Seller’s Disclosure QuestionnaireZZZ: Seller Disclosure NoticeStep 1 of 214%X/TwitterThis field is for validation purposes and should be left unchanged.Personal InformationName:* First Last Your Realtor's Name:* First Last Concerning Property Address:*Are you currently occupying the property?* Yes NoHave you ever occupied the property?* Yes NoApproximate date since you last occupied the property:* Section 1. The Property has the items marked below:(Mark Yes, No, or Unknown) This notice does not establish the items to be conveyed. The contract will determine which items will & will not convey.Cable TV Wiring* Yes No UnknownCarbon Monoxide Detector* Yes No UnknownCeiling Fans* Yes No UnknownCooktop* Yes No UnknownDishwasher* Yes No UnknownDisposal* Yes No UnknownEmergency Escape Ladder(s)* Yes No UnknownExhaust Fans* Yes No UnknownFences* Yes No UnknownFire Detection Equipment* Yes No UnknownFrench Drain* Yes No UnknownGas Fixtures* Yes No UnknownLiquid Propane Gas* Yes No Unknown– LP Community (Captive)* Yes No Unknown– LP on Property* Yes No UnknownNatural Gas Lines* Yes No UnknownFuel Gas Piping:* Yes No Unknown-Black Iron Pipe* Yes No Unknown-Copper* Yes No Unknown-Corrugated Stainless Steel Tubing* Yes No UnknownHot Tub* Yes No UnknownIntercom System* Yes No UnknownMicrowave* Yes No UnknownOutdoor Grill* Yes No UnknownPatio/Decking* Yes No UnknownPlumbing System* Yes No UnknownPool* Yes No UnknownPool Equipment* Yes No UnknownPool Maintenance Accessories* Yes No UnknownPool Heater* Yes No UnknownPump on the property?*(Sump or Grinder) Yes No UnknownPump Type:* Sump Grinder UnknownRain Gutters* Yes No UnknownRange/Stove* Yes No UnknownRoof/Attic Vents* Yes No UnknownSauna* Yes No UnknownSmoke Detector* Yes No UnknownSmoke Detector – Hearing Impaired* Yes No UnknownSpa* Yes No UnknownTrash Compactor* Yes No UnknownTV Antenna* Yes No UnknownWasher/Dryer Hookup* Yes No UnknownWindow Screens* Yes No UnknownPublic Sewer System* Yes No UnknownCentral A/C* Yes No UnknownAC Type Electric GasNumber of UnitsEvaporative Coolers* Yes No UnknownNumber of UnitsWall/Window AC Units* Yes No UnknownNumber of UnitsAttic Fan(s)* Yes No UnknownIf yes, please decribe:Central Heat* Yes No UnknownCentral Heat Type Electric GasNumber of UnitsOther Heat* Yes No UnknownIf yes, please decribe:Oven* Yes No UnknownNumber of Ovens*Oven Type* Electric Gas OtherOther*Fireplace and Chimney* Yes No UnknownFireplace/Chimney Type* Wood Gas logs Mock OtherOther*Carport* Yes No UnknownCarport Type* Attached Not attachedGarage* Yes No UnknownGarage Type* Attached Not attachedGarage Door Openers* Yes No UnknownNumber of Units*Number of Remotes*Satellite Dish & Controls* Yes No UnknownSatellite Dish & Controls is* Owned LeasedLeased From:*Security System* Yes No UnknownSecurity System is* Owned LeasedLeased From:*Solar Panels* Yes No UnknownSolar Panels are* Owned LeasedLeased From:*Water Heater* Yes No UnknownWater Heater Type Electric Gas Number of UnitsWater Softener* Yes No UnknownWater Softener is* Owned LeasedLeased From:Other Leased Items* Yes No UnknownIf yes, please describe:Underground Lawn Sprinkler* Yes No UnknownUnderground Lawn Sprinkler is Automatic ManualAreas Covered:Septic/On-Site Sewer Facility* Yes No UnknownWater supply provided by:* City Well MUD Co-op Unknown Was the property built before 1978* Yes No UnknownRoof Type:*Age:*Is there an overlay roof covering on the Property (shingles or roof covering placed over existing or roof covering)?* Yes NoAre you aware of any of the items listed in Section 1 that are not in working condition, that have defects, or are in need of repair?* Yes NoIf yes, describe:*Section 2. Are you aware of any defects or malfunctions in any of the following?