt of the Property Disclosure Document. This
termination or withdrawal will be without penalty to the BUYER and any deposit or earnest money must be
promptly returned to the BUYER (despite any agreement to the contrary).
DUTIES OF REAL ESTATE LICENSEES AND CONSEQUENCES FOR FAILURE TO FULFILL SUCH
DUTIES: Louisiana law requires real estate licensees to inform their clients of those clients’ duties and rights in
connection with the Property Disclosure Document. Failure to inform could subject the licensee to censure or
suspension or revocation of their license, as well as fines. The licensee is not liable for any error, inaccuracy,
or omission in a Property Disclosure Document, unless the licensee has actual knowledge of the error,
inaccuracy, or omission by the SELLER.
KEY DEFINITIONS:
• Residential real property or property is real property consisting of one or not more than four residential
dwelling units, which are buildings or structures each of which are occupied or intended for occupancy as
single-family residences.
• Known defect or defect is a condition found within the property that was actually known by the SELLER
and that results in one or all of the following:
(a) It has a substantial adverse effect on the value of the property.
(b) It significantly impairs the health or safety of future occupants of the property.
(c) If not repaired, removed, or replaced, significantly shortens the expected normal life of the property.
OTHER IMPORTANT PROVISIONS OF THE LAW:
• A Property Disclosure Document shall NOT be considered a warranty by the SELLER.
• A Property Disclosure Document is for disclosure purposes only; it is not intended to be part of any
contract between the SELLER and the BUYER.
• The Property Disclosure Document may not be used as a substitute for any inspections or
warranties that the BUYERS or SELLER may obtain.
• Nothing in this law precludes the rights or duties of a BUYER to inspect the physical condition of
the property.
• The SELLER shall not be liable for any error, inaccuracy, or omission, of any information required
to be delivered to the BUYERS if the error, inaccuracy, or omission, was not a willful
misrepresentation, according to the best of the SELLER's information, knowledge and belief or was
based on information provided by a public body or another person with a professional license or
special knowledge, who provided a written or oral report or opinion that the SELLER reasonably
believed to be correct and which was transmitted by the SELLER to the BUYER.
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 2 of 7
The Clean Water Act is a federal law that protects the wetlands of the United States. Section 404 of the Act
contains permit requirements for altering or building on property that has been determined a wetland by the
Army Corps of Engineers. The Corps may assess a fee to the SELLER or BUYER of a property for this
determination. A property that has been determined a wetland may result in additional costs for a Section 404
permit.
NK = No Knowledge
N = No
Y = Yes
The following representations are made by the SELLER and NOT by any real estate licensee.
It is not a substitute for any inspections or professional advice the BUYER may wish to obtain.
The following information is based only upon the SELLER’s actual knowledge of the property. The SELLER
can only disclose what the SELLER actually knows. The SELLER may not know about all material or
significant items affecting the property.
(1) What is the length of ownership of the property by the SELLER?
(2) Lot size or acres
(3) Are you aware of any servitudes/encroachments regarding the property, other than typical/customary
utility servitudes, that would affect the use of the property? □ Y □ N
(4) Are you aware of any rights vested in others? Check all that apply and explain at the end of this section.
□ Y
□ N
Common driveway
□ Y
□ N
□ Y
□ N
Mineral rights
□ Y
□ N
□ Y
□ N
Surface rights
□ Y
□ N
□ Y
□ N
Air rights
□ Y
□ N
□ Y
□ N
Usufruct
□ Y
□ N
Servitude of drainage □ Y □ N Other
(5) Has any part of the property been determined to be or pending determination as a wetland by the United
States Army Corps of Engineers under §404 of the Clean Water Act? □ Y □ N □ NK
If yes, documentation is attached and becomes a part of this Property Disclosure Document.
(6) Has any flooding, water intrusion, accumulation, or drainage problem been experienced with respect to
the land:
(a) during the time the SELLER owned the property? □ Y □ N
If yes, indicate the nature and frequency of the defect at the end of this section.
(b) prior to the time the SELLER owned the property? □ Y □ N □ NK
If yes, indicate the nature and frequency of the defect at the end of this section.
(7) What is/are the flood zone classification(s) of the property? What is the source and date of this
information? Check all that apply.
□ Survey/Date _____________ □ Elevation Certificate/Date _____________ □ Other/Date ___________
□ FEMA Flood Map - https://msc.fema.gov/portal
Question Number Explanation of “Yes” answers □ Additional sheet is attached
SECTION 1: LAND
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 3 of 7
SECTION 2: TERMITES, WOOD-DESTROYING INSECTS AND ORGANISMS
(8) Has the property ever had termites or other wood-destroying insects or organisms?
(a) during the time the SELLER owned the property? □ Y □ N
(b) prior to the time the SELLER owned the property? □ Y □ N □ NK
(c) Was there any damage to the property? □ Y □ NK
(d) Was the damage repaired? □ Y □ NK
(9) If the property is currently under a termite contract provide the following:
(a) Name of company
(b) Date contract expires
(c) List any structures not covered by contract
Question Number Explanation of “Yes” answers □ Additional sheet is attached
(10) What is the approximate age of all structures on property? Main structure
Other structures
(11) Have there been any additions or alterations made to the structures during the □ Y □ N
time the SELLER owned the property?
If yes, were the necessary permits and inspections obtained for all additions □ Y □ N □ NK
or alterations?
(12) What is the approximate age of the roof of each structure? Main structure
Other structures
(13) Are you aware of any defects regarding the following? Check all that apply and if yes, explain at the end
of this section.
Roof
Interior walls
□ Y
□ Y
□ N
□ N
Ceilings
Exterior walls
□ Y
□ Y
□ N
□ N
Floor
□ Y
□ N
Foundation
□ Y
□ N
Attic spaces
□ Y
□ N
Basement
□ Y
□ N
Porches
□ Y
□ N
Overhangs
□ Y
□ N
Steps/Stairways
□ Y
□ N
Railings
□ Y
□ N
Pool
□ Y
□ N
Spa
□ Y
□ N
Decks
□ Y
□ N
Patios
□ Y
□ N
Windows
□ Y
□ N
Other
(14) Has any structure on the property ever flooded, by rising water or otherwise?
(a) during the time the SELLER owned the property? □ Y □ N
(b) prior to the time the SELLER owned the property? □ Y □ N □ NK
If yes, give the nature and frequency of the defect at the end of this section.
(15) Is there flood insurance on the property? □ Y □ N
If yes, attach a copy of the policy declarations page.
(16) Does SELLER have a flood elevation certificate that will be shared with BUYER? □ Y □ N
SECTION 3: STRUCTURE(S)
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 4 of 7
SELLER must complete and provide the “Disclosure on Lead-Based Paint and Lead-Based Paint Hazard
Addendum” that is included with this property disclosure if any structure was built before 1978.
SECTION 4: PLUMBING, WATER, GAS, AND SEWERAGE
(17) Has there ever been any property damage, including, but not limited to, fire, wind, hail, lightning, or other
property damage, excluding flood damage referenced in Section 3?
(a) during the time the SELLER owned the property?
□ Y
□ N
(b) prior to the time the SELLER owned the property?
□ Y
□ N
□ NK
If yes, detail all property damages/defects and repair status at the end of this section
(18) Has there been any foundation repair?
(a) during the time the SELLER owned the property? □ Y □ N
(b) prior to the time the SELLER owned the property? □ Y □ N □ NK
(c) Is there a transferable warranty available? □ Y □ N □ NK
(d) If yes, provide the name of warranty company
(19) Does the property contain exterior insulation and finish system (EIFS)
or other synthetic stucco? □ Y □ N □ NK
Question Number Explanation of “Yes” answers □ Additional sheet is attached
(20) Are you aware of any defects with the plumbing system?
