Florida Real Estate Disclosure Form

In the State of Florida, prior to the actual transaction, property owner fulfills this form and serves it to the prospective buyer.Download

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Seller's Real Property Disclosure Statement

FLORIDA ASSOCIATION OF REALTORS®

NAME:
SELLER HAS HAS NOT OCCUPIED THE PROPERTY.
IS THE PROPERTY CURRENTLY LEASED? NO YES TERMINATION DATE OF LEASE:
DOES THE PROPERTY CURRENTLY HAVE HOMESTEAD EXEMPTION? NO YES ; YEAR
GENERAL INFORMATION ABOUT PROPERTY:
PROPERTY ADDRESS:
LEGAL DESCRIPTION:

NOTICE TO BUYER AND SELLER:
In Florida, a Seller is obligated to disclose to a Buyer all known facts that materially affect the value of
the property being sold and that are not readily observable. This disclosure statement is designed to
assist Seller in complying with the disclosure requirements under Florida law and to assist the Buyer in
evaluating the property being considered. This disclosure statement concerns the condition of the real
property located at above address. It is not a warranty of any kind by the Seller or any Licensee in this
transaction. It is not a substitute for any inspections or warranties the parties may wish to obtain. It is
based only upon Seller's knowledge of the property condition. This disclosure is not intended to be a
part of any contract for sale and purchase. All parties may refer to this information when they evaluate,
market, or present Seller's property to prospective Buyers.

The following representations are made by the Seller(s) and are not the
representations of any real estate licensees.

CLAIMS & ASSESSMENTS 1.

proposed increases in assessments and/or maintenance fees) affecting the property? NO
explain:
Have any local, state, or federal authorities notified you that repairs, alterations or corrections of the property
are required? NOIf yes, explain:

2. DEED/HOMEOWNERS' ASSOCIATION RESTRICTIONS

Are You Aware:

a.
 of any deed or homeowner restrictions? NO

b.
 of any proposed changes to any of the restrictions? NO

c.
 of  any resale restrictions? NO

d.
 of any  restrictions on leasing the property? NO
If any answer to questions 2a-2d is yes, please explain:
Are  access roads  private public ? If private, describe the terms and conditions of the maintenance
agreement:
If there is a homeowner association, is membership mandatory? NO, and are fees charged by the
homeowner association? NOIf yes, explain:

3. PROPERTY-RELATED ITEMS

Are You Aware:

a.
if you have ever had the property surveyed? NODate:

c.
of any walls, driveways, fences or other features shared in common with adjoining landowners or any
encroachments, boundary line disputes, setback  violations, or easements affecting the property? NO

d.
 of any portion of the property that is fenced? NO
If any answer to questions 3a-3d is yes, please explain:

SRPD-3 Rev. 10/05 © 2005      Florida Association of R
EALTORS
® All Rights Reserved
 Page 1 of 5 Pages.
YES
YESYES
YESYES
YES
YES
YES YES
YES
 b. a.
e.
f.
g.
b.
 if the property was  surveyed, did you receive an elevation certificate? NOYES If yes,
YES Date: DATE SELLER PURCHASED PROPERTY?

Phone:Fax:

Produced with ZipForm™ by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035  www.zipform.com
Keller Williams Classic Realty 5979 Vineland Road, Ste 101 Orlando, FL  32819
(407) 376 - 3092Ken  ThompsonHeinz - Forest
 Are you aware of existing,  pending, or  proposed legal actions, claims, special assessments, municipal service
taxing or benefit unit charges or unpaid assessments (including  homeowners' association maintenance fees or

THE LAND: 4.

properties?  NO Are You Aware:

a.
 of any past or present settling, soil movement, of sinkhole problems on the property or on adjacent

b.
 of any past or present drainage or flood problems affecting the property or adjacent properties? NO

c.
 of any past or present problems with driveways, walkways, patios, seawalls, or retaining walls on the property
or adjacent properties due to drainage, flooding, or soil movements? NO
If any answer to questions 4a-4c is yes, please explain:

5. ENVIRONMENT:

Was the property built before 1978? NO
Are You Aware:

a.
 of any substances, materials, or products which may be an environmental hazard, such as, but not limited to,
asbestos, urea formaldehyde, radon gas, mold, lead-based paint, fuel, propane or chemical storage tanks (active or

b.
 of any condition or proposed change in the vicinity of the property that does or will materially affect the value
of the property, such as, but not limited to, proposed development or proposed roadways? NO

c.
 of wetlands, mangroves, archeological sites, or other environmentally sensitive areas located on the property?
NO
If any answer to questions 5a-5c is yes, please explain:

6. ZONING:

Are You Aware:

a.
 of the zoning classification of the property? NO

b.
 of any zoning violations or nonconforming uses?  NO

c.
if the property is zoned for its current use? NO

e.
 if there are any zoning, land use or administrative regulations which are in conflict with the existing or intended
use of the property? NO
If any answer to questions 6a-6f is yes, please explain:

7.FLOOD:

Are You Aware:

a.
 if any portion of the property is in a special flood hazard area? NO

b.
 does the property require flood insurance? NO

c.
 whether any improvements including additions, are located below the base flood elevation? NO

d.
 whether such  improvements have been constructed in violation of applicable local flood guidelines? NO

e.
 if any portion of the property is seaward of the coastal construction control line? NO
If any answer to questions 7a-7e is yes, please explain:

Page 2 of 5 Pages.

SRPD-3 Rev. 10/05 © 2005      Florida Association of R
EALTORS
® All Rights Reserved
 YES
YES
YES
YES
YESYES
YES

d.
of any zoning restrictions affecting additions, improvements or replacement of the property? NO YESIf yes, identify the zoning classification
YES
YES
YES
YES
YES
YES
 f.
 of any restrictions other than association and flood area requirements affecting improvements or replacement
of the property? NO YES

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i.
ii.
iii.
of any sinkhole insurance claim that has been made on subject property? NO YES
if claim made, was claim paid? NO YES
was the full amount of the insurance proceeds used to repair the sinkhole damage?  NO YES
NO YES If yes, explain:

i.
of any damage to the structures located on the property due to any of the substances, materials or products
listed in subsection (a) above? NOIf yes, explain: YES abandoned), or contaminated soil or water on the property?
YESYES
 ii.
of any clean up, repairs, or remediation of the property due to any of the substances, materials or products
listed in subsection (a) above? NOIf yes, explain:
YES

Heinz - Forest

STRUCTURE-RELATED ITEMS: 9.

hail, landslide, or blasting, and which materially affect the value of the property? NO Are You Aware:

a.
 of any structural damage which may have  resulted from events including, but not limited to, fire, wind, flood,

b.
 of any structural condition or, in the case of a homeowner association, any condition in the common elements
that materially affects the value of the property? NO

c.
 of any improvements or additions to the property, whether by you or  by others, that have been constructed in
violation of  building codes  or without necessary permits?  NO

d.
 of any active permits on the property which have not been closed by a final inspection? NO
If any answer to questions 9a-9d is yes, please explain:

10.
ROOF-RELATED ITEMS:

Are You Aware:

a.
 of any  roof or overhang defects? NO

b.
 if the roof has leaked since you owned the property? NO

c.
 if anything was  done to correct the leaks? NO

d.
 if the roof has been replaced? NOIf yes, when:
If any answer to questions 10a-10f is yes, please explain:
 e.
 If there is a warranty on the roof? NO

f.
11. PLUMBING-RELATED ITEMS:

What is your drinking water source? Public Private Well Other Source . If your drinking water is from a
well or other source, when was your water last checked for safety and what was the result of the test?
Do you have a water conditioning system? NO
YESIf yes, type:
Owned Leased
What is the balance owed on the system? $
Do you have a  sewer or septic system ? If septic system describe the location of each system:
Are you aware of any septic tanks or wells on the property which are not currently being used?
NOIf yes, explain:
Are you aware of any plumbing leaks since you have owned the property? NOIf yes, explain:
Are you aware of any conditions that materially affect the value of the property relating to the septic tank/drain
field, sewer lines, or any other plumbing related items? NO
If yes, explain:

Page 3 of 5 Pages.

SRPD-3 Rev. 10/05 © 2005      Florida Association of R
EALTORS
® All Rights Reserved
 a.
YES
YES
YES
YES
YES
YES If yes, is it transferable? NO YES
If the roof has been inspected within the last twelve months? NO

b.
c.
d.
e.

