C-21 Southern Realty Group
TRANSACTION COVER SHEET
BUYER/TENANT ONE INFORMATION
Buyer 1 Name:
Street Address:
City:
State:
Zip Code:
County:
Home Phone Number:
Business Phone Number:
Fax Number:
Cellular Phone Number:
Email Address:
Buyer 1 Marital Status:
BUYER/TENANT TWO INFORMATION
Buyer 2 Name:
Street Address:
City:
State:
Zip Code:
County:
Home Phone Number:
Business Phone Number:
Fax Number:
Cellular Phone Number:
Email Address:
Buyer 2 Marital Status:
BUYER/TENANT THREE INFORMATION
Buyer 3 Name:
Street Address:
City:
State:
Zip Code:
County:
Home Phone Number:
Business Phone Number:
Fax Number:
Cellular Phone Number:
Email Address:
Buyer 3 Marital Status:
SELLER/LANDLORD ONE INFORMATION
Seller Name:
Street Address:
City:
State:
Zip Code:
County:
Home Phone Number:
Business Phone Number:
Fax Number #:
Cellular Phone Number:
Email Address:
Seller 1 Marital Status:
Kimberly
Guynn
[email protected]
Page 1 of 6
C-21 Southern Realty Group 2201 Highway 90 Gautier, MS 39553
Chad Woods
Phone: (228)258-2121
Fax:
Produced with ZipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipLogix.com
Guynn, Kimberly
TRANSACTION COVER SHEET
SELLER/LANDLORD TWO INFORMATION
Seller Name:
Street Address:
City:
State:
Zip Code:
County:
Home Phone Number:
Business Phone Number:
Fax Number:
Cellular Phone Number:
Email Address:
Seller 2 Marital Status:
SELLER/LANDLORD THREE INFORMATION
Seller Name:
Street Address:
City:
State:
Zip Code:
County:
Home Phone Number:
Business Phone Number:
Fax Number:
Cellular Phone Number:
Email Address:
Seller 3 Marital Status:
SELLING BROKER INFORMATION
Selling Office ID#:
Selling Broker Firm Name:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Sales Agent Name:
Agent's Phone Number:
Fax Number:
Cellular Phone Number:
Pager:
Email Address:
Selling Agent ID#:
LISTING BROKER INFORMATION
Listing Broker Firm Name:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Sales Agent Name:
Agent's Phone Number:
Fax Number:
Cellular Phone Number:
Pager:
Email Address:
Listing Office ID#:
Century 21 Southern Realty Group
2201 Hwy 90
Gautier
MS
39553
(228)258-2121
Lesli Ann Harris
(228)282-5950
(228)258-2124
(228)282-5950
Listing Agent ID#:
harrll15
[email protected]
Page 2 of 6
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Guynn, Kimberly
TRANSACTION COVER SHEET
PROPERTY INFORMATION
MLS Number:
2300 Bayou View Dr
Street Address:
Gautier
City:
Township:
Jackson
County:
MS
State:
39553
Zip Code:
Lot
127&127Hickory
Hill EstsS/D Unit7 PB11-22&23DB1207-10(230Map771.01-03
Legal Description:
85440715.000
Tax ID#:
Listing Date:
March 21, 2011
November 1, 2011
Listing Expiration Date
Listed Price:
$ 149,000.00
Balance of 1st Mortgage:
$
Balance of 2nd Mortgage:
$
Other Liens:
$
Description of Other Liens:
Total Encumbrances:
$
Homeowner Assoc. Dues:
$
Property Includes:
Property Excludes:
Leased Items:
Supplemental Info:
Purchase Price:
Purchase Agreement Date:
Deposit Amount:
Deposit Amount 1st Increase:
Deposit Amount 2nd Increase:
Deposit Amount 3rd Increase:
Offer Date:
Offer Expire Date:
Offer Acceptance Date:
Total Amount Financed:
Year Built:
Lot Number:
Unit Number:
Block:
Subdivision:
Plat Book:
Page Number:
School District:
Zoning Class:
Property Type: X Residential
$
Settlement Date
$
$
$
$
Offer Expire Time
A.M.
P.M.
$
Multi Family
Vacant Land
Commercial
ESCROW INFORMATION
Other
Escrow Company:
Escrow Number:
Street Address:
City:
State:
Zip Code:
Escrow Officer:
Escrow Officer Email Address:
Telephone Number:
Closing Date:
Deposit One:
Deposit Two:
Fax Number
Page 3 of 6
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Guynn, Kimberly
TRANSACTION COVER SHEET
BUYER'S LENDER INFORMATION
Lender Company Name:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Lender's Officer Name:
Fax Number:
Cell Phone Number:
Email Address:
Pager:
Conv.
Mortgage Type:
N/A
FHA
FMHA
VA
Other
APPRAISAL INFORMATION
Appraisal Company Name:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Appraisal Officer Name:
Fax Number:
Cell Phone Number:
Email Address:
Pager:
TITLE INFORMATION
Title Company Name:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Title Officer Name:
Fax Number:
Cell Phone Number:
Email Address:
ATTORNEY REPRESENTING BUYER(S)
Attorney Name, for Buyer(s):
Attorney's Firm Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:
ATTORNEY REPRESENTING SELLER(S)
Attorney Name, for Seller(s):
Attorney's Firm Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:
Page 4 of 6
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Guynn, Kimberly
TRANSACTION COVER SHEET
SURVEYOR'S INFORMATION
Survey Company Name:
Surveyor's Name:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Fax Number:
Cell Phone Number:
Email Address:
Survey Order Date:
Actual Survey Date:
HOME WARRANTY INFORMATION
Home Warranty Company Name:
Warranty Paid By:
Warranty Type:
Application processed Online
Application processed Phone
Application processed Fax
Contract Total
$
Contract #
Buyer
Seller
Traditional
Select
at
HOME INSPECTION INFORMATION
Home Inspection Company Name:
Name of Inspector:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Fax Number:
Cell Phone Number:
Email Address:
Date of Inspection:
Issues After Inspection?
Y
N
Refer to Home Inspection Addendum
TERMITE/PEST CONTROL INFORMATION
Termite/Pest Control Company Name:
Name of Inspector:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Fax Number:
Cell Phone Number:
Email Address:
Date of Inspection:
Issues After Inspection?
Y
N Treatment?
Y
N
Page 5 of 6
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Guynn, Kimberly
TRANSACTION COVER SHEET
SELLER'S REFERRAL INFORMATION
Referral Company Name:
Referral Contact Name:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Fax Number:
Cell Phone Number:
Email Address:
Referral Fee (If Applicable)
Referral Reference #
%
Federal ID:
BUYER'S REFERRAL INFORMATION
Referral Company Name:
Referral Contact Name:
Street Address:
City:
State:
Zip Code:
Office Phone Number:
Fax Number:
Cell Phone Number:
Email Address:
Referral Fee (If Applicable)
Referral Reference #
%
Federal ID:
CLOSING
Estimated Date to Close:
Actual Date to Close:
Location to Close:
Comments:
Time:
Time:
AM
AM
PM
PM
Page 6 of 6
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Guynn, Kimberly
EXCLUSIVE AUTHORIZATION AND RIGHT TO SELL
LISTING AGREEMENT
This is a legally binding agreement - READ IT CAREFULLY
This form is provided as a courtesy to the parties only. It is not required to be used in this transaction and may not fit the needs, goals and purposes of the parties. The
Mississippi Association of REALTORS® makes no statement or warranty as to this form, its contents or use, and the parties, by their use of this form, acknowledge said
facts and agree that neither the Mississippi Association of REALTORS® nor any member thereof shall be liable to any party or person for its contents or use. If any party
to this transaction does not fully understand it, or has any question, the party should seek advice from a competent legal professional before signing.
1
2
3
4
5
6
7
8
9
Are you currently a party to a referral agreement with a relocation company or another real estate broker?
YES
X NO
1.
EXCLUSIVE RIGHT TO SELL. I, the undersigned Owner, hereinafter called ''Owner'', hereby employ and grant
, hereinafter called ''Broker'', the exclusive and irrevocable right commencing on
, and expiring at midnight on
March 21, 2011
November 1, 2011 , to sell or exchange the real property
situated in the City of
, County of
, Mississippi, located at:
Jackson
Legal Description:
Lot 127&127Hickory Hill EstsS/D Unit7 PB11-22&23DB1207-10(230Map771.01-03
2300 Bayou View Dr
Gautier
39553
Street Address
City/Town
Zip Code
10
11
2.