(Mark Yes if you are aware and No if you are not aware).Basement* Yes NoCeilings* Yes NoDoors* Yes NoDriveways* Yes NoElectrical Systems* Yes NoExterior Walls* Yes NoFloors* Yes NoFoundation/Slab(s)* Yes NoInterior Walls* Yes NoLighting Fixtures* Yes NoPlumbing Systems* Yes NoRoof* Yes NoSidewalks* Yes NoWalls/Fences* Yes NoWindows* Yes NoOther Structural Components* Yes NoIf the answer to any of the above items is yes, please explain:Section 3. Are you aware of any of the following conditions?(Mark yes if you are aware and No if you are not aware)Aluminum Wiring* Yes NoAsbestos Components* Yes NoDiseased Trees* Yes NoType: Oak Wilt Endangered Species/Habitat on Property* Yes NoFault Lines* Yes NoHazardous or Toxic Waste* Yes NoImproper Drainage* Yes NoIntermittent or Weather Springs* Yes NoLandfill* Yes NoLead-Based Paint or Lead-Based Pt. Hazards* Yes NoEncroachments onto the Property* Yes NoImprovements encroaching on other's property* Yes NoLocated in Historic District* Yes NoHistoric Property Designation* Yes NoPrevious Foundation Repairs* Yes NoPrevious Roof Repairs* Yes NoPrevious Use of Premises for Manufacture of Methamphetamine* Yes NoRadon Gas* Yes NoSettling* Yes NoSoil Movement* Yes NoSubsurface Structure or Pits* Yes NoUnderground Storage Tanks* Yes NoUnplatted Easements* Yes NoUnrecorded Easements* Yes NoUrea-formaldehyde Insulation* Yes NoWater Damage Not Due to a Flood Event* Yes NoWetlands on Property* Yes NoWood Rot* Yes NoActive infestation of termites or other wood destroying insects (WDI)* Yes NoPrevious Treatment for termites or WDI* Yes NoPrevious termite or WDI damage repaired* Yes NoPrevious Fires* Yes NoTermite or WDI damage needing repair* Yes NoSingle Blockable Main Drain in Pool/Hot Tub/Spa* Yes NoA single blockable main drain may cause a suction entrapment hazard for an individual.If answer to any of the items in Section 3 is yes, explain:Section 4.Are you aware of any item, equipment, or system in or on the Property that is in need of repair, which has not been previously disclosed in this notice?* Yes NoIf yes, please explain:*5. Are you aware of any of the following conditions?(Mark yes if you are aware and check wholly or partly as applicable and No if you are not aware)Present flood insurance coverage* Yes NoPrevious flooding due to a failure or breach of a reservoir or a controlled or emergency release of water from a reservoir.* Yes NoPresent flooding due to a natural flood* Yes NoPrevious water penetration into a structure on the Property due to a natural flood event* Yes NoLocated in a 100-year floodplain* Yes No“100-year floodplain” means any area of land that: (A) is identified on the flood insurance rate map as a special flood hazard area, which is designated as Zone A, V, A99, AE, AO, AH, VE, or AR on the map; (B) has a one percent annual chance of flooding, which is considered to be a high risk of flooding; and (C) may include a regulatory floodway, flood pool, or reservoir.Located: Wholly PartlyLocated in a 500-year floodplain* Yes No“500-year floodplain” means any area of land that: (A) is identified on the flood insurance rate map as a moderate flood hazard area, which is designated on the map as Zone X (shaded); and (B) has a two-tenths of one percent annual chance of flooding which is considered to be a moderate risk of flooding.Located: Wholly PartlyLocated in a floodway* Yes No“Floodway” means an area that is identified on the flood insurance rate map as a regulatory floodway, which includes the channel of a river or other watercourse and the adjacent land areas that mist be reserved for the discharge of a base flood, also referred to as a 100-year flood, without cumulatively increasing the water surface elevation more than a designated height.Located: Wholly PartlyLocated in a flood pool* Yes No“Flood pool” means the area adjacent to a reservoir that lies above the normal maximum operating level of the reservoir and that is subject to controlled inundation under the management of the United States Army Corps of Engineers.Located: Wholly PartlyLocated in a reservoir* Yes No“Reservoir” means a water impoundment project operated by the United States Army Corps of Engineers that is intended to retain water or delay the runoff of water in a designated surface area of land.Located: Wholly PartlySection 6.Have you ever filed a claim for flood damage to the Property with any insurance provider including the National Flood Insurance Program?