| 1. TITLE | |
| A. Do you have legal authority to sell the property? | Yes No |
| B. To your knowledge, is title to the property subject to any of the following: First right of refusal Option Lease or rental agreement Other listing Life Estate | Yes No |
| C. Are you aware of any encroachments, boundary agreements, boundary disputes or recent boundary changes? | Yes No |
| D. Are you aware of any rights of way, easements or licenses (access limitations) that may affect your interest in the property? | Yes No |
| E. Are you aware of any written agreements for joint maintenance of an easement or right | Yes No |
| F. Are you aware of any governmental study, survey or notices that would affect the property? | Yes No |
| G. Are you aware of any pending or existing assessments against the property? | Yes No |
| H. Are you aware of any zoning violations or nonconforming uses? | Yes No |
| I. Are you aware of a boundary survey for the property? | Yes No |
| J. Are you aware of any covenants, conditions or restrictions which affect the property? | Yes No |
| 2. WATER | |
| A. Household Water | |
| i. The source of the water is: Public Community Private Shared | Yes No |
| ii. Water source information: | |
| a. Are you aware of any written agreements for shared water source? | Yes No |
| b. To your knowledge, is there an easement (recorded or unrecorded) for access to and/or maintenance of the water source? | Yes No |
| c. Are any known problems or repairs needed? | Yes No |
| iii. Are you aware of any water treatment systems for the property? Leased Owned | Yes No |
| B. Irrigation | Yes No |
| i. Are you aware of any water rights for the property? | Yes No |
| ii. *If there exist any, to your knowledge, have the water rights been used during the last five-year period? | Yes No |
| iii. *If so, is the certificate available? | Yes No |
| C. Outdoor Sprinkler system | Yes No |
| i. To your knowledge, is there an outdoor sprinkler system for the property? | Yes No |
| ii. To your knowledge, has a back flow valve been installed? | Yes No |
| iii. To your knowledge, is the outdoor sprinkler system operable? | Yes No |
| 3. SEWAGE | |
| A. To your knowledge, is the property connected to a sanitary sewer? | Yes No |
| B. Are you aware of any sanitary sewer proposed for the property? | Yes No |
| C. To your knowledge, is the property connected to a septic system or cesspool? | Yes No |
| D. Are you aware of any problems or repairs needed? | Yes No |
| E. To your knowledge, does your sewage system require on-site pumping to another level? | Yes No |
| 4. INSULATION | |
| A. To your knowledge, is there insulation in the: | Yes No |
| i. Ceiling? | Yes No |
| ii. Exterior walls? | Yes No |
| iii. Floors? | Yes No |
| B. To your knowledge, are there any defective insulated windows? | Yes No |
| 5. STRUCTURAL | |
| A. To your knowledge, has the roof leaked? | Yes No |
| If yes, has it been repaired? | Yes No |
| B. Additions/conversions/ remodeling? | Yes No |
| *If yes, are you aware of whether a building permit was obtained? | Yes No |
| Was final inspection obtained? | Yes No |
| C. To your knowledge, are there smoke alarms? | Yes No |
| D. To your knowledge, is there a woodstove? Make______ | Yes No |
| Was it installed with a permit? | Yes No |
| E. Are you aware of whether a pest or dry rot, structural or "whole house" inspection has been done? | Yes No |
| F. Are you aware of any moisture problems in the structure (especially in the basement)? | Yes No |
| If yes, explain frequency and extent of problem on attached sheet | Yes No |
| G. Are you aware of a sump pump on the property? | Yes No |
| 6. SYSTEMS AND FIXTURES | |
| If the following systems or fixtures are included in the purchase price, are they, to your knowledge, in good working order on the date this form is signed? | |
| A. Electrical system, including wiring, switches, outlets and service | Yes No |
| B. Plumbing system, including pipes, faucets, fixtures and toilets | Yes No |
| C. Hot water tank | Yes No |
| D. Garbage disposal | Yes No |
| E. Built-in range and oven | Yes No |
| F. Built-in dishwasher | Yes No |
| G. Sump pump | Yes No |
| H. Heating and cooling systems | Yes No |
| I. Security system Leased Owned | Yes No |
| 7. COMMON INTEREST | |
| A. Home Owners' Association? | Yes No |
| B. Regular periodic assessments: $_______ per Month Year Other _____ | Yes No |
| C. Are you aware of any pending special assessments? | Yes No |
| D. Are you aware of any shared "common areas" or any joint maintenance agreements (facilities such as walls, fences, pools, tennis courts, walkways or other areas co-owned in undivided interest with others)? | Yes No |
| 8. GENERAL | |
| A. Are you aware of any settling, soil, standing water or drainage problems on the property or in the immediate area? | Yes No |
| B. To your knowledge, does the property contain fill? | Yes No |
| C. Are you aware of any material damage to the property or any of the structure from fire, wind, floods, beach movements, earthquake, expansive soils or landslides? | Yes No |
| D. To your knowledge, is the property in a designated flood plain? | Yes No |
| E. To your knowledge, is the property in a designated slide zone? | Yes No |
| F. Are you aware of any substances, materials or products that may be an environmental hazard such as, but not limited to, asbestos, formaldehyde, radon gas, lead-based paint, mold, fuel or chemical storage tanks, and contaminated soil or water on the subject property? | Yes No |
| G. Has any portion of the subject property been tested or treated for asbestos, formaldehyde, radon gas, lead-based paint, mold, fuel or chemical storage tanks, or contaminated soil or water? | Yes No |
| H. Are you aware of any tanks or underground storage tanks (e.g., septic, chemical, fuel, etc.) on the property? | Yes No |
| I. To your knowledge, has the property ever been used as an illegal drug manufacturing site? | Yes No |
| J. Has anyone experienced long-term respiratory problems, headaches, fatigue, weakness, memory problems, unusual bleeding or other symptoms while residing on the property? | Yes No |
| 9. FULL DISCLOSURE BY SELLERS | |
| A. Are you aware of any other material defects affecting this property or its value that a prospective buyer should know about? | Yes No |