Seller's Disclosure Statement for Residential Property
Reference{e.9.,Seller& PrcWty)
Jungles1727
f;
AssocrArroN oFREALToRS'
lE)*
Seller'sDisclosureStatementfor ResidentialProperty 'Propertyf): No/e: The lollowing is a di*fo,vllre staf'ment nnde by Sdler concuning he followirlg Property (the 65324 Carnden 1727tullinqer CreekRd. =-Vp@_--6aT =-ffi-MO r.his disclosrrre statement may assr'sta Buyer in evaluating the Propcrfi, but it is not a varnnty of any kind by Setler or any broker or license in this transaction, and is not a substifl,tte fo1 any inspection or warranties a Buyer nny wisn to obtain. Real estate brokerc and licenws involved in the sa,ledo not insp*tthe Propertyfor efuc6ts oi guara,ntenilre accura,cyof flre information prwidd in thisform. TO THE SELLER: Please complete the following form, irrcluding or,st history or prcblems_if knwn. tlo not lave (orlfrffifrf,|ifi unklnowir),martr'MA' rnark'MA' (orliEEnEf,ITln Prcfrrty (or applkible a'wur to'wur prcidrtv any soices nnnt. tt {tte conAfuon is not ipptiiote @r unklnowh), brokeror repre*ntataonsof ol any any brofter are not not rcpre*ntatrbni madeliy 6vthe the Siller aid ete e*ntaii6ns ltr'onsmade Sellerand Tlollowin g are repre*nta disclosure of the history and condition of the Property gives you tDe Dest nplete and truthful disclo licensee. Complete answerc or tDe Buyei. Your answ protecti o n again st ffuture utu re charges that you violated a lqal-disclosure obligation to a Buyer. of 9g Are 4!e. sate. This rhp the-closing,of provide, either way, may have iqal consequences, consequ-ences,even after flrc-ctosrng bnsrrers you fail to>provi&, your disclosurc th9 Prcperty. you nrc€l not covq al, all aspects aspects ot of are-FroFny. guedionnaire queAionnaire should irclp nrcet ynur disclosurc ouigations, obligations, but it may notcover lrclp you Prooertv or-impair or impair the tf wu vou know of ol or suspeit susoeLt-sonrc mav negatively nsativelv atfect altect the value of the Property sonrc coidition which may it phFical condition or material defrcfs defrcts in the environnentalhaards, physicpl occupants (e.9., environmentalhaards, hdatth or safety of fuiure occupanb h6atth t:hespace the end of this form to furlher de*ribe that condition may-use use ure space at me then you nay tirte uereto), thereto), urcn Propefty PrcWrty or uue
andlu atach a&itional page if adclitionalspaceis rcquircd.
TO THE BIIYER: Srnce tDese disr,lreures are based on ilre Selle/s knowledge, Wu cantlpl M surc that tircre are, tDe Seller rb not aurareol them. IDe ansrerc given by the in fact, no problems with the Prcpfty simply b*au* Thus, Wu may want to condition your offer on a of the Prcperty. of the condition warranties Seller are not professional inspection(s) of the Property. You may also wislr to obhin a home protection planlwananty. Conditions of the Property that you can see on e neasonable inspction andlorthat are disclosed herein should either be faken into account in lhe purchase price or you sltould make the cortution of these conditions by the Seller a requirement of the sale contract. lF YOU S,GN A SALE CONTRACTTO PURCHASETHE PROPERIff., THAT CONTRACT,AND NOT THISD'SCIOSURE STATENENT,NflLL PROWDEIOR WHAT'S TO BE 'NCLUDED IN THE SAT.E.'F YOII EXPECTCERTAIN/,TENS,APPLANCES OR EQU'PHENTTO BE 'NCLUDED,THEY HIIST AS INCLUDEDIN THE SAIE CONTRACT. BE SPECIF//ED 1. HEAflNG, COOUNG ANDVENflLAIII\IG (Sate Cont*twill
con'4ol as to itenls ecfriatty included in sale)
P/easeexplainany 'yes" pnliler Wu glve in fhis ecfoA includingrepair history(attach additional pqes if neruded): _
0i lD pv6rp .,2. brrT nrY lYUtl L lrp
ttsc{uto
I Unknoun.
kgelof6
Merence (e.9, Sdler & Propeny)
Junoles1727
system?n YesAftg (d)Areyouau€reof anypmblemsor repdrsneededin theelec*rical Plea* explainany "yes" answeryou gave in this er,tr;'4 irduding repair history@tF,chffiitional pagesif reededj .
