Residential Property Disclosure Form (version 1)

REQUIRED Seller 1 Email*

example@example.com

REQUIRED Seller 2 Email

example@example.com

STATE OF OHIO DEPARTMENT OF COMMERCE

RESIDENTIAL PROPERTY DISCLOSURE FORM

Purpose of Disclosure Form: This is a statement of certain conditions and information concerning the property actually known by the owner. An owner may or may not have lived at the property and unless the potential purchaser is informed in writing, the owner has no more information about the property than could be obtained by a careful inspection of the property by a potential purchaser. Unless the potential purchaser is otherwise informed, the owner has not conducted any inspection of generally inaccessible areas of the property. This form is required by Ohio Revised Code Section 5302.30.

THIS FORM IS NOT A WARRANTY OF ANY KIND BY THE OWNER OR BY ANY AGENT OR SUBAGENT REPRESENTING THE OWNER. THIS FORM IS NOT A SUBSTITUTE FOR ANY INSPECTIONS. POTENTIAL PURCHASERS ARE ENCOURAGED TO OBTAIN THEIR OWN PROFESSIONAL INSPECTION(S).

Owner’s Statement: The statements contained in this form are made by the owner and are not the statements of the owner’s agent or subagent. The statements contained in this form are provided by the owner only to potential purchasers in a transfer made by the owner. The statements are not for purchasers in any subsequent transfers. The information contained in this disclosure form does not limit the obligation of the owner to disclose an item of information that is required by any other statute or law to be disclosed in the transfer of residential real estate.

OWNER INSTRUCTIONS

Instructions to Owner: (1) Answer ALL questions. (2) Report known conditions affecting the property. (3) Attach additional pages with your signature if additional space is needed. (4) Complete this form yourself. (5) If some items do not apply to your property, write NA (not applicable). If the item to be disclosed is not within your actual knowledge, indicate Unknown.

Pursuant to section 5302.30 of the Revised Code and rule 1301:5-6-10 of the Administrative Code.

Initial Seller 1*

Initial Seller 2*

Seller 1 Name*

Seller 2 Name*

Date*

Date

Listing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is owner occupying property? *

YESNO

If owner IS occupying the property, since what date*

Date

If owner IS NOT occupying the property, since what date*

Date

The source of water supply to the property is (check appropriate boxes)*

What is water source?*

Do you know of any current leaks, backups or other material problems with the water supply system or quality of the water?*

YesNo

If "Yes" to the question above, please describe and indicate any repairs completed (but not longer than the past 5 years):*

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Is the quantity of water sufficient for your household use? (NOTE: water usage will vary from household to household)*

YesNo

SEWER SYSTEM: The nature of the sanitary sewer system servicing the property is (check appropriate boxes)*

If not a public or private sewer, date of last inspection

Date

Inspected by:

Do you know of any previous or current leaks, backups or other material problems with the sewer system servicing the property?*

YesNo

If "Yes" to the question above, please describe and indicate any repairs completed (but not longer than the past 5 years)*

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Roof: Do you know of any previous or current leaks or other material problems with the roof or rain gutters?*

YesNo

If "Yes" to the question above, please describe and indicate any repairs completed (but not longer than the past 5 years)*

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WATER INTRUSION: Do you know of any previous or current water leakage, water accumulation, excess moisture or other defects to the property, including but not limited to any area below grade, basement or crawl space?*

YesNo

If "Yes" to the question above, please describe and indicate any repairs completed:*

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Do you know of any water or moisture related damage to floors, walls or ceilings as a result of flooding; moisture seepage; moisture condensation; ice damming; sewer overflow/backup; or leaking pipes, plumbing fixtures, or appliances?*

YesNo

If "Yes" to the question above, please describe and indicate any repairs completed:*

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Have you ever had the property inspected for mold by a qualified inspector? If "Yes", please describe and indicate whether you have an inspection report and any remediation undertaken:*

YesNo

If "Yes" to the question above, please describe and indicate whether you have an inspection report and any remediation undertaken*

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Purchaser is advised that every home contains mold. Some people are more sensitive to mold than others. If concerned about the issue, purchaser is encouraged to have a mold inspection done by a qualified inspector.

STRUCTURAL COMPONENTS (FOUNDATION, BASEMENT/CRAWL SPACE, FLOORS, INTERIOR AND EXTERIOR WALLS): Do you know of any previous or current movement, shifting, deterioration, material cracks/settlling (other than visible minor cracks or blemishes) or other material problems with the foundation, basement/crawl space, floors, or interior/exterior walls?*

YesNo

If "Yes" to the question above please describe and indicate any repairs, alterations, or modifications to control the cause or effect of any problem identified (but not longer than the past 5 years)*

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Do you know of any previous fire or smoke damage to the property?*

YesNo

If "Yes" to the question above, please describe and indicate and repairs completed:*

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WOOD DESTROYING INSECTS/TERMITES: Do you know of presence of any wood destroying insects/termites in or on the property or any existing damage to the property caused by wood destroying insects/termites?*

YesNo

If "Yes" to the question above, please describe and indicate any inspection or treatment (but not longer than the past 5 years):*

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MECHANICAL SYSTEMS: Do you know of any previous or current problems or defects with the following existingmechanical systems? If your property does not have the mechanical system, mark N/A (Not Applicable)

