4. OTHER DISCLOSURES
YES NO
DO NOT
KNOW
2. ROOF
YES NO
DO NOT
KNOW
Age, if known: ___________ Years.
Does the roof leak?
Is there present damage to the roof?
Is there more than one layer of shingles
on the house?
If yes, how many layers? ____________
3. HAZARDOUS CONDITIONS
NO
DO NOT
KNOW
Have there been or are there any
hazardous conditions on the property, such
as methane gas, lead paint, radon gas in
house or well, radioactive material, landfill,
mineshaft, expansive soil, toxic materials,
mold, other biological contaminants,
asbestos insulation, or PCB's?
Is there contamination caused by the
manufacture of a controlled substance on
the property that has not been certified as
decontaminated by an inspector approved
under IC 13-14-1-15?
Has there been manufacture of
methamphetamine or dumping of waste
from the manufacture of methamphetamine
in a residential structure on the property?
Explain:
Do structures have aluminum wiring?
Are there any foundation problems
with the structures?
Are there any encroachments?
Are there any violations of zoning,
building codes, or restrictive covenants?
Is the present use a non-conforming use?
Explain:
Have you received any notices by any
governmental or quasi-governmental
agencies affecting this property?
Are there any structural problems with
the building?
Have any substantial additions or
alterations been made without a required
building permit?
Are there moisture and/or water problems
in the basement, crawl space area, or any
other area?
Is there any damage due to wind, flood,
termites or rodents?
Have any structures been treated for
wood destroying insects?
Are the furnace/woodstove/chimney/flue
all in working order?
Is the property in a flood plain?
Do you currently pay flood insurance?
Does the property contain underground
storage tank(s)?
Is the homeowner a licensed real estate
salesperson or broker?
Is there any threatened or existing
litigation regarding the property?
Is the property subject to covenants,
conditions and/or restrictions of a
homeowner's association?
Is the property located within one (1) mile
of an airport?
The information contained in this Disclosure has been furnished by the Seller, who certifies to the truth thereof, based on the Seller's CURRENT
ACTUAL KNOWLEDGE. A disclosure form is not a warranty by the owner or the owner's agent, if any, and the disclosure form may not be used as
a substitute for any inspections or warranties that the prospective buyer or owner may later obtain. At or before settlement, the owner is required
to disclose any material change in the physical condition of the property or certify to the purchaser at settlement that the condition of the property
is substantially the same as it was when the disclosure form was provided. Seller and Purchaser hereby acknowledge receipt of this Disclosure by
signing below.
Is the access to your property via a
private road?
Is the access to your property via a
public road?
Is the access to your property via
an easement?
YES
E. ADDITIONAL COMMENTS AND/OR EXPLANATIONS:
(Use additional pages, if necessary)
Property address (number and street, city, state, and ZIP code)
Page 2 of 2
Signature of Seller Signature of Buyer Date (mm/dd/yy)Date (mm/dd/yy)
Date (mm/dd/yy) Signature of Buyer Date (mm/dd/yy)
The Seller hereby certifies that the condition of the property is substantially the same as it was when the Seller’s Disclosure form was originally provided to the Buyer.
Signature of Seller (at closing) Date (mm/dd/yy) Signature of Seller (at closing) Date (mm/dd/yy)
Signature of Seller
eForms
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