(Sale Contactwilt control asto ifelmsactually ircluded in sale) 3. APPLIANCESTFIXTURESTEQUIPMENT good unrking order: not in are/are The items belour ARE ARE N'A ARE ARE N'A NOT
Fences(includingpet systems, collarsand confols) Doors(if attached,including
P/easeexplainany "ArcNot' rcspones(affacf additionalpges if nrcssa,ry}
4, ROOF,GUTTERSAND DOWNSFOUTS t, | / t'f Years.Documented?B Yes f] hlo (a) What is the approximateage of the roof? @)Has the roof ever leakedduringlrourownership?[YesEfNo Pease explainany "yes"an$yels Wu gave in this *ction, induding repair hi#ory @ttachadditionalpryes if ne*d). (c) Has the roof or any portionof it beenrepaired,recoveredor replacedduringyoyr oumership?IYes (d) Are you auare of any problemswith the roof, gutbrs or dournspouts? [Yes f]],lo
EFlo
"yes"anflvel Ptege,gxOlaiqany rpu gavein thiswtbn, indudingrcpairhistory(afrach&ditional pagesit nffi)
:
5. PLUMBINGSYSTEM,FIXTURESAND EQUIPMENT (a) Pfr.rnbingSystem:dCWWr flGalvanized I Other:
,
DGa-s deectic Eother: iui waerHdat6r:
U u l,lo (c) Hot tuM/Vhirlpooll.)asnA?lYesfl !Yesp "yes", "yed', dateof la$ backflowdeviceinspectionor gertificab:(d) Lamr Lam SprinklerSystem:nYes pfNo [Unknonn. ffNo lf (ei Are you ar €re olany problemsor repairsneededin the plumbingsystems?[ Yes E ilo it needed.):fTease expbinany "yes" anstteryou gave in his wtbn, irdudirg rcpair hidory (attachafri(nnal oe1ges
osc{ooo
Page2 of6
Reference fe.g, Seller{3Prorynfl 6, WATER
Jungles 1727
(a)WaterSystenr9soure: I PublicfiifudlI Other:
lf \rell,' specifytype of well and aproximate providecopy tested?[ Yes M No lf \es,' idenb'ty rcsv$^blow or provide rrveffbeentested? rc,sylS^blow Has rrveff idenb'fydale exf,ain dateof 1epft qtd 44dexflain 'ves'.|4 Utvned Ownedff vorrhave a softener, soflener-filter filteroiother ou-rification wstem? lg'Yes ldYes Ll l-l No ff'yes',WOwned lflt'yes',l4 l-l -LeaseiJ LeasedJ / system? or other purificatim (b)Doyouhaveasoftener,filteroiotherpu-rificatimsystem? (b) Do you @Yes n [_Leased (cinre-you awareof any problemsrelatingto the watersystem,indudingqualityor sourceof watel?[ Yes ffl,lo Pleas exptainany "yes" answerWu gave in this *ction, includirE repair history@ftachdditional pagesif neded) : 7. SEWAGE (a) $rat is the type of serlragesystemto wttidt the houseis conneded? I RrblicI Rivate f(S"f,"nAenator fll tgnks/lateralJdrainfi eldsI Other] good Yes No
uorkingcondition?fl lift systemTfl Yes d fto F !es," is it in I @)IGtherea seu,age (c)Whenwastheseptic/aerator systemlastserviced? dDog . .= ., ioiar" youarmreof'anyleaks,odcrupsor otherproue Plea* explainany "yes"answeryougavein f/r.ssecfon,includingrcpair history@ttdt ffiitional pryesif nedd) :
8. CONSTRUCTION (a) Are you awareof any problemswith the footings,foundation,s.rb-floor,interioror exteriorwalls,roof consiruclion, or other load bearingor slructuralcomponents?! Yes SNo decks/porcfres J (b) Are you awareof any repairsor replacementsrelatingto any items li3tedin (a) above?[Yes g ]lo Ptea* explain any "yesoansweryou gave in f/ra secfion,includingrepair history@ftdr dditional pqes if need&) :
9. EXTERIORFINISH (a)ls an exterior finish and insulation system (EFIS - syntheticstucco) presentin the home? !Yes Eunknorrrm.ldentifydate installed,brandnameand installer,if knorm: (b) Are you auare of any hardboardsidirp on your Propefi? MYes E No lf 'y6,'whidt Upe? ,A+k for defectsin the siding?flYes M No (c) Are you awareof any claimsmadeagaind the me9uFaclurer (d) Was arrymoneyreceivedfor the daim? LlYes M f.lo (e) Are you awareof any repairsor replaements madeto the exteriorfinistr?[Yes n/nfo Plea* explainany "yes"answeryou gave in thb *ction, indudirg rcpah history@ftach#itional pagesif rcded)
./ EfNo
10. BASEMENTAND CRAWLSPACE / (a) Are you au6re of any dampness,water leakageor acormulation,in the basementor cravyl_space?tr Yes Ef No 1ninre iou auare of any repairsor other attemptsto controlany water or dampnessproblems?[Yes pp,lo "yes" ansfler fzease expldn any Wu gave in this*ction, indudirp rcpair history@ttachdclitional pagesif rc&ed)
DESTROYINGINSECTS,PESTS 11. TERIIIITESi'I'I'OOD -./ (a) Are you av\areof any termitesrhooddestroyinginsecls or pests affectng the PropertyZ^[V,qs I5_y-9 ini nre iou anare of anv unconecteddamaoeto the Propertycausedby any of the above?U Yes MIlo contractby-apest contnil company?D Ves E No lf !es", traytsfenable?[ Yes tci ts pioperty undera raaarnanty iO)nre ydu aimre of any termilb/pestcontrol reportsfor or treatnent of the Property? [ Yes El No Pteaseexptainany "yes' answeryou gave in this section,induding repair history@ttachadditional pagesif neded)
