Home Sale Worksheet

Home Sale Form

Owner's Name: _____________________ Date: _______________

Owner is (is not) occupying the property. If owner is occupying the property since what date __________.

This form is a representation of a disclosure statement required by law in certain states. The information contained within is provided by the owner exclusively to potential purchasers in a transfer made by the owner, and is not made to purchasers in any subsequent transfers. This in no way limits 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.

Water Supply

Public Water Service: [ ]
Private Water Service: [ ]
Well: [ ]
Holding Tank: [ ]
Cistern: [ ]
Spring: [ ]
Pond: [ ]
Unknown: [ ]
Other: [ ]_________________________________

1. Are there any existing problems with the water supply such as leaks, backups, or other problems?

If so, please describe the circumstances.

2. Are there any existing problems or has there ever been any problems with the quality of the water?

If so, please describe the circumstances.

Sewer System

Public Sewer Service [ ]
Private Sewer [ ]
Septic Tank [ ]
Leach Field [ ]
Aeration Tank [ ]
Filtration Bed [ ]
Unknown [ ]
Other [ ]________________________________

1. If the sanitary sewer system is other than public or private sewer, when was it last inspected?

2. Are there any existing problems with the sanitary sewer such as leaks, backups or other problems?

If so, please describe the circumstances.

Roof

1. Are there any known leaks or other material problems with the roof or rain gutters?

If so, please describe the nature of the problem.

2. Have there been any repairs completed on the roof and/or gutters since owning the property?

If so, please describe the nature of repairs.

Basement or Crawl Space

1. Are there any known leaks, water accumulation, excess dampness or other defects with the basement or crawl space?

If so, please describe the nature of the problem.

2. Have there been any repairs, alterations or modifications to the property or other attempts to control any water or dampness problems in the basement or crawl space since owning the property. Please include the dates.

If so, please describe the nature of any work done.

Structural Components

1. Has there been any movement, shifting, cracks, deterioration or other material problems with the foundation, floors, or interior/exterior walls?

If so, please describe the nature of structural problems.

2. Has there been any repairs, alterations or modifications to control the cause or effect of any structural problem since owning the property. Please include the dates.

If so, please describe the nature of any work done.

Mechanical Components

1. Please indicate which of the following amenities exist on the property.

central heating [ ]
air conditioning [ ]
sump pump [ ]
fireplace/chimney [ ]
lawn sprinkler [ ]
water softener [ ]
security system [ ]
central vacuum [ ]
other [ ]

2. Are you aware of any existing problems or defects with any of the amenities checked above?

If so, please describe the nature of the problem.

3. Are you aware of any existing problems or defects with the electrical system?

If so, please describe the nature of the problem.

4. Are you aware of any existing problems or defects with the plumbing?

If so, please describe the nature of the problem.

Wood Boring Insects/Termites

1. Are you aware of any existing problems with infestation (such as termites or other wood boring insects?

If so, please describe the nature of the problem.

2. Are you aware of any existing damage due to problems caused by wood boring insects/termites?

If so, please describe the nature of any damages.

3. Are you aware of any inspection or treatment for infestation since owning the property?

If so, please describe the details surrounding any inspection or treatment.

Presence of Hazardous Materials

1. Are you aware of the presence of any hazardous materials, including but not limited to those mentioned below?

Lead-Based Paint [ ]
Asbestos [ ]
Urea-Formaldehyde Foam Insulation [ ]
Radon Gas [ ]
Other toxic substance [ ]

If so, please describe in detail.

2. Has there been any inspection or treatment for any hazardous materials since owning the property?

If so, please describe in detail the circumstances surrounding any inspection and/or treatment rendered.

Drainage

1. Are you aware of any drainage problems affecting the property such as flooding, insufficient drainage, settling, grading problems, etc.?

If so, please describe the nature of any problem.

2. Has there been any repairs, modifications or alterations to the property or other attempts to control any flooding, drainage, settling or grading problems since owning the property.

If so, please describe the circumstances.

Code Violations

1. Have you been notified of any building or housing code violations on the property?

If so, please describe in detail.

Underground Storage Tanks/Wells

1. Do you know of any underground storage tanks, oil or natural gas wells (plugged or unplugged), or abandoned water wells on the property?

If so, please describe.

Other Known Material Defects

1. Are you aware of any existing material defects not specifically addressed above that would be dangerous to any occupants or the actual use of the property itself?

If so, please describe the nature of any defects in detail.

Important Notice: This document and information is provided to assist and educate you regarding personal legal matters. Your use of this material does not create an attorney-client relationship with Court TV or OverDrive Systems, Inc. Be aware that procedures and laws vary from state to state and may change. You are advised to seek the advice of an attorney regarding any issues or questions you have regarding your own personal situation. Neither OverDrive Systems, Inc., nor Court TV represent or warrant that the document you create using any of this material will lead to the result you desire and therefore are not responsible for any liability for your use of this material.