LIST PRICE. The list price shall be $ 149,000.00
12
13
14
15
16
17
18
19
3.
MULTIPLE LISTING SERVICE (MLS). Broker is a Participant of the
Multiple
MS Gulf Coast MLX
Listing Service (MLS) and this listing information will be provided to the MLS to be published and disseminated to its Participants.
The Listing Broker is also authorized to report the sale, when it occurs, including the price, terms and financing for the publication,
dissemination, information and use by authorized members, MLS participants and Subscribers. The Listing Broker is authorized to
cooperate with other licensed Brokers/Agents to sell this property and to share the compensation resulting from the sale with the
Selling Broker on a basis solely determined by the Listing Broker. It is the policy of the Listing Broker to compensate the Selling
Broker a percentage of the total agreed upon sales price as follows: 3.0%
.
20
21
22
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25
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29
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34
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4.
COMPENSATION.
(a) Owner agrees to pay Broker, irrespective of agency relationship(s), a commission of
% of the selling price OR a
6.000
and a base commission of $ n/a
commission of $ n/a
if the Property is sold during
the term of or any extension hereof on the terms herein set forth, or
% of the listing price OR a commission of
6.000
$ n/a
and a base commission of $ n/a
if the Property is withdrawn from sale,
transferred, conveyed, leased or rented without the consent of Broker or made unmarketable by Owner's voluntary act during the
term hereof or any extension hereof.
(b) The compensation provided for in subparagraph (a) above if property is sold, conveyed, or otherwise transferred within
45
days after the termination of this Contract or any extension thereof (Protection Period) to anyone to whom this property was shown
provided Owner has received notice in writing, including the names of the prospective purchasers, before or upon termination of
this agreement or any extension thereof.
(c) Owner shall be obligated to pay the compensation provided for in subparagraph (a) if, in the event of breach by Buyer, Seller
successfully secures specific performance by Buyer.
(d) Owner shall not be obligated to pay the compensation provided for in subparagraph (a) if a valid listing agreement is entered into
during the term of said Protection Period with another licensed real estate broker and a sale, lease or exchange of the property is
made during the term of said valid listing agreement.
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5.
DEPOSIT: X Listing
Selling Broker is authorized to accept and hold on Owner's behalf any deposit of earnest money set forth
in the Contract between the parties. In the event Buyer's earnest money is forfeited, one-half (1/2) of the same shall be retained by or
paid to the Listing Broker as their compensation, provided that the Listing Broker's portion of any such forfeited deposit shall not
exceed the amount of the above-referenced fee, and the remainder shall be paid to Owner.
40
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6.
I authorize Broker to advertise my property on the Internet
I authorize Broker to place a lockbox on my property
I agree to provide a Home Warranty upon sale of property
I authorize Broker to accept a fee for selling the referenced Home Warranty
I authorize Broker to accept a deposit of earnest money
I authorize Broker to obtain mortgage information on the above described property
46
47
48
49
and on the following terms As listed in GCMLX
or other price and terms that are acceptable to me.
X YES
X YES
YES
NO
NO
NO
NO
NO
X NO
X YES
X YES
NO
NO
YES
X YES
X YES
ACCT#
Mortgage Company
N/A
Address
I authorize Broker to place a For Sale/Sold sign on my property
I authorize Listing Broker to disclose to buyers or cooperating brokers the existence of offers on the property
Page 1 of 2
Copyright ©2010 by Mississippi Association of REALTORS®
F4 - Exclusive Right to Sell Listing Agreement
C-21 Southern Realty Group 2201 Highway 90 Gautier, MS 39553
Phone: (228)258-2121
Fax:
Chad Woods
Produced with ZipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026
Rev. Date 2/2010
Guynn, Kimberly
www.zipLogix.com
50
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7.
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The Listing Broker is hereby authorized as an MLS Participant to:
X Offer other licensed Brokers cooperation and compensation but not by subagency
Offer other licensed Brokers Subagency and compensation
X Act in the capacity of a Disclosed Dual Agent
8.