/ 12.SOL AND DRAINAGE Ga)Are Vouaraie of anyfill, elpansive soil or sinkholeson the Prope4 ? ! Yes g!9,/ of any soil, earthmovement,flood, drainageor gradingproblems?ZYes n No hi nre irou ar,nare DSC{tno
Prge3 of6
Referehce (eg., Sellu APrcperfi)
-lunoles 1727
(c) Are you awareof any past, plesent or proposedmining, stripmining, or any other excavationsthat affect or might affed the Property?[Yes E Nlo includiry repair history(attachaffiitional pagesif rreded) Pleaw explainany "yes'anweryar gave in this
R ENVIRONMENTALCONCERNS 13. HAZARDOUSSUBSTANGES/OTHE (a) Lead (1) Are you aware of the presenceof any lead hazards (e.g-, paint, water supply lines, etc.) on the Property? fl Yes I No (Note: Produc:tionof lead 0ased paint was bannedin 1978. fiAR Form DSC-?UDmay necd to be -omplefid in ann*tion wiilr this form). (2) Are you awareof the presenceof any iead in the soils? [ Yes gfNo (3) Are you awareif lead has ever beencoveredor removed?[ Yes [ZNo (4) Are you awareif the Propertyhas beentestedfor lead? 3 Yes /No (b) AsbestosMaterials (1) Are you awareof the presenceof asbestoTmaterialson the Property,such as roof shingles,siding,insulation, ceiling,flooring,pipe wp, etc.?a Yes g[]lo ,/ (2) Are you €n^areof any asbestosmaterialthat has beenencapsulatedor removed? [ Yep []lo (3) Are you awareif the Propertyhas beentestedfor the presenceof asbestos?n Yes VlNlo (c) Mold (1) Are you €rwareof the presenceof any mold on the Propeffi [ Yes g']tl" (2) Are you EMrare if anythingwith mold on the Prope$ has ever been coveredor removed?,I Yes (3) Are you €rwareif the Propertyhas ever beentes{edfor the presen@of mold?5 Yes pf ff (4) Are you awareif the Propertyhas ever beentreatedfor the presenceof mold? f] Yes gtlo (d) Radon (1) Are you awareif the Propertyhas been testedfor radongas? l Ves fllfo (2) Are you aurareif the Propertyhas ever beentreatedor mitigatedfor radongas? D Yes
elrc
gfr'r"
(e) Methamphetamine Are you awareif the Propertyis or was used as a site for methamphetamineproduc{ionor the plae of residenceof a petsonconvided of a crime involvingany ontrolled substancerelatedthereto? 'yes,' MAR Form DSC-$0olO must befilled out in conjunction with thisform. fJ Yes E No lf (f) OtherEnvironmential Conems Are you itvvareof any other environmentalcon@ms that may affecl the Propertysucfi as polychlorinatedbiphenyls (PCB's),eledro-magneticfields (EMF's),undergrcundfuel tanks, discolorationof soil or vegetation,oil sheensin wet usesof the Propeftyotherthan residential(e.9.,commercial,farming,landfill, areas,unusedsepticor storageTtanks, dumpingsite),etc.?n Yes E^lo Pleaseexplain any "yes" answer you gave in fDissecfion, including rcpair history,date(s) performed,type af fesfs or treatmentand results,and name of person/ampany who did the testingor mitigation(attach additional pagesif neded):
14.INSURANCE (4 16\re tot;ware of anyclaimsthathavebeenfiledfor damagesto the Propertyin the last5 years?n Yes glno t "yes," pleaseexplainand includethe following.Dateof claim,descriptionof claim, repairsand/or rcplaements nmfle@: (b) Are you awarethat any insuranceppplicationor prior coverageregardingany part of the Propertyhas been rejected orwill not be renevrred?DYesg/tlo / (c) Are you awarethat any existinginsurancecoveragewill be subjectedto increasedrates?n Yes p1'No 15. ROADS,STREETS& ALLEYS ./ (a) The roads,sheetsandloralleysservingthe Pmpertyare p[public npriyab? (b) ls there a reorded roadlsfeeUalleymaintenanceagreement?lYes Bfi,lo tlsc{mo
PagGf of6
(e.9, Sdler& PrWenfl Reference
Jungles 1727
(c) Are you aurareof any right of way, unrecordedea*mentorsimilarmatterwhichaffecttheProperty?W* M Uo Pleaseexplainany "yes" answeryou gave in thiss*tion, indudingrepairhistoryand identifymaintenaneprcviderand osts below (aftad affiitional pagesif needed) 16. MISCELLANEOUS ,-t. yeaq (a) ' ' The approximateage of the residenceis | y."o Seller'has beenthe-ownerof the Propertyfor ---l-Sellerhas ontinuously omrpied Qe Propertyfor Veans 5 lf ever vacant,whenand hor long? (b) ls the Prcpertylocatedin an area that requiresan occupancy( (c) ls the Propertydesignatedas a historicalhomeor locatedin a historicdasfict? flYes E/No (d) Do you have a surveythat includesallexisting improvernentson the Property?DYes g N o (e) Are you au€re of any pets ever havingbeen kept in the home at thefroperty? E Yes [] Flo (D Are you €il\rtreof any pets ever having been kept on the Property?M Yes tr lto (g) ls the Buyerbeingoffereda proteclionplan/homewarrantyat dosing at Selledsexpense?[Yes dr'n (h) Are you amrc of any: Inoperablewindows?E Yes ENo inoperabledoors? [Yes Eltlo f brokenthermalseals?flYes Efno / g) fs any portionof the Propertylocatedwithinthe 100yearflmd hazardarea (fJoodplain)? [Yes Ef trto (i) Are you aurareif carpethas been laid over a damageduroodflool? D Yes Eilo (k) Are you avlrareof any: / rrrells,set,rers,fences,roads,etc.)? ! Yes M trto Sharedor commonfeatureswith adjoiningpropertiet,(e.9.,rlrralls, wtricftaffectthe Property?DYes M m Encroachments t Existingor threatenedlegalactionaffectingthe Property?[ Yes M lto Molationsof local,state,-orfederatlawdregulations,induding zoning,relatingto the Property?n YFs E4to Additions,modifications,or alterationsmadeto the Propertywithoutnecessarypermits?f]Yes Eil,to Consentiequireclof anyoneotherthan the signe(s) of this form to conveytitle to the ProftrtyZ SVes U6fo (l) CurrentUtilityService. ElectrbCompany: Water Servie: CableService: Sewer: Tefephone: A+ n