(a) during the time the SELLER owned the property?
□ Y
□ N
(b) prior to the time the SELLER owned the property?
□ Y
□ N
□ NK
(21) Are there any known defects with the water piping?
(a) during the time the SELLER owned the property? □ Y □ N
(b) prior to the time the SELLER owned the property? □ Y □ N □ NK
(c) The water is supplied by:
□ Municipality □ Private utility □ On-site system □ Shared well system □ None
(d) How many private wells service the primary residence only?
(e) If there are private wells, when was the water last tested? Date Results
(f) Are you aware of any polybutylene piping in the structure? □ Y □ N □ NK
(22) Is there gas service available to the property? □ Y □ N □ NK
(a) If yes, what type? □ Butane □ Natural □ Propane
(b) If yes, are there any known defects with the gas service? □ Y □ NK
(c) If Butane or Propane, are tanks □ Owned or □ Leased
(23) Are there any known defects with any water heater?
(a) during the time the SELLER owned the property? □ Y □ N
(b) prior to the time the SELLER owned the property? □ Y □ N □ NK
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 5 of 7
SELLER must attach a private water/sewage disclosure if the property described herein is not served by a
municipality waste treatment.
SECTION 5: ELECTRICAL, HEATING AND COOLING, APPLIANCES
SECTION 6: MISCELLANEOUS
(24) The sewerage service is supplied by: □ Municipality □ Other
(a) How many private sewer systems service the primary residence only?
Question Number Explanation of “Yes” answers □ Additional sheet is attached
(25) Are there any known defects with the electrical system?
(a) during the time the SELLER owned the property?
□ Y
□ N
(b) prior to the time the SELLER owned the property?
□ Y
□ N
□ NK
(c) Are you aware of any aluminum wiring in the structure?
□ Y
□ N
□ NK
(26) Are there any known defects with the heating or cooling systems?
(a) during the time the SELLER owned the property?
□ Y
□ N
(b) prior to the time the SELLER owned the property?
□ Y
□ N
□ NK
(27) If a fireplace(s) exists, is it working?
□ Y
□ N
□ NK
(28) Are there any known defects in any permanently installed or built-in appliances?
(a) during the time the SELLER owned the property?
□ Y
□ N
(b) prior to the time the SELLER owned the property?
□ Y
□ N
□ NK
(29) What type of alarm system is installed? (check all that apply)
□ None □ Security □ Fire Are they: □ Leased □ Owned
Question Number Explanation of “Yes” answers□ Additional sheet is attached
(30) Are you aware of any building restrictions or restrictive covenants which may provide for restrictions as to
the use of the property or as to the type of construction or materials to be used in the construction of any
of structure on the property? □ Y □ N
(31) What is the zoning of the property?
Has it ever been zoned for commercial or industrial? □ Y □ NK
(32) Is the property located in an historic district? □ Y □ N □ NK
If yes, which historic district? . (See attached disclosure)
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 6 of 7
Any information contained in this property disclosure regarding homeowners’ associations (HOA),
condominium owners’ associations (COA), or property owners’ associations (POA) is summary in
nature. The covenants and association governing documents are a matter of public record and can be
obtained from the conveyance records on file at the Clerk of Court in the parish where the property is
located.
(33) Are you aware of any conflict with current usage of the property
and any zoning, building, and/or safety restrictions?
□ Y
□ N
(34) Are you aware of any current governmental liens or taxes owing on the property?
□ Y
□ N
(35) Is membership in a homeowners’ association (HOA), condominium owners’
association (COA), or property owners’ association (POA) required as the result of
owning this property?
□ Y
□ N
(a) Are any HOA, COA, or POA dues required?
□ Y
□ N
If yes, what is the amount? $_________ per
(b) Are there any current or pending special assessments?
□ Y
□ N □ NK
If yes, what is the amount? $________ per
(36) Are the streets accessing the property
□ Private
□ Public □ NK
(37) Is there a homestead exemption in effect?
□ Y
□ N □ NK
(38) Is there any pending litigation regarding the property not previously
disclosed in this document?
□ Y
□ N □ NK
(39) Has an animal or pet ever inhabited the structure?
(a) during the time the SELLER owned the property?
□ Y
□ N
(b) prior to the time the SELLER owned the property?
□ Y
□ N
□ NK
(40) Does the property or any of its structures contain any of the following? Check all that apply and provide
additional details at the end of this section.
Asbestos
Radon gas
Contaminated soil
□ Y □ N
□ Y □ N
□ Y □ N
□ NK
□ NK
□ NK
Formaldehyde
Chemical storage tanks
Contaminated water
□ Y □ N
□ Y □ N
□ Y □ N
□ NK
□ NK
□ NK
Hazardous waste
□ Y □ N
□ NK
Toxic Mold
□ Y □ N
□ NK
Mold/Mildew
□ Y □ N
□ NK
Electromagnetic fields
□ Y □ N
□ NK
Contaminated drywall/sheetrock
□ Y □ N
□ NK
Contaminated flooring
□ Y □ N
□ NK
Other adverse materials or conditions
□ Y □ N
□ NK
(41) Is there or has there ever been an illegal laboratory for the production or manufacturing of
methamphetamine in operation on the property? □ Y □ N □ NK
(42) Is there a cavity created within a salt stock by dissolution with water underneath the property?
□ Y
□ N
□ NK
(43) Is there a solution mining injection well within 2640 feet (1/2 mile) of the property?
□ Y
□ N
□ NK
Property Description (Address, City, State, Zip)
RPDI Rev. 1/1/20 BUYER’S Initials: _____ _____ SELLER’S Initials: _____ _____ Page 7 of 7
(44) Are there any solar panels on the property?
□ Y
□ N
□ NK
If yes, are they: □ Leased □ Owned □ Removable □ Monthly Payment Amount
(45) Was SELLER and/or previous owner a recipient of any of the following: □ NK
□ Road Home grant $ (amount received)
□ FEMA $ (amount received)
□ SBA $ (amount received)
□ Other Federal disaster flood assistance $ (amount received)
If YES, complete (a) - (e.i.) below.
a. Is the property subject to the Road Home Declaration of Covenants Running with
the Land or other requirements to obtain and maintain flood insurance on the property? □ Y □ NK
b. If YES, attach a copy of the Road Home Program Declaration of Covenants other
requirements to obtain and maintain flood insurance on the property.
c. Has SELLER personally assumed any terms of the Road Home Program
Grant Agreement? □ Y □ NK
d. Has the SELLER been a recipient of any elevation grants for this property? □ Y □ N
i. If YES, what is the amount received?
e. Was the previous owner of the property a recipient of any elevation
grants for this property? □ Y □ N □ NK
i. If YES, what was the amount received?
Question Number Explanation of “Yes” answers□ Additional sheet is attached
ACKNOWLEDGEMENTS
All SELLERS are required to make written disclosure of known defects regarding a property being transferred. I/We attest
that the above statements and explanations have been provided by me/us and are true and correct to the best of my/our
knowledge. (If either party is represented by a real estate licensee, your signature below acknowledges that you have
been informed of your duties and rights under LSA-R.S. 9:3196-3200 and have read and understand the informational
statement.)
Seller(s) acknowledge(s) that the information contained herein is current as of this date.
SELLER (sign) (print) Date Time
SELLER (sign) (print) Date Time
Buyer(s) signing below acknowledge(s) receipt of this property disclosure.
BUYER (sign) (print) Date Time
BUYER (sign) (print) Date Time
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PROPERTY DISCLOSURE EXEMPTION FORM In accordance with LSA-R.S. (Louisiana Louisiana Real Estate Commission)

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Completed 22 January 2021

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