* Yes NoIf yes, explain:*Section 7.Have you ever received assistance from FEMA or the U.S. Small Business Administration (SBA) for flood damage to the property* Yes NoPlease explain:*Section 8. Are you aware of any of the following?(Mark yes if you are aware and No if you are not aware)Room additions, structural modifications, or other alterations or repairs made without necessary permits, with unresolved permits, or not in compliance with building codes in effect at the time* Yes NoHomeowner's associations or maintenance fees or assessments* Yes NoName of association:*Manager's name:*Manager's Phone:*Fees or assessments are:*Per:* Monthly Quarterly Annually Fees or assessments are:* Mandatory VoluntaryAny unpaid fees or assessments for the Property?* Yes NoAmountAny common areas (facilities such as pools, tennis courts, walkways, or other) co-owned in undivided interest with others* Yes NoAny optional user fees for common facilities charged?* Yes NoIf yes, describe:*Any notices of violations of deed restrictions or governmental ordinances affecting the condition or use of the Property* Yes NoAny lawsuits or other legal proceedings directly or indirectly affecting the Property (Includes but not limited to: divorce, foreclosure, heirship, bankruptcy, and taxes.)* Yes NoAny death on the Property except for those deaths caused by: natural causes, suicide, or accident unrelated to the condition of the property* Yes NoAny condition on the Property which materially affects the health or safety of an individual* Yes NoAny repairs or treatments, other than routine maintenance, made to the Property to remediate environmental hazards such as asbestos, radon, lead-based paint, urea-formaldehyde or mold* Yes NoAny rainwater harvesting system located on the Property that is larger than 500 gallons and that uses a public water supply as an auxiliary water source.* Yes NoThe Property is located in a propane gas system service area owned by a propane distribution system retailer* Yes NoAny portion of the property that is located in a groundwater conservation district or subsidence district* Yes NoIf the answer to any of the items in Section 8 is yes, explain:Section 9.Within the last 4 years, have you received any written inspection reports from persons who regularly provide inspections and who are licensed as inspectors or otherwise permitted by law to perform inspections?* Yes NoInspection date:* Type:*Name of Inspector:*No. of Pages:*Have another inspection to add? Yes NoInspection date:* Type:*Name of Inspector:*No. of Pages:*Section 10.Check any tax exemptions which you currently claim for the Property: Homestead Wildlife Management Senior Citizen Agricultural Disabled Disabled Veteran Unknown OtherOther:Section 11.Have you ever filed a claim for damage, other than flood damage, to the Property with any insurance provider?* Yes NoSection 12.Have you ever received proceeds for a claim for damage to the Property (for example, an insurance claim or settlement or award in legal proceeding) and not used the proceeds to make the repairs for which the claim was made?* Yes NoPlease explain:*Section 13.Does the Property have working smoke detectors installed in accordance with the smoke detector with the smoke detector requirements of Chapter 766 of the Health and Safety Code?* Unknown No YesIf no or unknown please explain:Services:Please give provider information for the following services if applicable.Electric:Electric Phone:Sewer:Sewer Phone:Water:Water Phone:Cable:Cable Phone:Trash:Trash Phone:Natural Gas:Natural Gas Phone:Phone Company:Phone Company Phone:PropanePropane Phone:InternetInternet Phone:
