RESIDENTIAL PROPERTY CONDITION DISCLOSURE REPORT
Seller’s Name: ________________________________
Property Address: ________________________________________
The Uniform Property Condition Disclosure Act (Public Act No. 95-311) requires the seller of residential property to provide this disclosure to the prospective purchaser prior to the prospective purchaser’s execution of any binder, contract to purchase, option or lease containing a purchase option. These provisions apply to the transfer of residential real property of four dwelling units or less made with or without the assistance of a licensed broker or salesperson. The seller will be required to credit the purchaser with the sum of $300.00 at closing if the seller fails to furnish this report as required by this act.
Please note that Connecticut law requires the owner of any dwelling in which children under the age of 6 reside to abate or manage materials containing toxic levels of lead.
I. SELLERS’ CERTIFICATION
Pursuant to the Uniform Property Condition Disclosure Act, the seller is obligated to disclose here any knowledge of any problem regarding the following:
I. GENERAL INFORMATION | |||||||
1. How long have you occupied the property? Age of structure | |||||||
2. Does anybody other than yourself have any right to use any part of your property, or does anybody else claim to own any part of your property? | Yes | No | Unknown | ||||
If yes, explain | |||||||
3. Is the property in a flood plain area or an area containing wetlands? | Yes | No | Unknown | ||||
II. SYSTEM/UTILITIES | |||||||
4. Heating system problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
a. Heating System and Fuel Type | |||||||
b. Is there an underground fuel tank? | Yes | No | Unknown | ||||
If yes, location and age | |||||||
5. Hot water heater problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
Type of hot water heater | |||||||
Age | |||||||
6. Plumbing system problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
7. Sewage system problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
a. Type of sewage disposal system (central sewer, septic, cesspool, etc.) | |||||||
b. If private: (a) Name of service company (b) Date last pumped frequency | |||||||
8. Air conditioning problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
Air Conditioning Type | Central | Window | Other | ||||
9. Electrical system problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
10. Drinking water problems? | Yes | No | Unknown | ||||
If yes, quality or quantity?Explain | |||||||
11. Electronic Security System Problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
12. Carbon monoxide or smoke detector problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
13. Fire sprinkler system problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
III. BUILDING/STRUCTURE/IMPROVEMENTS | |||||||
14. Foundations/slab problems/settling? | Yes | No | Unknown | ||||
If yes, explain | |||||||
15. Basement Water/Seepage/Damage? | Yes | No | Unknown | ||||
If yes explain:(a) Amount (b) Frequency (c) Location | |||||||
16. Sump Pump Problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
17. Roof leaks, problems? | Yes | No | Unknown | ||||
If yes:(a) Roof type (b) Age | |||||||
18. Interior walls/ceiling problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
19. Exterior siding problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
20. Floor problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
21. Chimney/fireplace/wood or coal stove problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
22. Any knowledge of fire/smoke damage? | Yes | No | Unknown | ||||
If yes, explain | |||||||
If made of wood, is wood treated or untreated? | |||||||
23. Patio/deck problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
24. Driveway problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
25. Termite/insect/rodent/pest infestation problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
26. Is house insulated? | Yes | No | Unknown | ||||
If yes:(a) Type (b) Location | |||||||
27. Rot and water damage problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
28. Water drainage problems? | Yes | No | Unknown | ||||
If yes, explain | |||||||
29. Are asbestos containing insulation or building materials present? | Yes | No | Unknown | ||||
If yes, location | |||||||
30. Is lead paint present? | Yes | No | Unknown | ||||
If yes, explain | |||||||
31. Is lead plumbing present? | Yes | No | Unknown | ||||
If yes, location | |||||||
32. Has test for radon been done? | Yes | No | Unknown | ||||
If yes, attach copy. | |||||||
State whether a radon control system is in place | Yes | No | Unknown | ||||
The Seller should use this area to further explain any item above. Attach additional pages if necessary and indicate here the number of additional pages attached.
_______________________________________________________
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I. Seller’s Certification
To the extent of the Seller(s) knowledge as a property owner, the Seller acknowledges that the information contained above is true and accurate for those areas of the property listed. In the event a real estate broker or salesperson is utilized, the Seller authorizes the brokers or salespersons to provide the above information to prospective buyers, selling agents or buyer’s agents.
DATE ____________________
SELLER_________________ SELLER _____________________
Signature (Type or Print) _________________________________
DATE ____________________
SELLER_________________ SELLER _____________________
Signature (Type or Print) _________________________________
II. Responsibilities of Real Estate Brokers
This report in no way relieves a real estate broker of his or her obligation under the provisions of Section 20-328-5a of the Regulations of Connecticut State Agencies to disclose any material facts. Failure to do so could result in punitive action taken against the broker, such as fines, suspension or revocation of license.
III. Statements Not to Constitute a Warranty
Any representations made by the seller on this report shall not constitute a warranty to the buyer.
IV. Nature of Disclosure Report
This residential disclosure report is not a substitute for inspections, tests, and other methods of determining the physical condition of the property.
V. Buyer’s Certification
The Buyer is urged to carefully inspect the property and, if desired, to have the property inspected by an expert. The Buyer understands that there are areas of the property for which the Seller has no knowledge and this disclosure statement does not encompass those areas. The Buyer also acknowledges that the Buyer has read and received a signed copy of this statement from the Seller or Seller’s agent.
DATE ____________________
BUYER____________________ BUYER ______________________
Signature (Type or Print) __________________________________
DATE ________________________
BUYER_____________________ BUYER _____________________
Signature (Type or Print) __________________________________
State Specific Real Estate Forms
–For State Specific Real Estate Forms you can download in Word format, go to http://www.uslegalforms.com/realestate/