Gas:
Gabage:_ Fire Disbict: Fire DuesPaidwitr Taxes? ([]p/ease markif additbnal pges are attrched): AdditionafCommentdExplanation
17.SUBDTVTSTON 1a;Name: N lA ( u ins s e s s m
Assessment: $ -per : E str eetm al
n month fl quarterI half-year - a tenni n iyear. c our t founnou5' tr poot
fl entrancesign/s{ructueI other commonfacility(ies): (c) Are you av€re of any existingor proposedspecialassessnents?[Yes nl.lo (e) Are llou .nyareof any violationof zuMivision restrictions,rulesor regulationsby yourselfor others?flYes nNo (d) Are you armre of any writtensubdivisionrestrictions,rules,or regulations?n Yes nNo (f) Are you au€re of any condition or claim whicfi may cause an increase in assesgnents or fees? [ Yes [No Pleaseexplain any *yes" answersyau gave in this *ction (aftach additional pagesif needed):
18.CONDOMINIUM, (a) Name: DSC{O00
(if applicable) OR SHAREDCOST DEVELOPITENT
PrgF5 ofo
(e.9,Sefler8PrWng Jungles172i Reference (explain): flCoOp I Otnersharedcostdevelopment O) TypeflCondonrinium per _tl monthn quarter[_half-year ! year(c) Assessment$ (01nssessrnentinauAe4cnxX attnat apptyl:fl water trcooting I heating [] sewer nhash removal Dsnov,r (numberlflgarage fl secudty remqralI doormanI streetmaintenance f] asdgnedparkingspace(s) pd building insunanceon realstatetaxesfl dubhouse[ landscaping fl tenniscourtI exercisearea tr I fl tacility: common other facility[ rrcption I (e) Exteriormaintenance:flfully coveredby assessrnent[ partlycoveredby assessnent.Area(s)exduded:
(f) Are )rou Eil/are of any existing or proposedspecial assesgnents?[ Yes f]],lo (g) Are you trwareof any materialdefeds in your buildingor other sharedelements?n Yesf] No (h) Are you ariare of any writtencondominium,co-opor other sharcdcost developmentagreernents,resfic{ions,rulesor regulations?[ Yes f] tlo (i) Are you ayrrare of any violationof any such restrictions,rulesor regulationsby yourselfor others?lYes n No yott of any conditfonor daim wfiicfi may causean increasein assessrnentsorfees? [ Yesn No auare Are O "yes" answerWu gave in this *ction (aftacfi adclitionalpqes it neded) Hease explain any
(SaleContract will contol as to items actually included in sale) 19. BOAT DOCKS, (a) Doesthe Propertyindude or availableto it any boat docks,slips,lifts or similarfeatures?[ Yes n No ,if appliable) lf yes,ch*kallthat apply:ndock ,if applicable) [seanall (Permit# other ,if appliable) Ifl dip (pennit# pleawfufthersrycifyit it or theyare lee,sed or othemise lf any of the above are checkedand arc notowned other such written agreement,if available,and also transferable.ff so, pleaseprovide a @py of the lease, identrfythe nameand availableantacl informationforthe actual
n year
per tl mmth !
(b)Assessment $
(c) Assessmentindudes (checkall that apply): IpermiB/licens fees lstorage
flinsunance[othec
Selle/s Acknowledgement Brokersare herebyauthorizedto distributethis informationto potentialbuyersfor this Property.Seller has carefully examinedthis statementand acknowledgesthat the informationcontainedabove is true and accurateto the best of Selter'sknowledge.Seller will fully and promptly disclose in writing to Buyer any new informationpertainingto the Propertythat is discoveredby or made known to Seller at any time prior to closingor settlementand constitutesan adversematerialfact or would make any existinginformationset forth hereinfalse or
Date Seller Buye/s Acknowledgement Buyer shouldverify informationcontainedin this disdosure statementand is urgedto caretutryinspectthe Propertyand, if desired,to have the Propertyinspec-tedby an independent,pro{essionalerpert(s). Buyer uhdeistandsthat ihere are areas of the Propertyof wtrichSeller may have no krcwledge and that this disriosre stalementdoes not encompassthose areasand is limited to informationof which Sellerhas knowledge.Buyeralso acknowledgeshaving receivedand read a signedcopy of this disclozurestatementfiom Seller or the listing brokerand that brokersand licenseesare not experts at deteding or repairing physical defeds in pmperty.
