Maryland Residential Disclosure Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you owned the property?
*
Property System: Water, Sewage, Heating & Air Conditioning (Answer ALL the apply)
Water Supply
*
Public
Well
Other
Sewage Disposal
*
Public
Septic
Other
Septic system approved for _____(# of bedrooms)
*
Garbage Disposal
*
Yes
No
Dishwasher
*
Yes
No
Heating
*
Oil
Natural Gas
Electric
Heat Pump
Other
Age of Heating System
*
Air Conditioning
*
Oil
Natural Gas
Electric
Heat Pump
Other
Age of Air Conditioning System
*
Hot Water
*
Oil
Natural Gas
Electric
Other
Electric Capacity
*
Age of Electric System
*
Please indicate your actual knowledge with respect to the following:
1. Foundation: Any settlement or other problems?
*
Yes
No
Unknown
Comments about the Foundation
2. Basement: Any leaks or evidence of moisture?
*
Yes
No
Unknown
Does not apply
Comments about the Basement
3. Roof: Any leaks or evidence of moisture?
*
Yes
No
Unknown
Type of Roof? (ex. slate, asphalt shingle, composite shingle, etc)
*
Age of Roof
*
Comments about the Roof
Roof: Is there any existing fire retardant treated plywood?
*
Yes
No
Unknown
Comments about existing fire retardant treated plywood
4. Other Structural Systems, including exterior walls and floors: Any defects (structural or otherwise)?
*
Yes
No
Unknown
Comments about structural systems, including exterior walls and floors
5. Plumbing System: Is the system in operating condition?
*
Yes
No
Unknown
Comments about plumbing system
6. Heating Systems: Is heat supplied to all finished rooms?
*
Yes
No
Unknown
Is the heating system in operating conditon?
Yes
No
Unknown
Comments about Heating Systems
7. Air Conditioning System: Is cooling supplied to all finished rooms?
*
Yes
No
Unknown
Does not apply
Comments about Air Conditioning Systems
Is the Air Conditioning system in operating condition?
*
Yes
No
Unknown
Does not apply
Comments about Air Conditioning operating condition
8. Will the smoke alarms provide an alarm in the event of a power outage?
*
Yes
No
Are the smoke alarms over 10 years old?
*
Yes
No
If the smoke alarms are battery operated, are they sealed, tamper resistant units incorporating a silence/hush button, which use long-life batteries as required in all Maryland homes by 2018?
*
Yes
No
Comments about smoke alarms
9. Septic Systems: Is the septic system functioning properly?
*
Yes
No
Unknown
Does not apply
When was the septic system last pumped? (supply approximate date if known)
Comments about septic system
10. Water Supply: Any problem with water supply?
*
Yes
No
Unknown
Comments about Water Supply
Home water treatment system:
*
Yes
No
Unknown
Comments about home water treatment system
Fire sprinkler system:
*
Yes
No
Unknown
Does Not Apply
Comments about fire sprinkler system
Are the water systems in operating condition?
*
Yes
No
Unknown
Does Not Apply
Comments about water systems
11. Insulation in exterior walls?
*
Yes
No
Unknown
11. Insulation in ceiling/attic?
*
Yes
No
Unknown
11. Insulation in any other areas?
*
Yes
No
Where is the additional insulation located?
*
Comments about insulation
12. Exterior Drainage: Does water stand on the property for more than 24 hours after a heavy rain?
*
Yes
No
Unknown
Comments about exterior drainage
Are gutters and downspouts in good repair?
*
Yes
No
Unknown
Comments about gutters and downspouts
13. Wood-Destroying Insects (WDI): Any infestation and/or prior damage?
*
Yes
No
Unknown
Any WDI treatments or repairs?
*
Yes
No
Unknown
Any WDI warranties?
*
Yes
No
Unknown
Comments about wood destroying insects
14. Are there any hazardous or regulated materials (including, but not limited to, licensed landfills, asbestos, radon gas, lead-based paint, underground storage tanks, or other contamination) on the property?
*
Yes
No
Unknown
If yes, specify:
*
15. If property relies on the combustion of fossil fuel for heat, ventilation, hot water, or clothes dryer operation, is a carbon monoxide alarm installed in the property?
*
Yes
No
Unknown
Comments about carbon monoxide alarm
16. Are there any zoning violations, nonconforming uses, violation of building restrictions or setback requirements or any recorded or unrecorded easement, except for utilities, o or affecting the property?
*
Yes
No
Unknown
If yes, specify below
*
16A. If you or a contractor have made improvements to the property were the required permits pulled from the county or local permitting office?
*
Yes
No
Does Not Apply
Unknown
Comments about permits
17. Is the property located in a flood zone, conservation area, wetland area, Chesapeake Bay critical area or Designated Historic District?
*
Yes
No
Unknown
If yes, specify below
18. Is the property subject to any restriction imposed by a Home Owners Association or any other type of community association?
*
Yes
No
Unknown
If yes, specify below
*
19. Are there any other material defects, including latent defects, affecting the physical condition of the property?
*
Yes
No
Unknown
If yes, specify below
*
I confirm the information contained herein is true, to the best of my knowledge
Yes
Submit
Should be Empty: