SELLER'S PROPERTY DISCLOSURE STATEMENT I
SELLER'S PROPERTY DISCLOSURE STATEMENT I Property Address 27520 W Ingram Island Road, Monroe, OR 97456 INSTRUCTIONS TO THE SELLER 1 2 3
Please complete the following form. Do not leave any spaces blank. Please refer to the line number(s) of the question(s) when you provide your explanation(s). If you are not claiming an exclusion or refusing to provide the form under ORS 105.475 (4), you should date and sign each page of this disclosure statement and each attachment.
4 5 6 7
Each seller of residential property described in ORS 105.465 must deliver this form to each buyer who makes a written offer to purchase. Under ORS 105.475 (4), refusal to provide this form gives the buyer the right to revoke their offer at any time prior to closing the transaction. Use only the section(s) of the form that apply to the transaction for which the form is used. If you are claiming an exclusion under ORS 105.470, fill out only Section 1.
8 9 10
An exclusion may be claimed only if the seller qualifies for the exclusion under the law. If not excluded, the seller must disclose the condition of the property or the buyer may revoke their offer to purchase anytime prior to closing the transaction. Questions regarding the legal consequences of the seller's choice should be directed to a qualified attorney.
11
DO NOT FILL OUT THIS SECTION UNLESS YOU ARE CLAIMING AN EXCLUSION UNDER ORS 105.470
12 13 14 15 16
Section 1. EXCLUSION FROM ORS 105.465 TO 105.490: You may claim an exclusion under ORS 105.470 only if you qualify under the statute. If you are not claiming an exclusion, you must fill out Section 2 of this form completely. r,^~~~~*~~~~"~~~~~~~~~~" ~~————_____ Initial only the exclusion you wish to claim. ^--*"" ' This is the first sale of a dwelling never occupied. The dwelling is constructed or installed under building or installation permit(s) #
17
issued by
,^^
•
,^'
18
This sale is by a financial institution that acquired the^pfoperty as custodian, agent or trustee, or by foreclosure or deed in lieu of
19
foreclosure.
20
The seller is a court appointed (Check only QX&: D receiver Q personal representativeD trustee D conservator D guardian
21
This sale or transfer is by a governmental agency.
,,"'
Date
Rodney Mooars
4- Seller
Date Suzanne Mooers
24
SignaWe(s) of Buyer^afAcknowledging Seller's Claim
25
Buyer
26 27
IF YOU DID NOT CLAIM AN EXCLUSION IN SECTION 1, YOU MUST FILL OUT THIS SECTION. Section 2. SELLER'S PROPERTY DISCLOSURE STATEMENT
28
(NOT A WARRANTY) (ORS 105.465)
Date
Buyer_
Date
29
NOTICE TO THE BUYER: THE FOLLOWING REPRESENTATIONS ARE MADE BY THE SELLER(S) CONCERNING THE CONDITION OF THE
30
PROPERTY LOCATED AT 27520 W Ingram Island Road, Monroe, OR 97456
31 32 33 34 35
DISCLOSURES CONTAINED IN THIS FORM ARE PROVIDED BY THE SELLER ON THE BASIS OF SELLER'S ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME OF DISCLOSURE. BUYER HAS FIVE BUSINESS DAYS FROM THE SELLER'S DELIVERY OF THIS SELLER'S DISCLOSURE STATEMENT TO REVOKE BUYER'S OFFER BY DELIVERING BUYER'S SEPARATE SIGNED WRITTEN STATEMENT OF REVOCATION TO THE SELLER DISAPPROVING THE SELLER'S DISCLOSURE STATEMENT, UNLESS BUYER WAIVES THIS RIGHT AT OR PRIOR TO ENJSRING INTO A SALE AGREEMENT.
36
SELLER
Date
SELLER
/
Suz
"THE PROPERTY."
