NC- Property Disclosure Form-140-5

NORTH CAROLINA REAL ESTATE COMMISSION

Residential Property And Owners'

Association Disclosure Statement

Protecting the Public INterest in Real Estate Brokerage Transactions
TaskID
Property Address Description*
Owners Name(s)*
North Carolina law N.C.G.S. 47E requires residential property owners to complete this Disclosure Statement and provide it to the buyer prior to any offer to purchase. There are limited exemptions for completing the form, such as new home construction that has never been occupied. Owners are advised to seek legal advice if they believe they are entitled to one of the limited exemptions contained in N.C.G.S. 47/E-2

An owner is required to provide a response to every question by selecting Yes (Y), No (N), No Representation (NR), or Not Applicable (NA). An owner is not required to disclose any of the material facts that have a NR option, even if they have knowledge of them. However, failure to disclose latent (hidden) defects may result in civil liability. The disclosures made in this Disclosure Statement are those of the owner(s), not the owner's broker.

*If an owner selects Y or N, the owner is only obligated to disclose information about which they have actual knowledge. If an owner selects Y in response to any question about a problem, the owner must provide a written explanation or attach a report from an attorney, engineer, contractor, pest control operator, or other expert or public agency describing it.

*If an owner selects N, the owner has no actual knowledge of the topic of the question, including any problem. If the owner selects N and the owner knows there is a problem or that the owner's answer is not correct, the owner may be liable for making an intentional misstatement.

*If an owner selects NR, it could mean that the owner (1) has knowledge of an issue and chooses not to disclose it; or (2) simply does not know.

*If an owner selects NA, it means the property does not contain a particular item or feature.

For purposes of completing this Disclosure Statement: "Dwelling" means any structure intended for human habitation, "Property" means any structure intended for human habitation and the tract of land, and "Not Applicable" means the item does not apply to the property or exist on the property.

OWNERS: The owner must give a completed and signed Disclosure Statement to the buyer no later than the time the buyer makes an offer to purchase property. If the owner does not, the buyer can, under certain conditions, cancel any resulting contract. An owner is responsible for completing and delivering the Disclosure Statement to the buyer even if the owner is represented in the sale of the property by a licensed real estate broker and the broker must disclose any material facts about the property that the broker knows or reasonably should know, regardless of the owner's response.

The owner should keep a copy signed by the buyer for their records. If something happens to make the Disclosure Statement incorrect or inaccurate (for example, the roof begins to leak), the owner must promptly give the buyer an updated Disclosure Statement or correct the problem. Note that some issues, even if repaired, such as structural issues and fire damage, remain material facts and must be disclosed by a broker even after repairs are made.

BUYERS: The owner's responses contained in this Disclosure Statement are not a warranty and should not be a substitute for conducting a careful and independent evaluation of the property.

Buyers are strongly encouraged to:

*Carefully review the entire Disclosure Statement.

*Obtain their own inspections from a licensed home inspector and/or other professional.

DO NOT assume that an answer of N or NR is a guarantee of no defect. If an owner selects N, that means the owner has no actual knowledge of any defects. It does not mean that a defect does not exist. If an owner selects NR, it could mean the owner (1) has knowledge of an issue and chooses not to disclose it, or (2) simply does not know.

BROKERS: A licensed real estate broker shall furnish their seller-client with a Disclosure Statement for the seller to complete in connection with the transaction. A broker shall obtain a completed copy of the Disclosure Statement and provide it to their buyer-client to review and sign. All brokers shall (1) review the completed Disclosure Statement to ensure the seller responded to all questions, (2) take reasonable steps to disclose material facts about the property that the broker knows or reasonably should know regardless of the owner's responses or representations, and (3) explain to the buyer that this Disclosure Statement does not replace an inspection and encourage the buyer to protect their interests by having the property fully examined to the buyer's satisfaction.

*Brokers are NOT permitted to complete this Disclosure Statement on behalf of their seller-clients.

*Brokers who own the property may select NR in this Disclosure Statement but are obligated to disclose material facts they know or reasonably should know about the property.
Owners Initials Acknowledging Pg 1*

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Owners Initials Acknowledging Pg 1

Clear
SECTION A.

STRUCTURE/FLOORS/WALLS/CEILING/WINDOW/ROOF
A1. Is the property currently owner-occupied?*

YesNoNR
Date owner acquired the property*

MonthDayYear
Date
If not owner occupied how long has it been since the owner occupied the property
A2. In what year was the dwelling constructed or select NR next*
A2 if Selecting "NR"

NR
A3. Have there been any structural additions or other structural or mechanical changes to the dwelling(s)?*

YesNoNR
A4. The dwelling's exterior walls are made of what type of material? (Check all that apply)*

Brick VeneerVinylStoneFiber CementSynthetic StuccoComposition HardboardConcreteAluminumWoodAsbestosNROther
A5. In what year was the dwellings roof covering installed? OR select NR next*
A5 if selecting "NR"