Buyer
Ilate
Buyer
Approred by legal counsel for use exclusively by rrcmbers of the ltfissouri Association of Redtors, Cdumtia, Missori. No.wananty is niiiG 61iiri*e6?s to tre hgal vdifty r a@Ecy of fias do{u.nent, a tril it csr1*es h wery reepect nffr f,re hur c ftd its useis 4ropriate br dl situalios. Local law, tuetoms and p6ctice, and Ctering circumstances in each fansaclim, may eac-hdictate lhat amendments b this document be made. O2003MissruriAssociatftxtof Redtors LretRwised 17g1l0g. Page6 of0
Company: Rovided by:
CokhrellBanker
S/N: PC.trs-1?O3g
t-ake Country hhtd
Eilg
SoftwG
from Prcfcrrionrl
tlotrp.tln
FmN
co- v. I 2r{)9
Jungles1727
f;
AssocrArroN oFREALToRS'
lE)*
Seller'sDisclosureStatementfor ResidentialProperty 'Propertyf): No/e: The lollowing is a di*fo,vllre staf'ment nnde by Sdler concuning he followirlg Property (the 65324 Carnden 1727tullinqer CreekRd. =-Vp@_--6aT =-ffi-MO r.his disclosrrre statement may assr'sta Buyer in evaluating the Propcrfi, but it is not a varnnty of any kind by Setler or any broker or license in this transaction, and is not a substifl,tte fo1 any inspection or warranties a Buyer nny wisn to obtain. Real estate brokerc and licenws involved in the sa,ledo not insp*tthe Propertyfor efuc6ts oi guara,ntenilre accura,cyof flre information prwidd in thisform. TO THE SELLER: Please complete the following form, irrcluding or,st history or prcblems_if knwn. tlo not lave (orlfrffifrf,|ifi unklnowir),martr'MA' rnark'MA' (orliEEnEf,ITln Prcfrrty (or applkible a'wur to'wur prcidrtv any soices nnnt. tt {tte conAfuon is not ipptiiote @r unklnowh), brokeror repre*ntataonsof ol any any brofter are not not rcpre*ntatrbni madeliy 6vthe the Siller aid ete e*ntaii6ns ltr'onsmade Sellerand Tlollowin g are repre*nta disclosure of the history and condition of the Property gives you tDe Dest nplete and truthful disclo licensee. Complete answerc or tDe Buyei. Your answ protecti o n again st ffuture utu re charges that you violated a lqal-disclosure obligation to a Buyer. of 9g Are 4!e. sate. This rhp the-closing,of provide, either way, may have iqal consequences, consequ-ences,even after flrc-ctosrng bnsrrers you fail to>provi&, your disclosurc th9 Prcperty. you nrc€l not covq al, all aspects aspects ot of are-FroFny. guedionnaire queAionnaire should irclp nrcet ynur disclosurc ouigations, obligations, but it may notcover lrclp you Prooertv or-impair or impair the tf wu vou know of ol or suspeit susoeLt-sonrc mav negatively nsativelv atfect altect the value of the Property sonrc coidition which may it phFical condition or material defrcfs defrcts in the environnentalhaards, physicpl occupants (e.9., environmentalhaards, hdatth or safety of fuiure occupanb h6atth t:hespace the end of this form to furlher de*ribe that condition may-use use ure space at me then you nay tirte uereto), thereto), urcn Propefty PrcWrty or uue
andlu atach a&itional page if adclitionalspaceis rcquircd.
TO THE BIIYER: Srnce tDese disr,lreures are based on ilre Selle/s knowledge, Wu cantlpl M surc that tircre are, tDe Seller rb not aurareol them. IDe ansrerc given by the in fact, no problems with the Prcpfty simply b*au* Thus, Wu may want to condition your offer on a of the Prcperty. of the condition warranties Seller are not professional inspection(s) of the Property. You may also wislr to obhin a home protection planlwananty. Conditions of the Property that you can see on e neasonable inspction andlorthat are disclosed herein should either be faken into account in lhe purchase price or you sltould make the cortution of these conditions by the Seller a requirement of the sale contract. lF YOU S,GN A SALE CONTRACTTO PURCHASETHE PROPERIff., THAT CONTRACT,AND NOT THISD'SCIOSURE STATENENT,NflLL PROWDEIOR WHAT'S TO BE 'NCLUDED IN THE SAT.E.'F YOII EXPECTCERTAIN/,TENS,APPLANCES OR EQU'PHENTTO BE 'NCLUDED,THEY HIIST AS INCLUDEDIN THE SAIE CONTRACT. BE SPECIF//ED 1. HEAflNG, COOUNG ANDVENflLAIII\IG (Sate Cont*twill
con'4ol as to itenls ecfriatty included in sale)
P/easeexplainany 'yes" pnliler Wu glve in fhis ecfoA includingrepair history(attach additional pqes if neruded): _
0i lD pv6rp .,2. brrT nrY lYUtl L lrp
ttsc{uto
I Unknoun.
kgelof6
Merence (e.9, Sdler & Propeny)
Junoles1727
system?n YesAftg (d)Areyouau€reof anypmblemsor repdrsneededin theelec*rical Plea* explainany "yes" answeryou gave in this er,tr;'4 irduding repair history@tF,chffiitional pagesif reededj .
(Sale Contactwilt control asto ifelmsactually ircluded in sale) 3. APPLIANCESTFIXTURESTEQUIPMENT good unrking order: not in are/are The items belour ARE ARE N'A ARE ARE N'A NOT
Fences(includingpet systems, collarsand confols) Doors(if attached,including
P/easeexplainany "ArcNot' rcspones(affacf additionalpges if nrcssa,ry}
4, ROOF,GUTTERSAND DOWNSFOUTS t, | / t'f Years.Documented?B Yes f] hlo (a) What is the approximateage of the roof? @)Has the roof ever leakedduringlrourownership?[YesEfNo Pease explainany "yes"an$yels Wu gave in this *ction, induding repair hi#ory @ttachadditionalpryes if ne*d). (c) Has the roof or any portionof it beenrepaired,recoveredor replacedduringyoyr oumership?IYes (d) Are you auare of any problemswith the roof, gutbrs or dournspouts? [Yes f]],lo
EFlo
"yes"anflvel Ptege,gxOlaiqany rpu gavein thiswtbn, indudingrcpairhistory(afrach&ditional pagesit nffi)
:
5. PLUMBINGSYSTEM,FIXTURESAND EQUIPMENT (a) Pfr.rnbingSystem:dCWWr flGalvanized I Other:
,
DGa-s deectic Eother: iui waerHdat6r:
U u l,lo (c) Hot tuM/Vhirlpooll.)asnA?lYesfl !Yesp "yes", "yed', dateof la$ backflowdeviceinspectionor gertificab:(d) Lamr Lam SprinklerSystem:nYes pfNo [Unknonn. ffNo lf (ei Are you ar €re olany problemsor repairsneededin the plumbingsystems?[ Yes E ilo it needed.):fTease expbinany "yes" anstteryou gave in his wtbn, irdudirg rcpair hidory (attachafri(nnal oe1ges
osc{ooo
Page2 of6
Reference fe.g, Seller{3Prorynfl 6, WATER
Jungles 1727
(a)WaterSystenr9soure: I PublicfiifudlI Other:
lf \rell,' specifytype of well and aproximate providecopy tested?[ Yes M No lf \es,' idenb'ty rcsv$^blow or provide rrveffbeentested? rc,sylS^blow Has rrveff idenb'fydale exf,ain dateof 1epft qtd 44dexflain 'ves'.|4 Utvned Ownedff vorrhave a softener, soflener-filter filteroiother ou-rification wstem? lg'Yes ldYes Ll l-l No ff'yes',WOwned lflt'yes',l4 l-l -LeaseiJ LeasedJ / system? or other purificatim (b)Doyouhaveasoftener,filteroiotherpu-rificatimsystem? (b) Do you @Yes n [_Leased (cinre-you awareof any problemsrelatingto the watersystem,indudingqualityor sourceof watel?[ Yes ffl,lo Pleas exptainany "yes" answerWu gave in this *ction, includirE repair history@ftachdditional pagesif neded) : 7. SEWAGE (a) $rat is the type of serlragesystemto wttidt the houseis conneded? I RrblicI Rivate f(S"f,"nAenator fll tgnks/lateralJdrainfi eldsI Other] good Yes No
uorkingcondition?fl lift systemTfl Yes d fto F !es," is it in I @)IGtherea seu,age (c)Whenwastheseptic/aerator systemlastserviced? dDog . .= ., ioiar" youarmreof'anyleaks,odcrupsor otherproue Plea* explainany "yes"answeryougavein f/r.ssecfon,includingrcpair history@ttdt ffiitional pryesif nedd) :
8. CONSTRUCTION (a) Are you awareof any problemswith the footings,foundation,s.rb-floor,interioror exteriorwalls,roof consiruclion, or other load bearingor slructuralcomponents?! Yes SNo decks/porcfres J (b) Are you awareof any repairsor replacementsrelatingto any items li3tedin (a) above?[Yes g ]lo Ptea* explain any "yesoansweryou gave in f/ra secfion,includingrepair history@ftdr dditional pqes if need&) :
9. EXTERIORFINISH (a)ls an exterior finish and insulation system (EFIS - syntheticstucco) presentin the home? !Yes Eunknorrrm.ldentifydate installed,brandnameand installer,if knorm: (b) Are you auare of any hardboardsidirp on your Propefi? MYes E No lf 'y6,'whidt Upe? ,A+k for defectsin the siding?flYes M No (c) Are you awareof any claimsmadeagaind the me9uFaclurer (d) Was arrymoneyreceivedfor the daim? LlYes M f.lo (e) Are you awareof any repairsor replaements madeto the exteriorfinistr?[Yes n/nfo Plea* explainany "yes"answeryou gave in thb *ction, indudirg rcpah history@ftach#itional pagesif rcded)
./ EfNo
10. BASEMENTAND CRAWLSPACE / (a) Are you au6re of any dampness,water leakageor acormulation,in the basementor cravyl_space?tr Yes Ef No 1ninre iou auare of any repairsor other attemptsto controlany water or dampnessproblems?[Yes pp,lo "yes" ansfler fzease expldn any Wu gave in this*ction, indudirp rcpair history@ttachdclitional pagesif rc&ed)
DESTROYINGINSECTS,PESTS 11. TERIIIITESi'I'I'OOD -./ (a) Are you av\areof any termitesrhooddestroyinginsecls or pests affectng the PropertyZ^[V,qs I5_y-9 ini nre iou anare of anv unconecteddamaoeto the Propertycausedby any of the above?U Yes MIlo contractby-apest contnil company?D Ves E No lf !es", traytsfenable?[ Yes tci ts pioperty undera raaarnanty iO)nre ydu aimre of any termilb/pestcontrol reportsfor or treatnent of the Property? [ Yes El No Pteaseexptainany "yes' answeryou gave in this section,induding repair history@ttachadditional pagesif neded)
/ 12.SOL AND DRAINAGE Ga)Are Vouaraie of anyfill, elpansive soil or sinkholeson the Prope4 ? ! Yes g!9,/ of any soil, earthmovement,flood, drainageor gradingproblems?ZYes n No hi nre irou ar,nare DSC{tno
Prge3 of6
Referehce (eg., Sellu APrcperfi)
-lunoles 1727