£ML>fc^—
Date
This form has been licensed for use solely by Lisa Johnson pursuant to a Forms License Agreement wtth Oregon Real Estate Forms, LLC.
LINES WITH THIS SYMBOL 4- REQUIRE A SIGNATURE AND DATE Copyright Oregon Real Estate Forms, LLC 2000 - 2015 www.orefonline.com
Buyer Initials
No portion may be reproduced without express permission of Oregon Real Estate Forms, LLC Produced with zipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 46026
Date OREF 020 Page 1 of 5
www.zioLoqix.com
SELLER'S PROPERTY DISCLOSURE STATEMENT I Property Address 27520 W Ingram Island Road, Monroe, OR 97456 37 38 39 40
FOR A MORE COMPREHENSIVE EXAMINATION OF THE SPECIFIC CONDITION OF THIS PROPERTY, BUYER IS ADVISED TO OBTAIN AND PAY FOR THE SERVICES OF A QUALIFIED SPECIALIST TO INSPECT THE PROPERTY ON BUYER'S BEHALF INCLUDING, FOR EXAMPLE, ONE OR MORE OF THE FOLLOWING: ARCHITECTS, ENGINEERS, PLUMBERS, ELECTRICIANS, ROOFERS, ENVIRONMENTAL INSPECTORS, BUILDING INSPECTORS, CERTIFIED HOME INSPECTORS, OR PEST AND DRY ROT INSPECTORS.
41
Seller D is D is not occupying the property. 1. S E L L E R ' S R E P R E S E N T A T I O N S
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79
The following are representations made by the seller and are not the representations of any financial institution that may have made or may make a loan pertaining to the property, or that may have or take a security interest in the property, or any real estate licensee engaged by the seller or the buyer. *lf you mark yes on Items with *, attach a copy or explain on an attached sheet. 1. TITLE (^^ A. Do you have legal authority to sell the property? ^Yes D No *B. Is title to the property subject to any of the following: Q Yes* |g-No D First right of refusal n Option Q Lease or rental agreement n Other listing n Life estate *C. Is the property being transferred an unlawfully established unit of land?. Q Yes* "0 No *D. Are there any encroachments, boundary agreements, boundary disputes or recent boundary changes?. D Yes* ^ No *E. Are there any rights of way, easements, licenses, access limitations or claims that may affect your interest in the property? n Yes* X9 No *F. Are there any agreements for joint maintenance of an easement or right of way?. Q Yes* 0 No *G. Are there any governmental studies, designations, zoning overlays, surveys or notices that would affect the property? fj Yes* ^ No *H. Are there any pending or existing governmental assessments against the property? Q Yes* JH No *l. Are there any zoning violations or nonconforming uses?. Q Yes* |g No *J. Is there a boundary survey for the property? Q Yes* n No *K. Are there any covenants, conditions, restrictions or private assessments that affect the property? n Yes* QNo *L. Is the property subject to any special tax assessment or tax treatment that may result in levy of additional taxes if the property is sold?. n Yes* fi No 2. WATER A. Household water (1) The source of the water is (check ALL that apply): Q Public Q Community Q Private n Other (2) Water source information: *a) Does the water source require a water permit?. n Yes* Q No If yes, do you have a permit?. D Yes Q No *b) Is the water source located on the property?. §f]Yes* D No *lf not, are there any written agreements forashared water source?. n Yes* D No *c) Is there an easement (recorded or unrecorded) for your access to or maintenance of the water source?. Q Yes* 0-No d) If the source of water is from a well or spring, have you had any of the following in the past 12 months? Q Yes g] No [3 Flow test fj Bacteria test Q Chemical contents test *e) Are there any water source plumbing problems or needed repairs?. D Yes* |gj No (3) Are there any water treatment systems for the property? fjCj-Yes D No fj Leased 0vOwned
SELLER
Date
n Unknown Q Unknown n Unknown n Unknown n Unknown n Unknown D Unknown D Unknown Q Unknown 0 Unknown rj Unknown Q Unknown
n Unknown Q Unknown Q Unknown n Unknown
D NA Q NA S^NA
Q Unknown n Unknown
D NA
fj Unknown n Unknown
SELLER
Date
Suzaflne M0oers
This form has been licensed for use solely by Lisa Johnson pursuant to a Forms License Agreement with Oregon Real Estate Forms, LLC. LINES WITH THIS SYMBOL «• REQUIRE A SIGNATURE AND DATE Copyright Oregon Real Estate Forms, LLC 2000-2015 www.orefonline.com No portion may be reproduced without express permission of Oregon Real Estate Forms, LLC Produced with zipForm® by zipLogix 18070 Fifteen Mite Road, Fraser, Michigan 48026
Buyer Initials
/
Date OREF 020 Page 2 of 5
www.zipLoaix.com
SELLER'S PROPERTY DISCLOSURE STATEMENT Property Address 2 7 520 W Inaram Island Road, Monroe, OR 97456 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125
B.
C.
Irrigation (1) Are there any d water rights or d other rights for the property? * (2) If any exist, has the irrigation water been used during the last five-year period?. * (3) Is there a water rights certificate or other written evidence available?. Outdoor sprinkler system
d Yes dYes* d Yes*
(1) (2)
Is there an outdoor sprinkler system for the property? Has a back flow valve been installed?
d Yes dYes
(3)
Is the outdoor sprinkler system operable?
d Yes
3. SEWAGE SYSTEM A. Is the property connected to a public or community sewage system? B Are there any new public or community sewage systems proposed for the property? C. Is the property connected to an on-site septic system? (1) If yes, when was the system installed? (2) *lf yes was the system installed by permit? (3) *Has the system been repaired or altered? (4) Has the condition of the system been evaluated and a report issued? (5) Has the septic tank ever been pumped? If yes, when? (6) *Does the system have a pump? (7) *Does the system have a treatment unit such as a sand filter or an aerobic unit? (8) *ls a service contract for routine maintenance required for the system? (9) 'Are all components of the system located on the property? *D Are there any sewage system problems or needed repairs?. E. Does your sewage system require on-site pumping to another level?
£3 No
j^j Yes
dNo
dYes* dYes* dYes* dYes*
d Yes
5. DWELLING STRUCTURE *A. Has the roof leaked?. If yes has it been repaired"? B Are there any additions, conversions or remodeling"? If yes was a building permit required? If yes was a building permit obtained'? If yes was final inspection obtained? C Are there smoke alarms or detectors'? . . /. D Are there carbon monoxide alarms'?.... VXi^L.^fydjroOx^.. ...*No D Unknown *lf yes, explain on attached sheet the frequency and extent of problem and any insurance claims, repairs or remediation done. Is there a sump pump on the property? ................................................................................... D Yes No D Unknown Are there any materials used in the construction of the structure that are or have been the subject of a recall, class action suit, settlement or litigation? ......................... Q Yes j@LNo D Unknown If yes, what are the materials? _ (1) Are there problems with the materials?..........................................................................D Yes D No D Unknown (2) Are the materials covered by a warranty?............................,.................................... ...... D Yes D No D Unknown (3) Have the materials been inspected? ............................................................................... D Yes Q Unknown D No Q Unknown (4) Have there ever been claims filed for these materials by you or by previous owners?.. D Yes Q No If yes, when? _ (5) Was money received? ..................................................................................................... Q Yes D Unknown D No (6) Were any of the materials repaired or replaced? ............................................................ D Yes D No n Unknown
6. DWELLING SYSTEMS AND FIXTURES If the following systems or fixtures are included in the purchase price, are they in good working order on the date this form is signed? A. Electrical system, including wiring, switches, outlets and service........................................... _3 Yes DNo D Unknown B. Plumbing system, including pipes, faucets, fixtures and toilets...............................................0 Yes DNo D Unknown Water heater tank...................................................................................................................& Yes DNo D Unknown C. D. Garbage disposal...................................................................................................................Q Yes DNo D Unknown E. Built-in range and oven...........................................................................................................Q Yes ONo D Unknown F. Built-in dishwasher..................................................................................................................D Yes D Unknown DNo Sump pump ......................................... ..... ., ...... ..................................................................... D Yes Q Unknown G. DNo Heating and cooling systems ...... . ^ ^ ^ . . . . V ^ ^ A r .................................................. Jg] Yes D Unknown H. DNo
153 154 155
162 163 164
Are there any moisture problems, areas of water penetration, mildew odors
If yes, when? _ Was money received?.....................................................................................................D Yes Were any of the materials or products repaired or replaced? ......................................... D Yes
7. COMMON INTEREST A. Is there a Home Owners' Association or other governing entity? ........................................... D Yes Name of Association or Other Governing Entity
B. *C. D. E. F.
DNo
D Unknown
•Kl No
D Unknown
DNo DNo DNo DNo
D D D D
DNo DNo
D Unknown D Unknown
No
D Unknown
Contact Person Phone Number Address _ ____________ _ ___ _ _ Regular periodic assessments: $ per D Month D Year D Other Are there any pending or proposed special assessments?. D Yes* 'No Are there shared "common areas" or joint maintenance agreement for facilities like walls, fences, pools, tennis courts, walkways or other areas co-owned in undivided interest with others?... D Yes Is the Home Owners' Association or other governing entity a party to pending litigation or subject to an unsatisfied judgment? D Yes D No Is the property in violation of recorded covenants, conditions and ^ions or in violation of other bylaws or governing rules, whether recorded or not? D Yes D No
SELLER
Date /
SELLER
Unknown Unknown Unknown Unknown
&NA
0NA
QNA
SNA jfa NA SJNA
SNA
Unknown D Unknown D Unknown D Unknown
J_i£NA
Date
Suzi
This form has been licensed for use solely by Lisa Johnson pursuant to a Forms License Agreement with Oregon Real Estate Forms, LLC. LINES WITH THIS SYMBOL «- REQUIRE A SIGNATURE AND DATE Copyright Oregon Real Estate Forms, LLC 2000 - 2015 www.orefonline.com No portion may be reproduced without express permission of Oregon Real Estate Forms, LLC Produced with zipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026
Buyer Initials
www.zipLopix.Qom ww.zipLoqix.QQm
/
Date OREF 020 Page 4 of 5
SELLER'S PROPERTY DISCLOSURE STATEMENT I Property Address 27520 W Ingram Island Road, Monroe, OR 176 177 178 179
8. GENERAL A. Are there problems with settling, soil, standing water or drainage on the property or in the immediate area? B. Does the property contain fill?
180 181 182 183 184 185 186 187 188 189 190
C.
190 191 192 193 194
97456
fj Yes fj Yes
Is there an/material damage to the property or any of the structure(s) from fire, wind, floods, beach movements, earthquake, expansive soils or landslides? []] Yes Is the property in a designated floodplain? Ef-Yes Is the property in a designated slide or other geologic hazard zone? n Yes Was any portion of the property been tested or treated for asbestos, formaldehyde, radon, gas, lead-based paint, mold, fuel or chemical storage tanks or contaminated soil or water?. fj Yes* Are there any tanks or underground storage tanks (e.g^iptjc^chemical, fuel, etc.) on the property? £§ Yes Has the property ever been used as an illegal drug manufacturing or distribution site? n Yes "If yes, was a Certificate of Fitness issued?. Q Yes* Has the property been classified as forestland-urban interface? fj Yes
D. E. * F. G. H. I.
G Unknown G Unknown
QNo 0No
Q Unknown G Unknown G Unknown G Unknown G G G G
Unknown Unknown Unknown Unknown
&NA
9. FULL DISCLOSURE BY SELLER(S) *A. Are there any other material defects affecting this property or its value-that ^ \ c*JrY*'
Please complete the following form. Do not leave any spaces blank. Please refer to the line number(s) of the question(s) when you provide your explanation(s). If you are not claiming an exclusion or refusing to provide the form under ORS 105.475 (4), you should date and sign each page of this disclosure statement and each attachment.
