SUPPLEMENTAL DISCLOSURE QUESTIONNAIRE

If any of the statements below are true, please provide an explanation on the following page and refer to the statement number.

  1. Within the last 3 years, there has been a death upon the Property.
  2. There has been an order from a government health official identifying the Property as being contaminated by methamphetamine.
  3. The Property is located in or adjacent to an “industrial use” zone, or affected by a nuisance created by one.
  4. The Property is located within one mile of a former federal or state ordnance location, which generally means an area used for military training that may contain explosives or munitions.
  5. Within the last 5 years, there have been insurance claims related to the Property.
  6. There are items that require recurring maintenance on the Property, such as a pest control service or sewer clean-out.
  7. Within the last 5 years, there have been material repairs or modifications of the Property.
  8. There are portions of the Property that are defective.
  9. The Property has experienced, at any time, water intrusion or leaks.
  10. The Property has experienced, at any time, problems with mold, mildew or fungus.
  11. The Property has experienced, at any time, problems with livestock, wildlife, or insects.
  12. There are pending or proposed dues increases, assessments, rule changes, or fines by an applicable homeowner association.
  13. The Property experiences neighborhood noise problems or other nuisances.
  14. There are pending or proposed changes in laws that will affect the Property.

[    ] No, none of the statements above are true.

[   ] Yes, some of the statements above are true, as explained below:


Is there any other material fact affecting the value or desirability of the Property not otherwise disclosed above or on the other disclosures you are delivering to Buyer?

[    ] No

[    ] Yes, as explained below:


Seller represents that the above information is true and correct to the best of Seller's knowledge as of the date signed by Seller below.

Seller____________________________            Date_________________

Seller____________________________            Date_________________

Buyer acknowledges receipt of this statement as of the date written below.

Buyer____________________________            Date_________________


Buyer____________________________            Date_________________