NR
A6. Is there a leakage or other problem with the dwelling's roof or related existing damage?*

YesNoNR
A7. Is there water seepage, leakage, dampness, or standing water in the dwelling's basement, crawl space, or slab?*

YesNoNR
A8. Is there an infestation present in the dwelling or damage from past infestations of wood destroying insects or organisms that has not been repaired?*

YesNoNR

A9. Is there a problem, malfunction, or defect with the dwellings:*

	N/A	Yes	No	NR
Foundation
Slab
Patio
Floors
Windows
Doors
Ceilings
Deck
Attached Garage
Fireplace Chimney
Interior Exterior Walls
Other (Explain below)

If selecting "Other" in A9, explain problem, malfunction, or defect
Explanations for questions in Section A (identify the specific question for each explanation)
SECTION B. HVAC/ELECTRICAL
B1. Is there a problem, malfunction, or defect with the dwelling's electrical system (outlets, wiring, panels, switches, fixtures, generator, etc?*

YesNoNR
B2. Is there a problem, malfunction, or defect with the dwelling's heating and/or air conditioning?*

YesNoNR
B3. What is the dwelling's heat source? (Check all that apply; indicate the year of each system manufacture, below)*

FurnaceHeat PumpBaseboardNROther
# of Furnace Units
Furnace Manufacture Year
# of Heat Pump Units
Heat Pump Manufacture Year
# of Bedrooms with Baseboard units
Baseboard Manufacture Year
Other HVAC Manufacture Year
Owners Initials Acknowledging Pg 2*

Clear
Owners Initials Acknowledging Pg 2

Clear
B4. What is the dwelling's cooling source? (Check all that apply; indicate the year of each system manufacture, below)*

Central Forced AirWall Window UnitsOtherNR
Central Forced Air Manufacture Year
# of Wall Windows Units
Wall Windows Units Manufacture Year
Other Unit Type
Other Unit Year
B5. What is the dwelling's fuel source? (Check all that apply)*

ElectricNatural GasSolarPropaneOilNROther
Explanations for questions in Section B (identify the specific question for each explanation)
SECTION C.

PLUMBING/WATER SUPPLY/SEWER/SEPTIC
C1. What is the dwelling's water supply source? (Check all that apply)*

City/CountyShared WellCommunity SystemPrivate WellNROther
If the dwelling's water supply source is supplied by a private well, identify whether the private well has been tested for: (Check all that apply)

QualityPressureQuantity
If the dwellings water source is supplied by a private well what was the date of the last water quality quantity test

MonthDayYear
Date
C2. The dwelling's water pipes are made of what type of material? (Check all that apply)*

CopperGalvanizedPlasticPolybutyleneNROther
C3. What is the dwelling's water heater fuel source? (Check all that apply; indicate the year of each system manufacture)*

GasElectricSolarNROther
C4. What is the dwelling's sewage disposal system? (Check all that apply)*

Septic tank with pumpCommunity systemSeptic tankDrip SystemConnected to City/County SystemCity/County system availableNRStraight pipe (wastewater does not go into a septic or other sewer system) *Note: Use of this type of system violates State Law.Other
If the dwelling is serviced by a Septic System system, how many bedrooms are allowed by the septic system permit?
Septic System

No Records Available
Date the septic system was last pumped

MonthDayYear
Date

C5. Is there a problem, malfunction, or defect with the dwelling's:*

	N/A	Yes	No	NR
Septic System
Sewer System
Plumbing system (pipes, fixtures, water heater, etc
Water supply (water quality, quantity, or pressure)

Explanations for questions in Section C (identify the specific question for each explanation)
Owners Initials Acknowledging Pg 3*

Clear
Owners Initials Acknowledging Pg 3

Clear
SECTION D

FIXTURES/APPLIANCES
D1. Is the dwelling equipped with an elevator system?*

YesNoNR
If Yes, when was it last inspected
Date of last maintenance service

MonthDayYear
Date

D2. Is there a problem, malfunction, or defect with the dwelling's:*

	N/A	Yes	No	NR
Attic fan, exhaust fan, ceiling fan
Elevator system or component
Appliances to be conveyed
Irrigation system
Pool/hot tub /spa
TV cable wiring or satellite dish
Sump pump
Gas logs
Central Vacuum
Garage door systems
Security system
Other

Explanations for questions in Section D (identify the specific question for each explanation)
SECTION E

LAND/ZONING

E2-E6 Required *

	Yes	No	NR
E1. Is there a problem, malfunction, or defect with the drainage, grading, or soil stability of the property?
E2. Is the property in violation of any local zoning ordinances, restrictive covenants, or local land-use restrictions (including setback requirements?)
E3. Is the property in violation of any building codes (including the failure to obtain required permits for room additions or other changes/improvements)?
E4. Is the property subject to any utility or other easements, shared driveways, party walls, encroachments from or on adjacent property, or other land use restrictions?
E5. Does the property abut or adjoin any private road(s) or street(s)?
E6. If there is a private road or street adjoining the property, are there any owners' association or maintenance agreements dealing with the maintenance of the road or street?

Explanations for questions in Section E (identify the specific question for each explanation):
SECTION F.

ENVIRONMENTAL/FLOODING

Required *

	Yes	No	NR
F1. Is there hazardous or toxic substance, material, or product (such as asbestos, formaldehyde, radon gas, methane gas, lead-based paint) that exceed government safety standards located on or which otherwise affect the property?

Owners Initials Acknowledging Pg 4*

Clear
Owners Initials Acknowledging Pg 4

Clear
SECTION F.

ENVIRONMENTAL/FLOODING (con't)

F2-F10 Required *

	Yes	No	NR
F2. Is there an environmental monitoring or mitigation device or system located on the property?
F3. Is there debris (whether buried or covered), an underground storage tank, or an environmentally hazardous condition (such as contaminated soil or water or other environmental contamination) located on or which otherwise affect the property?
F4. Is there any noise, odor, smoke, etc., from commercial, industrial, or military sources that affects the property?
F5. Is the property located in a federal or other designated flood hazard zone?
F6. Has the property experienced damage due to flooding, water seepage, or pooled water attributable to a natural event such as heavy rainfall, coastal storm surge, tidal inundation, or river overflow?
F7. Have you ever filed a claim for flood damage to the property with any insurance provider, including the National Flood Insurance Program?
F8. Is there a current flood insurance policy covering the property?
F9. Have you received assistance from FEMA, U.S. Small Business Administration, or any other federal disaster flood assistance for flood damage to the property?
F10. Is there a flood or FEMA elevation certificate for the property?

NOTE: An existing flood insurance policy may be assignable to a buyer at a lesser premium than a new policy. For properties that have received disaster assistance, the requirement to obtain flood insurance passes down to all future owners. Failure to obtain flood insurance can result in an owner being ineligible for future assistance.
Explanations for questions in Section F (identify the specific question for each explanation):
SECTION G

MISCELLANEOUS

G1-G3 Required *

	Yes	No	NR
G1. Is the property subject to any lawsuits, foreclosures, bankruptcy, judgments, tax liens, proposed assessments, mechanics' liens, materialmens' liens, or notices from any governmental agency that could affect title to the property?
G2. Is the property subject to a lease or rental agreement?
G3. Is the property subject to covenants, conditions, or restrictions or to governing documents separate from an owners' association that impose various mandatory covenants, conditions, and or restrictions upon the lot or unit?

Explanations for questions in Section G (identify the specific question for each explanation):
Owners Initials Acknowledging Pg 5*

Clear
Owners Initials Acknowledging Pg 5

Clear
SECTION H.

OWNERS' ASSOCIATION DISCLOSURE

If you answer 'Yes' to question H1, you must complete the remaining questions in Section H. If you answered 'No' or 'No Representation' to question H1, you do not need to answer the remaining questions in Section H.
H1. Is the property subject to regulation by one or more owners' association(s) including, but not limited to, obligations to pay regular assessments or dues and special assessments? If "yes," please provide the information requested below as to each owners' association to which the property is subject [insert N/A into any blank that does not apply]:*

YesNoNR
a. (specify name) whose regular assessments ("dues") are $ per       The name, address, telephone number, and website of the president of the owners' association or the association manager are:
b. (specify name) whose regular assessments ("dues") are $ per       The name, address, telephone number, and website of the president of the owners' association or the association manager are:
c. Are there any changes to dues, fees, or special assessment which have been duly approved and to which the lot is subject? If "yes," state the nature and amount of the dues, fees, or special assessments to which the property is subject:
H2. Is there any fee charged by the association or by the association's management company in connection with the conveyance or transfer of the lot or property to a new owner?

YesNoNR
If H2 is "Yes" state the amount of the fees
H3. Is there any unsatisfied judgment against, pending lawsuit, or existing or alleged violation of the association's governing documents involving the property? If "yes," state the nature of each pending lawsuit, unsatisfied judgment, or existing or alleged violation:

YesNoNR
If H3 is "Yes" state the nature of each pending lawsuit unsatisfied judgment or existing or alleged violation
H4. Is there any unsatisfied judgment or pending lawsuits against the association?

YesNoNR
If "yes," state the nature of each unsatisfied judgment or pending lawsuit:
Explanations for questions in Section H (identify the specific question for each explanation):
Owner(s) acknowledge(s) having reviewed this Disclosure Statement before signing and that all information is true and correct to the best of their knowledge as of the date signed.
Owner Signature*

Clear
Date*

MonthDayYear
Date
Owner Signature

Clear
Date

MonthDayYear
Date
Buyers(s) acknowledge(s) receipt of a copy of this Disclosure Statement and that they have reviewed it before signing.
Should be Empty:

SECTION B. HVAC/ELECTRICAL