4 5 6 7
Each seller of residential property described in ORS 105.465 must deliver this form to each buyer who makes a written offer to purchase. Under ORS 105.475 (4), refusal to provide this form gives the buyer the right to revoke their offer at any time prior to closing the transaction. Use only the section(s) of the form that apply to the transaction for which the form is used. If you are claiming an exclusion under ORS 105.470, fill out only Section 1.
8 9 10
An exclusion may be claimed only if the seller qualifies for the exclusion under the law. If not excluded, the seller must disclose the condition of the property or the buyer may revoke their offer to purchase anytime prior to closing the transaction. Questions regarding the legal consequences of the seller's choice should be directed to a qualified attorney.
11
DO NOT FILL OUT THIS SECTION UNLESS YOU ARE CLAIMING AN EXCLUSION UNDER ORS 105.470
12 13 14 15 16
Section 1. EXCLUSION FROM ORS 105.465 TO 105.490: You may claim an exclusion under ORS 105.470 only if you qualify under the statute. If you are not claiming an exclusion, you must fill out Section 2 of this form completely. r,^~~~~*~~~~"~~~~~~~~~~" ~~————_____ Initial only the exclusion you wish to claim. ^--*"" ' This is the first sale of a dwelling never occupied. The dwelling is constructed or installed under building or installation permit(s) #
17
issued by
,^^
•
,^'
18
This sale is by a financial institution that acquired the^pfoperty as custodian, agent or trustee, or by foreclosure or deed in lieu of
19
foreclosure.
20
The seller is a court appointed (Check only QX&: D receiver Q personal representativeD trustee D conservator D guardian
21
This sale or transfer is by a governmental agency.
,,"'
Date
Rodney Mooars
4- Seller
Date Suzanne Mooers
24
SignaWe(s) of Buyer^afAcknowledging Seller's Claim
25
Buyer
26 27
IF YOU DID NOT CLAIM AN EXCLUSION IN SECTION 1, YOU MUST FILL OUT THIS SECTION. Section 2. SELLER'S PROPERTY DISCLOSURE STATEMENT
28
(NOT A WARRANTY) (ORS 105.465)
Date
Buyer_
Date
29
NOTICE TO THE BUYER: THE FOLLOWING REPRESENTATIONS ARE MADE BY THE SELLER(S) CONCERNING THE CONDITION OF THE
30
PROPERTY LOCATED AT 27520 W Ingram Island Road, Monroe, OR 97456
31 32 33 34 35
DISCLOSURES CONTAINED IN THIS FORM ARE PROVIDED BY THE SELLER ON THE BASIS OF SELLER'S ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME OF DISCLOSURE. BUYER HAS FIVE BUSINESS DAYS FROM THE SELLER'S DELIVERY OF THIS SELLER'S DISCLOSURE STATEMENT TO REVOKE BUYER'S OFFER BY DELIVERING BUYER'S SEPARATE SIGNED WRITTEN STATEMENT OF REVOCATION TO THE SELLER DISAPPROVING THE SELLER'S DISCLOSURE STATEMENT, UNLESS BUYER WAIVES THIS RIGHT AT OR PRIOR TO ENJSRING INTO A SALE AGREEMENT.
36
SELLER
Date
SELLER
/
Suz
"THE PROPERTY."
£ML>fc^—
Date
This form has been licensed for use solely by Lisa Johnson pursuant to a Forms License Agreement wtth Oregon Real Estate Forms, LLC.
LINES WITH THIS SYMBOL 4- REQUIRE A SIGNATURE AND DATE Copyright Oregon Real Estate Forms, LLC 2000 - 2015 www.orefonline.com
Buyer Initials
No portion may be reproduced without express permission of Oregon Real Estate Forms, LLC Produced with zipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 46026
Date OREF 020 Page 1 of 5
www.zioLoqix.com
SELLER'S PROPERTY DISCLOSURE STATEMENT I Property Address 27520 W Ingram Island Road, Monroe, OR 97456 37 38 39 40
FOR A MORE COMPREHENSIVE EXAMINATION OF THE SPECIFIC CONDITION OF THIS PROPERTY, BUYER IS ADVISED TO OBTAIN AND PAY FOR THE SERVICES OF A QUALIFIED SPECIALIST TO INSPECT THE PROPERTY ON BUYER'S BEHALF INCLUDING, FOR EXAMPLE, ONE OR MORE OF THE FOLLOWING: ARCHITECTS, ENGINEERS, PLUMBERS, ELECTRICIANS, ROOFERS, ENVIRONMENTAL INSPECTORS, BUILDING INSPECTORS, CERTIFIED HOME INSPECTORS, OR PEST AND DRY ROT INSPECTORS.
41
Seller D is D is not occupying the property. 1. S E L L E R ' S R E P R E S E N T A T I O N S
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79
The following are representations made by the seller and are not the representations of any financial institution that may have made or may make a loan pertaining to the property, or that may have or take a security interest in the property, or any real estate licensee engaged by the seller or the buyer. *lf you mark yes on Items with *, attach a copy or explain on an attached sheet. 1. TITLE (^^ A. Do you have legal authority to sell the property? ^Yes D No *B. Is title to the property subject to any of the following: Q Yes* |g-No D First right of refusal n Option Q Lease or rental agreement n Other listing n Life estate *C. Is the property being transferred an unlawfully established unit of land?. Q Yes* "0 No *D. Are there any encroachments, boundary agreements, boundary disputes or recent boundary changes?. D Yes* ^ No *E. Are there any rights of way, easements, licenses, access limitations or claims that may affect your interest in the property? n Yes* X9 No *F. Are there any agreements for joint maintenance of an easement or right of way?. Q Yes* 0 No *G. Are there any governmental studies, designations, zoning overlays, surveys or notices that would affect the property? fj Yes* ^ No *H. Are there any pending or existing governmental assessments against the property? Q Yes* JH No *l. Are there any zoning violations or nonconforming uses?. Q Yes* |g No *J. Is there a boundary survey for the property? Q Yes* n No *K. Are there any covenants, conditions, restrictions or private assessments that affect the property? n Yes* QNo *L. Is the property subject to any special tax assessment or tax treatment that may result in levy of additional taxes if the property is sold?. n Yes* fi No 2. WATER A. Household water (1) The source of the water is (check ALL that apply): Q Public Q Community Q Private n Other (2) Water source information: *a) Does the water source require a water permit?. n Yes* Q No If yes, do you have a permit?. D Yes Q No *b) Is the water source located on the property?. §f]Yes* D No *lf not, are there any written agreements forashared water source?. n Yes* D No *c) Is there an easement (recorded or unrecorded) for your access to or maintenance of the water source?. Q Yes* 0-No d) If the source of water is from a well or spring, have you had any of the following in the past 12 months? Q Yes g] No [3 Flow test fj Bacteria test Q Chemical contents test *e) Are there any water source plumbing problems or needed repairs?. D Yes* |gj No (3) Are there any water treatment systems for the property? fjCj-Yes D No fj Leased 0vOwned
SELLER
Date
n Unknown Q Unknown n Unknown n Unknown n Unknown n Unknown D Unknown D Unknown Q Unknown 0 Unknown rj Unknown Q Unknown
n Unknown Q Unknown Q Unknown n Unknown
D NA Q NA S^NA
Q Unknown n Unknown
D NA
fj Unknown n Unknown
SELLER
Date
Suzaflne M0oers
This form has been licensed for use solely by Lisa Johnson pursuant to a Forms License Agreement with Oregon Real Estate Forms, LLC. LINES WITH THIS SYMBOL «• REQUIRE A SIGNATURE AND DATE Copyright Oregon Real Estate Forms, LLC 2000-2015 www.orefonline.com No portion may be reproduced without express permission of Oregon Real Estate Forms, LLC Produced with zipForm® by zipLogix 18070 Fifteen Mite Road, Fraser, Michigan 48026
Buyer Initials
/
Date OREF 020 Page 2 of 5
www.zipLoaix.com
SELLER'S PROPERTY DISCLOSURE STATEMENT Property Address 2 7 520 W Inaram Island Road, Monroe, OR 97456 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125
B.