(c) Are you awareof any past, plesent or proposedmining, stripmining, or any other excavationsthat affect or might affed the Property?[Yes E Nlo includiry repair history(attachaffiitional pagesif rreded) Pleaw explainany "yes'anweryar gave in this
R ENVIRONMENTALCONCERNS 13. HAZARDOUSSUBSTANGES/OTHE (a) Lead (1) Are you aware of the presenceof any lead hazards (e.g-, paint, water supply lines, etc.) on the Property? fl Yes I No (Note: Produc:tionof lead 0ased paint was bannedin 1978. fiAR Form DSC-?UDmay necd to be -omplefid in ann*tion wiilr this form). (2) Are you awareof the presenceof any iead in the soils? [ Yes gfNo (3) Are you awareif lead has ever beencoveredor removed?[ Yes [ZNo (4) Are you awareif the Propertyhas beentestedfor lead? 3 Yes /No (b) AsbestosMaterials (1) Are you awareof the presenceof asbestoTmaterialson the Property,such as roof shingles,siding,insulation, ceiling,flooring,pipe wp, etc.?a Yes g[]lo ,/ (2) Are you €n^areof any asbestosmaterialthat has beenencapsulatedor removed? [ Yep []lo (3) Are you awareif the Propertyhas beentestedfor the presenceof asbestos?n Yes VlNlo (c) Mold (1) Are you €rwareof the presenceof any mold on the Propeffi [ Yes g']tl" (2) Are you EMrare if anythingwith mold on the Prope$ has ever been coveredor removed?,I Yes (3) Are you €rwareif the Propertyhas ever beentes{edfor the presen@of mold?5 Yes pf ff (4) Are you awareif the Propertyhas ever beentreatedfor the presenceof mold? f] Yes gtlo (d) Radon (1) Are you awareif the Propertyhas been testedfor radongas? l Ves fllfo (2) Are you aurareif the Propertyhas ever beentreatedor mitigatedfor radongas? D Yes
elrc
gfr'r"
(e) Methamphetamine Are you awareif the Propertyis or was used as a site for methamphetamineproduc{ionor the plae of residenceof a petsonconvided of a crime involvingany ontrolled substancerelatedthereto? 'yes,' MAR Form DSC-$0olO must befilled out in conjunction with thisform. fJ Yes E No lf (f) OtherEnvironmential Conems Are you itvvareof any other environmentalcon@ms that may affecl the Propertysucfi as polychlorinatedbiphenyls (PCB's),eledro-magneticfields (EMF's),undergrcundfuel tanks, discolorationof soil or vegetation,oil sheensin wet usesof the Propeftyotherthan residential(e.9.,commercial,farming,landfill, areas,unusedsepticor storageTtanks, dumpingsite),etc.?n Yes E^lo Pleaseexplain any "yes" answer you gave in fDissecfion, including rcpair history,date(s) performed,type af fesfs or treatmentand results,and name of person/ampany who did the testingor mitigation(attach additional pagesif neded):
14.INSURANCE (4 16\re tot;ware of anyclaimsthathavebeenfiledfor damagesto the Propertyin the last5 years?n Yes glno t "yes," pleaseexplainand includethe following.Dateof claim,descriptionof claim, repairsand/or rcplaements nmfle@: (b) Are you awarethat any insuranceppplicationor prior coverageregardingany part of the Propertyhas been rejected orwill not be renevrred?DYesg/tlo / (c) Are you awarethat any existinginsurancecoveragewill be subjectedto increasedrates?n Yes p1'No 15. ROADS,STREETS& ALLEYS ./ (a) The roads,sheetsandloralleysservingthe Pmpertyare p[public npriyab? (b) ls there a reorded roadlsfeeUalleymaintenanceagreement?lYes Bfi,lo tlsc{mo
PagGf of6
(e.9, Sdler& PrWenfl Reference
Jungles 1727
(c) Are you aurareof any right of way, unrecordedea*mentorsimilarmatterwhichaffecttheProperty?W* M Uo Pleaseexplainany "yes" answeryou gave in thiss*tion, indudingrepairhistoryand identifymaintenaneprcviderand osts below (aftad affiitional pagesif needed) 16. MISCELLANEOUS ,-t. yeaq (a) ' ' The approximateage of the residenceis | y."o Seller'has beenthe-ownerof the Propertyfor ---l-Sellerhas ontinuously omrpied Qe Propertyfor Veans 5 lf ever vacant,whenand hor long? (b) ls the Prcpertylocatedin an area that requiresan occupancy( (c) ls the Propertydesignatedas a historicalhomeor locatedin a historicdasfict? flYes E/No (d) Do you have a surveythat includesallexisting improvernentson the Property?DYes g N o (e) Are you au€re of any pets ever havingbeen kept in the home at thefroperty? E Yes [] Flo (D Are you €il\rtreof any pets ever having been kept on the Property?M Yes tr lto (g) ls the Buyerbeingoffereda proteclionplan/homewarrantyat dosing at Selledsexpense?[Yes dr'n (h) Are you amrc of any: Inoperablewindows?E Yes ENo inoperabledoors? [Yes Eltlo f brokenthermalseals?flYes Efno / g) fs any portionof the Propertylocatedwithinthe 100yearflmd hazardarea (fJoodplain)? [Yes Ef trto (i) Are you aurareif carpethas been laid over a damageduroodflool? D Yes Eilo (k) Are you avlrareof any: / rrrells,set,rers,fences,roads,etc.)? ! Yes M trto Sharedor commonfeatureswith adjoiningpropertiet,(e.9.,rlrralls, wtricftaffectthe Property?DYes M m Encroachments t Existingor threatenedlegalactionaffectingthe Property?[ Yes M lto Molationsof local,state,-orfederatlawdregulations,induding zoning,relatingto the Property?n YFs E4to Additions,modifications,or alterationsmadeto the Propertywithoutnecessarypermits?f]Yes Eil,to Consentiequireclof anyoneotherthan the signe(s) of this form to conveytitle to the ProftrtyZ SVes U6fo (l) CurrentUtilityService. ElectrbCompany: Water Servie: CableService: Sewer: Tefephone: A+ n
