STATE OF NORTH CAROLINA
MINERAL AND OIL AND GAS RIGHTS MANDATORY DISCLOSURE STATEMENT
Instructions to Property Owners
1. e Residential Property Disclosure Act (G.S. 47E) (“Disclosure Act”) requires owners of certain residential real estate such as single-
family homes, individual condominiums, townhouses, and the like, and buildings with up to four dwelling units, to furnish purchasers
a Mineral and Oil and Gas Rights Disclosure Statement (“Disclosure Statement”). is form is the only one approved for this purpose.
2. A disclosure statement is not required for some transactions. For a complete list of exemptions, see G.S. 47E-2(a). A DISCLOSURE
STATEMENT IS REQUIRED FOR THE TRANSFERS IDENTIFIED IN G.S. 47E-2(b), including transfers involving the rst sale of
a dwelling never inhabited, lease with option to purchase contracts where the lessee occupies or intends to occupy the dwelling, and transfers
between parties when both parties agree not to provide the Residential Property and Owner’s Association Disclosure Statement.
3. You must respond to each of the following by placing a check √ in the appropriate box.
MINERAL AND OIL AND GAS RIGHTS DISCLOSURE
Mineral rights and/or oil and gas rights can be severed from the title to real property by conveyance (deed) of the mineral rights
and/or oil and gas rights from the owner or by reservation of the mineral rights and/or oil and gas rights by the owner. If mineral
rights and/or oil and gas rights are or will be severed from the property, the owner of those rights may have the perpetual right to
drill, mine, explore, and remove any of the subsurface mineral and/or oil or gas resources on or from the property either directly
from the surface of the property or from a nearby location. With regard to the severance of mineral rights and/or oil and gas
rights, Seller makes the following disclosures:
Yes No No Representation
___________
Buyer Initials
1. Mineral rights were severed from the property by a previous owner.
□ □ □
___________
Buyer Initials
2. Seller has severed the mineral rights from the property.
□ □
___________
Buyer Initials
3. Seller intends to sever the mineral rights from the property prior to
transfer of title to the Buyer.
□ □
___________
Buyer Initials
4. Oil and gas rights were severed from the property by a previous owner.
□ □
□
___________
Buyer Initials
5. Seller has severed the oil and gas rights from the property.
□ □
___________
Buyer Initials
6. Seller intends to sever the oil and gas rights from the property prior
to transfer of title to Buyer.
□ □
Note to Purchasers
If the owner does not give you a Mineral and Oil and Gas Rights Disclosure Statement by the time you make your oer to
purchase the property, or exercise an option to purchase the property pursuant to a lease with an option to purchase, you
may under certain conditions cancel any resulting contract without penalty to you as the purchaser. To cancel the contract,
you must personally deliver or mail written notice of your decision to cancel to the owner or the owner's agent within three
calendar days following your receipt of this Disclosure Statement, or three calendar days following the date of the contract,
whichever occurs rst. However, in no event does the Disclosure Act permit you to cancel a contract after settlement of the
transaction or (in the case of a sale or exchange) after you have occupied the property, whichever occurs rst.
Property Address: _______________________________________________________________________
Owner's Name(s):_______________________________________________________________________
Owner(s) acknowledge having examined this Disclosure Statement before signing and that all information is true and correct as of the
date signed.
Owner Signature:_____________________________________________________ Date _________, ____
Owner Signature:_____________________________________________________ Date _________, ____
Purchaser(s) acknowledge receipt of a copy of this Disclosure Statement; that they have examined it before signing; that they understand
that this is not a warranty by owner or owner's agent; and that the representations are made by the owner and not the owner's agent(s)
or subagent(s).
Purchaser Signature:____________________________________________________ Date ________, ____
Purchaser Signature:____________________________________________________ Date ________, ____
REC 4.25
1/1/15