C.
Irrigation (1) Are there any d water rights or d other rights for the property? * (2) If any exist, has the irrigation water been used during the last five-year period?. * (3) Is there a water rights certificate or other written evidence available?. Outdoor sprinkler system
d Yes dYes* d Yes*
(1) (2)
Is there an outdoor sprinkler system for the property? Has a back flow valve been installed?
d Yes dYes
(3)
Is the outdoor sprinkler system operable?
d Yes
3. SEWAGE SYSTEM A. Is the property connected to a public or community sewage system? B Are there any new public or community sewage systems proposed for the property? C. Is the property connected to an on-site septic system? (1) If yes, when was the system installed? (2) *lf yes was the system installed by permit? (3) *Has the system been repaired or altered? (4) Has the condition of the system been evaluated and a report issued? (5) Has the septic tank ever been pumped? If yes, when? (6) *Does the system have a pump? (7) *Does the system have a treatment unit such as a sand filter or an aerobic unit? (8) *ls a service contract for routine maintenance required for the system? (9) 'Are all components of the system located on the property? *D Are there any sewage system problems or needed repairs?. E. Does your sewage system require on-site pumping to another level?
£3 No
j^j Yes
dNo
dYes* dYes* dYes* dYes*
d Yes
5. DWELLING STRUCTURE *A. Has the roof leaked?. If yes has it been repaired"? B Are there any additions, conversions or remodeling"? If yes was a building permit required? If yes was a building permit obtained'? If yes was final inspection obtained? C Are there smoke alarms or detectors'? . . /. D Are there carbon monoxide alarms'?.... VXi^L.^fydjroOx^.. ...*No D Unknown *lf yes, explain on attached sheet the frequency and extent of problem and any insurance claims, repairs or remediation done. Is there a sump pump on the property? ................................................................................... D Yes No D Unknown Are there any materials used in the construction of the structure that are or have been the subject of a recall, class action suit, settlement or litigation? ......................... Q Yes j@LNo D Unknown If yes, what are the materials? _ (1) Are there problems with the materials?..........................................................................D Yes D No D Unknown (2) Are the materials covered by a warranty?............................,.................................... ...... D Yes D No D Unknown (3) Have the materials been inspected? ............................................................................... D Yes Q Unknown D No Q Unknown (4) Have there ever been claims filed for these materials by you or by previous owners?.. D Yes Q No If yes, when? _ (5) Was money received? ..................................................................................................... Q Yes D Unknown D No (6) Were any of the materials repaired or replaced? ............................................................ D Yes D No n Unknown
6. DWELLING SYSTEMS AND FIXTURES If the following systems or fixtures are included in the purchase price, are they in good working order on the date this form is signed? A. Electrical system, including wiring, switches, outlets and service........................................... _3 Yes DNo D Unknown B. Plumbing system, including pipes, faucets, fixtures and toilets...............................................0 Yes DNo D Unknown Water heater tank...................................................................................................................& Yes DNo D Unknown C. D. Garbage disposal...................................................................................................................Q Yes DNo D Unknown E. Built-in range and oven...........................................................................................................Q Yes ONo D Unknown F. Built-in dishwasher..................................................................................................................D Yes D Unknown DNo Sump pump ......................................... ..... ., ...... ..................................................................... D Yes Q Unknown G. DNo Heating and cooling systems ...... . ^ ^ ^ . . . . V ^ ^ A r .................................................. Jg] Yes D Unknown H. DNo
153 154 155
162 163 164
Are there any moisture problems, areas of water penetration, mildew odors
If yes, when? _ Was money received?.....................................................................................................D Yes Were any of the materials or products repaired or replaced? ......................................... D Yes
7. COMMON INTEREST A. Is there a Home Owners' Association or other governing entity? ........................................... D Yes Name of Association or Other Governing Entity
B. *C. D. E. F.
DNo
D Unknown
•Kl No
D Unknown
DNo DNo DNo DNo
D D D D
DNo DNo
D Unknown D Unknown
No
D Unknown
Contact Person Phone Number Address _ ____________ _ ___ _ _ Regular periodic assessments: $ per D Month D Year D Other Are there any pending or proposed special assessments?. D Yes* 'No Are there shared "common areas" or joint maintenance agreement for facilities like walls, fences, pools, tennis courts, walkways or other areas co-owned in undivided interest with others?... D Yes Is the Home Owners' Association or other governing entity a party to pending litigation or subject to an unsatisfied judgment? D Yes D No Is the property in violation of recorded covenants, conditions and ^ions or in violation of other bylaws or governing rules, whether recorded or not? D Yes D No
SELLER
Date /
SELLER
Unknown Unknown Unknown Unknown
&NA
0NA
QNA
SNA jfa NA SJNA
SNA
Unknown D Unknown D Unknown D Unknown
J_i£NA
Date
Suzi
This form has been licensed for use solely by Lisa Johnson pursuant to a Forms License Agreement with Oregon Real Estate Forms, LLC. LINES WITH THIS SYMBOL «- REQUIRE A SIGNATURE AND DATE Copyright Oregon Real Estate Forms, LLC 2000 - 2015 www.orefonline.com No portion may be reproduced without express permission of Oregon Real Estate Forms, LLC Produced with zipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026
Buyer Initials
www.zipLopix.Qom ww.zipLoqix.QQm
/
Date OREF 020 Page 4 of 5
SELLER'S PROPERTY DISCLOSURE STATEMENT I Property Address 27520 W Ingram Island Road, Monroe, OR 176 177 178 179
8. GENERAL A. Are there problems with settling, soil, standing water or drainage on the property or in the immediate area? B. Does the property contain fill?
180 181 182 183 184 185 186 187 188 189 190
C.
190 191 192 193 194
97456
fj Yes fj Yes
Is there an/material damage to the property or any of the structure(s) from fire, wind, floods, beach movements, earthquake, expansive soils or landslides? []] Yes Is the property in a designated floodplain? Ef-Yes Is the property in a designated slide or other geologic hazard zone? n Yes Was any portion of the property been tested or treated for asbestos, formaldehyde, radon, gas, lead-based paint, mold, fuel or chemical storage tanks or contaminated soil or water?. fj Yes* Are there any tanks or underground storage tanks (e.g^iptjc^chemical, fuel, etc.) on the property? £§ Yes Has the property ever been used as an illegal drug manufacturing or distribution site? n Yes "If yes, was a Certificate of Fitness issued?. Q Yes* Has the property been classified as forestland-urban interface? fj Yes
D. E. * F. G. H. I.
G Unknown G Unknown
QNo 0No
Q Unknown G Unknown G Unknown G Unknown G G G G
Unknown Unknown Unknown Unknown
&NA
9. FULL DISCLOSURE BY SELLER(S) *A. Are there any other material defects affecting this property or its value-that ^ \ c*JrY*'