Gas:
Gabage:_ Fire Disbict: Fire DuesPaidwitr Taxes? ([]p/ease markif additbnal pges are attrched): AdditionafCommentdExplanation
17.SUBDTVTSTON 1a;Name: N lA ( u ins s e s s m
Assessment: $ -per : E str eetm al
n month fl quarterI half-year - a tenni n iyear. c our t founnou5' tr poot
fl entrancesign/s{ructueI other commonfacility(ies): (c) Are you av€re of any existingor proposedspecialassessnents?[Yes nl.lo (e) Are llou .nyareof any violationof zuMivision restrictions,rulesor regulationsby yourselfor others?flYes nNo (d) Are you armre of any writtensubdivisionrestrictions,rules,or regulations?n Yes nNo (f) Are you au€re of any condition or claim whicfi may cause an increase in assesgnents or fees? [ Yes [No Pleaseexplain any *yes" answersyau gave in this *ction (aftach additional pagesif needed):
18.CONDOMINIUM, (a) Name: DSC{O00
(if applicable) OR SHAREDCOST DEVELOPITENT
PrgF5 ofo
(e.9,Sefler8PrWng Jungles172i Reference (explain): flCoOp I Otnersharedcostdevelopment O) TypeflCondonrinium per _tl monthn quarter[_half-year ! year(c) Assessment$ (01nssessrnentinauAe4cnxX attnat apptyl:fl water trcooting I heating [] sewer nhash removal Dsnov,r (numberlflgarage fl secudty remqralI doormanI streetmaintenance f] asdgnedparkingspace(s) pd building insunanceon realstatetaxesfl dubhouse[ landscaping fl tenniscourtI exercisearea tr I fl tacility: common other facility[ rrcption I (e) Exteriormaintenance:flfully coveredby assessrnent[ partlycoveredby assessnent.Area(s)exduded:
(f) Are )rou Eil/are of any existing or proposedspecial assesgnents?[ Yes f]],lo (g) Are you trwareof any materialdefeds in your buildingor other sharedelements?n Yesf] No (h) Are you ariare of any writtencondominium,co-opor other sharcdcost developmentagreernents,resfic{ions,rulesor regulations?[ Yes f] tlo (i) Are you ayrrare of any violationof any such restrictions,rulesor regulationsby yourselfor others?lYes n No yott of any conditfonor daim wfiicfi may causean increasein assessrnentsorfees? [ Yesn No auare Are O "yes" answerWu gave in this *ction (aftacfi adclitionalpqes it neded) Hease explain any
(SaleContract will contol as to items actually included in sale) 19. BOAT DOCKS, (a) Doesthe Propertyindude or availableto it any boat docks,slips,lifts or similarfeatures?[ Yes n No ,if appliable) lf yes,ch*kallthat apply:ndock ,if applicable) [seanall (Permit# other ,if appliable) Ifl dip (pennit# pleawfufthersrycifyit it or theyare lee,sed or othemise lf any of the above are checkedand arc notowned other such written agreement,if available,and also transferable.ff so, pleaseprovide a @py of the lease, identrfythe nameand availableantacl informationforthe actual
n year
per tl mmth !
(b)Assessment $
(c) Assessmentindudes (checkall that apply): IpermiB/licens fees lstorage
flinsunance[othec
Selle/s Acknowledgement Brokersare herebyauthorizedto distributethis informationto potentialbuyersfor this Property.Seller has carefully examinedthis statementand acknowledgesthat the informationcontainedabove is true and accurateto the best of Selter'sknowledge.Seller will fully and promptly disclose in writing to Buyer any new informationpertainingto the Propertythat is discoveredby or made known to Seller at any time prior to closingor settlementand constitutesan adversematerialfact or would make any existinginformationset forth hereinfalse or
Date Seller Buye/s Acknowledgement Buyer shouldverify informationcontainedin this disdosure statementand is urgedto caretutryinspectthe Propertyand, if desired,to have the Propertyinspec-tedby an independent,pro{essionalerpert(s). Buyer uhdeistandsthat ihere are areas of the Propertyof wtrichSeller may have no krcwledge and that this disriosre stalementdoes not encompassthose areasand is limited to informationof which Sellerhas knowledge.Buyeralso acknowledgeshaving receivedand read a signedcopy of this disclozurestatementfiom Seller or the listing brokerand that brokersand licenseesare not experts at deteding or repairing physical defeds in pmperty.
Buyer
Ilate
Buyer
Approred by legal counsel for use exclusively by rrcmbers of the ltfissouri Association of Redtors, Cdumtia, Missori. No.wananty is niiiG 61iiri*e6?s to tre hgal vdifty r a@Ecy of fias do{u.nent, a tril it csr1*es h wery reepect nffr f,re hur c ftd its useis 4ropriate br dl situalios. Local law, tuetoms and p6ctice, and Ctering circumstances in each fansaclim, may eac-hdictate lhat amendments b this document be made. O2003MissruriAssociatftxtof Redtors LretRwised 17g1l0g. Page6 of0
Company: Rovided by:
CokhrellBanker
S/N: PC.trs-1?O3g
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SoftwG
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