Seller Disclosure Agreement – CoordinateThat.com

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Personal Information

Name:*

First Last

Your Realtor's Name:*

First Last

Concerning Property Address:*

Are you currently occupying the property?*

Yes

Have you ever occupied the property?*

Yes

Approximate date since you last occupied the property:*

MM slash DD slash YYYY

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

Unknown

Carbon Monoxide Detector*

Yes

Unknown

Ceiling Fans*

Yes

Unknown

Cooktop*

Yes

Unknown

Dishwaser*

Yes

Unknown

Disposal*

Yes

Unknown

Emergency Escape Ladder(s)*

Yes

Unknown

Exhaust Fans*

Yes

Unknown

Fences*

Yes

Unknown

Fire Detection Equipment*

Yes

Unknown

French Drain*

Yes

Unknown

Gas Fixtures*

Yes

Unknown

Liquid Propane Gas*

Yes

Unknown

– LP Community (Captive)*

Yes

Unknown

– LP on Property*

Yes

Unknown

Natural Gas Lines*

Yes

Unknown

Fuel Gas Piping:*

Yes

Unknown

-Black Iron Pipe*

Yes

Unknown

-Copper*

Yes

Unknown

-Corrugated Stainless Steel Tubing*

Yes

Unknown

Hot Tub*

Yes

Unknown

Intercom System*

Yes

Unknown

Microwave*

Yes

Unknown

Outdoor Grill*

Yes

Unknown

Patio/Decking*

Yes

Unknown

Plumbing System*

Yes

Unknown

Pool*

Yes

Unknown

Pool Equipment*

Yes

Unknown

Pool Maintenance Accessories*

Yes

Unknown

Pool Heater*

Yes

Unknown

Pump on the property?*

(Sump or Grinder)

Yes

Unknown

Pump Type:*

Sump

Grinder

Unknown

Rain Gutters*

Yes

Unknown

Range/Stove*

Yes

Unknown

Roof/Attic Vents*

Yes

Unknown

Sauna*

Yes

Unknown

Smoke Detector*

Yes

Unknown

Smoke Detector – Hearing Impaired*

Yes

Unknown

Spa*

Yes

Unknown

Trash Compactor*

Yes

Unknown

TV Antenna*

Yes

Unknown

Washer/Dryer Hookup*

Yes

Unknown

Window Screens*

Yes

Unknown

Public Sewer System*

Yes

Unknown

Central A/C*

Yes

Unknown

AC Type*

Electric

Gas

Number of Units*

Evaporative Coolers*

Yes

Unknown

Number of Units*

Wall/Window AC Units*

Yes

Unknown

Number of Units*

Attic Fan(s)*

Yes

Unknown

If yes, please decribe:*

Central Heat*

Yes

Unknown

Central Heat Type*

Electric

Gas

Number of Units*

Other Heat*

Yes

Unknown

If yes, please decribe:*

Oven*

Yes

Unknown

Oven Type*

Electric

Gas

Other

Other*

Number of Ovens*

Fireplace and Chimney*

Yes

Unknown

Fireplace/Chimney Type*

Wood

Gas logs

Mock

Other

Other*

Carport*

Yes

Unknown

Carport Type*

Attached

Not attached

Garage*

Yes

Unknown

Garage Type*

Attached

Not attached

Garage Door Openers*

Yes

Unknown

Number of Units*

Number of Remotes*

Satellite Dish & Controls*

Yes

Unknown

Satellite Dish & Controls is*

Owned

Leased

Leased From:*

Security System*

Yes

Unknown

Security System is*

Owned

Leased

Leased From:*

Solar Panels*

Yes

Unknown

Solar Panels are*

Owned

Leased

Leased From:*

Water Heater*

Yes

Unknown

Water Heater Type*

Electric

Gas

Other

Number of Units*

Water Softener*

Yes

Unknown

Water Softener is*

Owned

Leased

Leased From:*

Other Leased Items*

Yes

Unknown

If yes, please describe:*

Underground Lawn Sprinkler*

Yes

Unknown

Underground Lawn Sprinkler is*

Automatic

Manual

Areas Covered:*

Septic/On-Site Sewer Facility*

Yes

Unknown

Water supply provided by:*

City

Well

MUD

Co-op

Unknown

Other

Was the property built before 1978*

Yes

Unknown

Roof Type:*

Age:*

Is there an overlay roof covering on the Property (shingles or roof covering placed over existing or roof covering)?*

Yes

Are 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

If 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

Ceilings*

Yes

Doors*

Yes

Driveways*

Yes

Electrical Systems*

Yes

Exterior Walls*

Yes

Floors*

Yes

Foundation/Slab(s)*

Yes

Interior Walls*

Yes

Lighting Fixtures*

Yes

Plumbing Systems*

Yes

Roof*

Yes

Sidewalks*

Yes

Walls/Fences*

Yes

Windows*

Yes

Other Structural Components*

Yes

If 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

Asbestos Components*

Yes

Diseased Trees*

Yes

Type:*

Oak Wilt

Other

Endangered Species/Habitat on Property*

Yes

Fault Lines*

Yes

Hazardous or Toxic Waste*

Yes

Improper Drainage*

Yes

Intermittent or Weather Springs*

Yes

Landfill*

Yes

Lead-Based Paint or Lead-Based Pt. Hazards*

Yes

Encroachments onto the Property*

Yes

Improvements encroaching on other's property*

Yes

Located in Historic District*

Yes

Historic Property Designation*

Yes

Previous Foundation Repairs*

Yes

Previous Roof Repairs*

Yes

Previous Use of Premises for Manufacture of Methamphetamine*

Yes

Radon Gas*

Yes

Settling*

Yes

Soil Movement*

Yes

Subsurface Structure or Pits*

Yes

Underground Storage Tanks*

Yes

Unplatted Easements*

Yes

Unrecorded Easements*

Yes

Urea-formaldehyde Insulation*

Yes

Water Damage Not Due to a Flood Event*

Yes

Wetlands on Property*

Yes

Wood Rot*

Yes

Active infestation of termites or other wood destroying insects (WDI)*

Yes

Previous Treatment for termites or WDI*

Yes

Previous termite or WDI damage repaired*

Yes

Previous Fires*

Yes

Termite or WDI damage needing repair*

Yes

Single Blockable Main Drain in Pool/Hot Tub/Spa*

A single blockable main drain may cause a suction entrapment hazard for an individual.

Yes

If the 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

If 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

Previous flooding due to a failure or breach of a reservoir or a controlled or emergency release of water from a reservoir.*

Yes

Present flooding due to a natural flood*

Yes

Previous water penetration into a structure on the Property due to a natural flood event*

Yes

Located in a 100-year floodplain*

“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.

Yes

Located:*

Wholly

Partly

Located in a 500-year floodplain*

“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.

Yes

Located:*

Wholly

Partly

Located in a floodway*

“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.

Yes

Located:*

Wholly

Partly

Located in a flood pool*

“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.

Yes

Located:*

Wholly

Partly

Located in a reservoir*

“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.

Yes

Located:*

Wholly

Partly

If the answer to any of the above is yes, explain

Section 6.

Have you ever filed a claim for flood damage to the Property with any insurance provider including the National Flood Insurance Program?*

Yes

If 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

Please 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

Homeowner's associations or maintenance fees or assessments*

Yes

Name of association:*

Manager's name:*

Manager's Phone:*

Fees or assessments are:*

Per:*

Monthly

Quarterly

Annually

Other

Fees or assessments are:*

Mandatory

Voluntary

Any unpaid fees or assessments for the Property?*

Yes

Amount*

Any common areas (facilities such as pools, tennis courts, walkways, or other) co-owned in undivided interest with others*

Yes

Any optional user fees for common facilities charged?*

Yes

If yes, describe:*

Any notices of violations of deed restrictions or governmental ordinances affecting the condition or use of the Property*

Yes

Any lawsuits or other legal proceedings directly or indirectly affecting the Property (Includes but not limited to: divorce, foreclosure, heirship, bankruptcy, and taxes.)*

Yes

Any death on the Property except for those deaths caused by: natural causes, suicide, or accident unrelated to the condition of the property*

Yes

Any condition on the Property which materially affects the health or safety of an individual*

Yes

Any 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

Any 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

The Property is located in a propane gas system service area owned by a propane distribution system retailer*

Yes

Any portion of the property that is located in a groundwater conservation district or subsidence district*

Yes

Check any tax exemptions which you currently claim for the Property:*

Homestead

Wildlife Management

Senior Citizen

Agricultural

Disabled

Disabled Veteran

Unknown

Other

Other:*

Section 11.

Have you ever filed a claim for damage, other than flood damage, to the Property with any insurance provider?*

Yes

Section 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

Please 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

Yes

If 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:

Propane

Propane Phone:

Internet

Internet Phone:

Name

This field is for validation purposes and should be left unchanged.