Section 876IAC9-1-2. Residential sales disclosure; form

   The following is the seller's residential real estate sales disclosure form:

SELLER'S RESIDENTIAL REAL ESTATE SALES DISCLOSURE								Date (month, day, year)
		State Form 46234 (R/1293)
Seller states that the information contained in this Disclosure is correct to the best of Seller's CURRENT ACTUAL KNOWLEDGE as of the above date. The prospective buyer and the owner may wish to obtain professional advice or inspections of the property and provide for appropriate provisions in a contract between them concerning any advice, inspections, defects, or warranties obtained on the property. The representations in this form are the representations of the owner and are not the representations of the agent, if any. This information is for disclosure only and is not intended to be a part of any contract between the buyer and the owner. Indiana law (IC 32-21-5) generally requires sellers of 1–4 unit residential property to complete this form regarding the known physical condition of the property. An owner must complete and sign the disclosure form and submit the form to a prospective buyer before an offer is accepted for the sale of the real estate.
Property address (number and street, city, state, ZIP code)
1. The following are in the conditions indicated:
A. APPLIANCES	None/Not Included	Defective	Not Defective	Do Not Know		C. WATER & SEWER SYSTEM	None/Not Included	Defective	Not Defective	Do Not Know
Built-in Vacuum System						Cistern
Clothes Dryer						Septic Field/Bed
Clothes Washer						Hot Tub
Dishwasher						Plumbing
Disposal						Aerator System
Freezer						Sump Pump
Gas Grill						Irrigation Systems
Hood						Water Heater/Electric
Microwave Oven						Water Heater/Gas
Oven						Water Heater/Solar
Range						Water Purifier
Refrigerator						Water Softener
Room Air Conditioner(s)						Well
Trash Compactor						Septic and Holding Tank/Septic Mound
TV Antenna/Dish						Geothermal and Heat Pump
TV Antenna/Dish						Other Sewer System (Explain)
Other:						Swimming Pool and Pool Equipment
								Yes	No	Do Not Know
						Are the structures connected to a public water system?
						Are the structures connected to a public sewer system?
						Are there any additions that may require improvements to the sewage disposal system?
						If yes, have the improvements been completed on the sewage disposal system?
						Are the improvements connected to a private/community water system?
						Are the improvements connected to a private/community sewer system?
B. ELECTRICAL SYSTEM	None/Not Included	Defective	Not Defective	Do Not Know		D. HEATING & COOLING SYSTEM	None/Not Included	Defective	Not Defective	Do Not Know
Air Purifier						Attic Fan
Burglar Alarm						Central Air Conditioning
Ceiling Fan(s)						Hot Water Heat
Garage Door Opener/Controls						Furnace Heat/Gas
Inside Telephone Wiring and Blocks/Jacks						Furnace Heat/Electric
						Solar House-Heating
Intercom						Wood burning Stove
Light Fixtures						Fireplace
Sauna						Fireplace Insert
Smoke/Fire Alarm(s)						Air Cleaner
Switches and Outlets						Humidifier
Vent Fan(s)						Propane Tank
60/100/200 Amp Service (Circle one)						Other Heating Source
NOTE: "Defect" means a condition that would have a significant adverse effect on the value of the property that would significantly impair the health or safety of future occupants of the property or that, if not repaired, removed, or replaced, would significantly shorten or adversely affect the expected normal life of the premises.
The information contained in this Disclosure has been furnished by the Seller, who certifies to the truth thereof, based on the Seller's CURRENT ACTUAL KNOWLEDGE. A disclosure form is not a warranty by the owner or the owner's agent, if any, and the disclosure form may not be used as a substitute for any inspections or warranties that the prospective buyer or owner may later obtain. At or before settlement, the owner is required to disclose any material change in the physical condition of the property or certify to the purchaser at settlement that the condition of the property is substantially the same as it was when the disclosure form was provided. Seller and Purchaser hereby acknowledge receipt of this Disclosure by signing below:
Signature of Seller:			Date:			Signature of Buyer:			Date:
Signature of Seller:			Date:			Signature of Buyer:			Date:
The Seller hereby certifies that the condition of the property is substantially the same as it was when the Seller's Disclosure form was originally provided to the Buyer.
Signature of Seller (at  closing):			Date:			Signature of Seller (at  closing):			Date:
Property Address (number and street, city, state, ZIP code)
2. ROOF		YES	NO	DO NOT KNOW		4. OTHER DISCLOSURES		YES	NO	DO NOT KNOW
Age, if known: ____ Years						Do structures have aluminum wiring?
Does the roof leak?						Are there any foundation problems with the structures?
Is there present damage to the roof?						Are there any encroachments?
Is there more than one layer of shingles on the house?						Are there any violations of zoning, building codes, or restrictive covenants?
If yes, how many layers? __________						Is the present use a nonconforming use? Explain:
						Is the access to your property via a private road?
3. HAZARDOUS CONDITIONS		YES	NO	DO NOT KNOW		Is the access to your property via a public road?
Have there been or are there any hazardous conditions on the property, such as methane gas, lead paint, radon gas in house or well, radioactive material, landfill, mineshaft, expansive soil, toxic materials, mold, other biological contaminants, asbestos insulation, or PCB's? Explain:						Is the access to your property via an easement?
						Have you received any notices by any governmental or quasi-governmental agencies affecting this property?
						Are there any structural problems with the building?
						Have any substantial additions or alterations been made without a required building permit?
						Are there moisture and/or water problems in the basement, crawl space area, or any other area?
						Is there any damage due to wind, flood, termites, or rodents?
						Have any structures been treated for wood destroying insects?
						Are the furnace/woodstove/chimney/flue all in working order?
						Is the property in a flood plain?
						Do you currently pay flood insurance?
						Does the property contain underground storage tank(s)?
						Is the homeowner a licensed real estate broker?
						Is there any  threatened or  existing litigation  regarding the property?
						Is the property subject to covenants, conditions, and/or restrictions of a homeowner's association?
						Is the property located within one (1) mile of an airport?
E. ADDITIONAL COMMENTS AND/OR EXPLANATIONS: (Use additional pages if necessary)
The information contained in this Disclosure has been furnished by the Seller, who certifies to the truth thereof, based on the Seller's CURRENT ACTUAL KNOWLEDGE. A disclosure form is not a warranty by the owner or the owner's agent, if any, and the disclosure form may not be used as a substitute for any inspections or warranties that the prospective buyer or owner may later obtain. At or before settlement, the owner is required to disclose any material change in the physical condition of the property or certify to the purchaser at settlement that the condition of the property is substantially the same as it was when the disclosure form was provided. Seller and Purchaser hereby acknowledge receipt of this Disclosure by signing below:
Signature of Seller:			Date:			Signature of Buyer:			Date:
Signature of Seller:			Date:			Signature of Buyer:			Date:
The Seller hereby certifies that the condition of the property is substantially the same as it was when the Seller's Disclosure form was originally provided to the Buyer.
Signature of Seller (at  closing):			Date:			Signature of Seller (at  closing):			Date:

(Indiana Real Estate Commission; 876 IAC 9-1-2; filed May 22, 2014, 11:50 a.m.: 20140618-IR-876140061FRA, eff Jul 1, 2014)

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