Do You Have Previous or Current Defects with Electrical*

YesNoN/A

Do You Have Previous or Current Defects with Plumbing (pipes)*

YesNoN/A

Do You Have Previous or Current Defects with Central Heating*

YesNoN/A

Do You Have Previous or Current Defects with Central Air Conditioning*

YesNoN/A

Do You Have Previous or Current Defects with Sump Pump*

YesNoN/A

Do You Have Previous or Current Defects with Fireplace Chimney*

YesNoN/A

Do You Have Previous or Current Defects with Lawn Sprinkler*

YesNoN/A

Do You Have Previous or Current Defects with Water Softener*

YesNoN/A

Is Water Softener Leased*

YesNo

Do you Have Previous or Current Defect with the Security System*

YesNoN/A

Is the Security System Leased*

YesNo

Do You Have Previous or Current Defects Central Vaccum*

YesNoN/A

Do You Have Previous or Current Defects with Built in Appliances*

YesNoN/A

Do You Have Previous or Current Defects with Other Mechanical Systems*

YesNoN/A

If the answer to any of the above questions about Mechanicals is "Yes", please describe and indicate any repairs to the mechanical system (but not longer than the past 5 years)

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PRESENCE OF HAZARDOUS MATERIAL: Do you know of the previous or current presence of any of the below identified hazardous materials on the property?

Do You Have Previous or Current Presence of Lead-Based Paint*

YesNoUnknown

Do You Have Previous or Current Presence of Asbestos*

YesNoUnknown

Do You Have Previous or Current Presence of Urea-Formaldehyde Foam Insulation*

YesNoUnknown

Do You Have Previous or Current Presence of Radon Gas*

YesNoUnknown

If you answered "Yes" to Radon Gas indicate the level

Do You Have Previous or Current Presence of other Toxic or Hazardous Substances*

YesNoUnknown

If the answer "Yes" to any of the above Toxic or Hazardous Substance questions, please describe and indicate any repairs, remediation or mitigation to the property

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UNDERGROUND STORAGE TANKS/WELLS: Do you know of any underground storage tanks (existing or removed), oil or natural gas wells (plugged or unplugged), or abandoned water wells on the property?*

YesNo

If "Yes" to underground storage tanks or wells, please describe*

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Do you know of any oil, gas, or other mineral right leases on the property?*

YesNo

Purchaser should exercise whatever due diligence purchaser deems necessary with respect to oil, gas, and other mineral rights. Information may be obtained from records contained within the recorder's office in the county where the property is located.

FLOOD PLAIN/LAKE ERIE COASTAL EROSION AREA

Is the property located in a designated flood plain?*

YesNoUnknown

Is the property or any portion of the property included in a Lake Erie Coastal Erosion Area?*

YesNoUnknown

DRAINAGE/EROSION Do you know of any previous or current flooding, drainage, settling or grading or erosion problems affecting the property?*

YesNo

If answered "Yes" to the question above, please describe and indicate any repairs, modifications or alterations to the property or other attempts to control any problems (but not longer than the past 5 years)*

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ZONING/CODE VIOLATIONS/ASSESSMENTS/HOMEOWNERS' ASSOCIATION: Do you know of any violations of building or housing codes, zoning ordinances affecting the property or any nonconforming uses of the property?*

YesNo

If you answer "Yes" to the question above please describe*

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Is the structure on the property designated by any governmental authority as a historic building or as being located in an historic district? NOTE: such designation may limit changes or improvements that may be made to the property.*

YesNo

If the answer to the above question is "Yes" please describe.*

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Do you know of any recent or proposed assessments, fees or abatements, which could affect the property?*

YesNo

If you answered "Yes" to the question above please describe

0/130

List any assessment paid in full (date/amount)

0/130

List any current assessments

List Assessment Monthly Fee if any

Length of Assessment Payment # years

Length of Assessment Payment # months

Do you know of any recent or proposed rules or regulations of, or the payment of any fees or charges associated with this property, including but not limited to a Community Association, SID, CID, LID, etc.

YesNo

If you answered "Yes" to the question above please describe amount*

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BOUNDARY LINES/ENCROACHMENT/SHARED DRIVEWAY/PARTY WALLS: Do you know of any of the following conditions affecting the property?

Do you know of a Boundary Agreement?*

YesNo

Do you know of a Boundary Dispute?*

YesNo

Do you know of a Recent Boundary Change?*

YesNo

Do you know of a Shared Driveway?*

YesNo

Do you know of Party Walls?*

YesNo

Do you know of Encroachments from or on Adjacent Property?*

YesNo

If you answered "Yes" to the any of the above questions please describe

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For purposes of this section, material defects would include any non-observable physical condition existing on the property that could be dangerous to anyone occupying the property or any non-observable physical condition that could inhibit a person's use of the

OTHER KNOWN MATERIAL DEFECTS: The following are other known material defects in or on the property

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Presence of lead-based paint and/or lead-based paint hazards check YES or NO*

YES - Known lead-based paint and/or lead-based paint hazards are present in the housingNO - Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing

Lead Paint Records and reports available to the seller check YES or NO*

YES - Seller has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housingNO- Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazardss in the housing

CERTIFICATION OF OWNER

Owner certifies that the statements contained in this form are made in good faith and based on his/her actual knowledge as of the date signed by the Owner. Owner is advised that the information contained in this disclosure form does not limit the obligation of the owner to disclose an item of information that is required by any other statute or law or that may exist to preclude fraud, either by misrepresentation, concealment or nondisclosure in a transaction involving the transfer of residential real estate.

Signature Seller 1*

Signature Seller 2*