YES
YES
YES
 f.
g. 8. TERMITES, DRY ROT, PESTS, WOOD DESTROYING ORGANISMS:
a.
 Do you have any knowledge of termites, dry rot, pests or wood destroying organisms on or affecting any
improvements located on the property or any structural damage to the property by them? NOIf yes,

b.
 Have you ever had the property inspected for termites, dry rot, pest or wood destroying organism?
Date of inspectionIf so, what was the outcome of the inspection?

c.
 Has the property been treated for termites, dry rot, pest or wood destroying organisms? NO
Date
, Company name: explain:YES
YES NO
YES
and type of treatment
YES YES YES
YES

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Heinz - Forest

14.ELECTRICAL SYSTEM:

Are You Aware:

a.
 of any damaged or malfunctioning switches, receptacles, or wiring? NO

b.
 of any conditions that materially affect the value or operating capacity of the electrical system? NO
If answers to questions 14a or 14b is yes, please explain:If yes, explain:

15. HEATING AND AIR CONDITIONING:

Indicate  existing equipment:

Air conditioning:

Central Window/Wall Number of  units

Solar Heating:

Owned Leased

Wood-burning stove:
 NO

Fireplace:
 NODescribe  fireplace equipment:
Heating:

Electric Fuel Oil Gas Other
If yes, explain:

16. OTHER EQUIPMENT:

Indicate  existing equipment:
Security System: NOLeased Owned Connected to Central Monitor Monthly Fee $
Smoke Detectors: NO
Lawn Sprinkler System: NOSprinkler water source:If well is source, is
there an iron filter? NOIs there a timer? NOIs the timer automatic? NO
Garage door openers? NO, Number of transmitters?, Humidistat? NO
Humidifier? NOElectric air filters? NOVent fans? NO

17. OTHER MATTERS:

Is there anything else that materially affects the value of  the property? NO
If yes, explain:

Page 4 of 5 Pages.

SRPD-3 Rev. 10/05 © 2005      Florida Association of R
EALTORS
® All Rights Reserved
YES
YES
YES
YESYES
YES
YES
YES
YES
YES
YESYES YESYES
YESYESYES
YES
Paddle fans? NOYES
, Number of paddle fans?, Number of smoke detectors?
 12. POOLS/HOT TUBS/SPAS:
a.
 Does the property have a swimming pool? NOHot tub? NOSpa? NO

b.
 If you answered yes to any part of 12a, was the certificate of completion received after Oct. 1, 2000 for the
pool? NOFor the  spa?  NO YES For the hot tub? NO

c.
 Check the pool safety features (as defined by Section 515.27, Florida Statutes) your swimming pool, hot tub or
spa has: Enclosure that  meets the pool barrier  requirements Approved safety pool cover
Required door and window exit alarms Required door locks none

d.
 Are you aware of any conditions regarding these items that materially affect the value of the property?
NOIf yes, explain:

13. MAJOR APPLIANCES:

Indicate  existing equipment:
Range Oven Microwave Dishwasher Garbage  Disposal Trash  Compactor Refrigerator
Freezer Washer Dryer
Are any of these appliances leased? NOAre any of these gas appliances? NO
Is the water heater: owned leased ; Is the water heater: electric gasYESYESYES
YES YES
YES
YES YES

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Heinz - Forest
 Are you aware of any problems with these appliances, including whether any of the appliances have  leaked or
overflowed, since you  have owned the property? NO
Are you aware of any defects, malfunctioning or condensation problems regarding these items, since you have
owned the property? NO

SRPD-3 Rev. 10/05 © 2005      Florida Association of R
EALTORS
® All Rights Reserved
 ACKNOWLEDGEMENT OF SELLER

The undersigned Seller  represents that the information set forth in the above disclosure statement is accurate and com-
plete to the best of the Seller's knowledge on  the date signed below. Seller does not intend for this disclosure statement
to be a warranty or guaranty of any kind. Seller hereby authorizes disclosure of the information contained in this disclo-
sure statement to prospective Buyers of the property. Seller understands and agrees that Seller will notify the Buyer in
writing within five business days after Seller becomes aware that any information set forth in this disclosure statement
has become inaccurate or incorrect in any way during the term of the pending purchase by the Buyer.
Seller:
Seller:Date:
Date:

RECEIPT AND ACKNOWLEDGEMENT OF BUYER

Seller is using this form to disclose Seller's knowledge of the condition of the real property and improvements located on
the property as of the date signed by Seller. This disclosure form is not a warranty of any kind. The information con-
tained in the disclosure is limited to information to which the seller has knowledge. It is not intended to be a substitute for
any inspections or professional advice the Buyer may wish to obtain. An  independent professional inspection is encour-
aged and may be helpful to verify the condition of the property and to determine the cost of repairs, if any. Buyer under-
stands these representations are not made by any real estate licensee.
Buyer hereby acknowledges having received a copy of this disclosure statement.
Buyer:Date:
Buyer:Date:
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Heinz - Forest