IMPROVEMENTS: All improvements and appurtenances are included in the Purchase Price including, if now in or on the Property,
the following: lighting fixtures and their shades, ceiling fans, drapery and curtain hardware, window shades and blinds, window and
door screens, stationary laundry tubs, water heaters, smoke detectors, built-in security systems, TV antenna and satellite dish and
complete rotor equipment, mailbox, remote control garage door opener(s), water pump and pressure tank, built-in kitchen appliances,
attached gas grill, awnings, all plumbing and heating and air conditioning equipment including any window units. Seller shall provide
to buyer or selling broker at closing at least one (1) exterior door key to the main dwelling.
none
List any leased equipment:
62
YES
Is security system under contract that must be fulfilled?
X NO
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9.
LEAD BASED PAINT: If dwelling was built before 1978, a lead-based paint inspection may be required and the presence of known
lead-based paint must be disclosed.
65
66
10.
HOMESTEAD EXEMPTION: Homestead exemption
Condition Disclosure Statement.
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11.
OWNER'S ACKNOWLEDGEMENT. I hereby certify that all information provided herein and on the Property Condition Disclosure
Statement attached has been written by me and is complete, true and accurate to the best of my knowledge and belief. I, the Owner,
agree to defend, indemnify and hold harmless the Broker and their salespersons against and from any losses, damages, claims, suits at
law (including court costs and attorneys fees) or other costs or expenses relating to or resulting from any actual or alleged inaccuracy
or incompleteness of the property information contained herein or any other information provided by me.
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is or
is not in effect for the current year as represented by the Property
By signing below I acknowledge that the mandatory Working With a Real Estate Broker disclosure form has been fully explained to
me and I acknowledge receipt of a signed copy. I, as Owner, acknowledge that I have read and understand this Agreement and, have
received a copy. I further acknowledge that I have good title to the Property and full authority to execute this Agreement. I further
agree to permit Broker to reassign me to another agent within the firm for representation should I and Broker agree that reassignment is
best.
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12.
BROKER ACKNOWLEDGEMENT. Broker/Agent agrees: (1) to exercise all duties to Seller(s) as set forth in the Working With a
Real Estate Broker disclosure prescribed by the Mississippi Real Estate Commission, including the fiduciary duties of confidentiality,
obedience, disclosure, full accounting and the duty to use skill, care and diligence; and (2) to exercise the duty of honest and fair
dealing to Seller(s) and Buyer(s).
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13.
EQUAL HOUSING OPPORTUNITY: This property is offered in compliance with applicable anti-discrimination laws.
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14.
ATTORNEY FEES: In any legal action, proceeding or arbitration arising out of this Agreement, the prevailing party shall be entitled
to reasonable attorney's fees and costs from the non-prevailing party.
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15.
ENTIRE AGREEMENT. There are no other agreements or conditions except as set forth herein and on the MLS profile sheet
attached, if any. No verbal statements, representations, promises or inducements shall have any validity or effect nor shall be a part of
this Agreement. Any amendments, changes, additions or deletions to this Agreement must be in writing signed by all parties. Owner
should seek professional, legal and/or tax advice.
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16.
NOTICE. Any notices required or permitted to be given under this contract shall be delivered by hand or mailed by certified or
registered mail, return receipt requested, in a postage prepaid envelope; by nationally recognized overnight carrier service; by facsimile
with receipt acknowledgment (if the fax number is listed below); or by email (if the email address is listed below), at Sender's option,
and addressed to Owner as follows:
91
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93
Address:
Facsimile:
Email: [email protected]
94
Signed this the
95
BROKER:
day of
, at
a.m.
OWNER:
Kimberly
96
p.m., and a copy hereof received:
Broker's Firm Name Century 21 Southern Realty Group
97
Lesli Ann Harris
Guynn
Phone:
OWNER:
Broker's Affiliated Salesperson
98
Phone: (228)258-2121
Phone:
Page 2 of 2
Rev. Date 2/2010
Copyright ©2010 by Mississippi Association of REALTORS®
F4 - Exclusive Right to Sell Listing Agreement
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Guynn, Kimberly
INFORMATIONAL STATEMENT FOR MISSISSIPPI PROPERTY CONDITION
DISCLOSURE STATEMENT (EFFECTIVE JULY 1, 2008)
In accordance with Sections 89-1-501 through 89-1-527 of the Mississippi Code of 1954, as amended, effective July 1, 2005, a TRANSFEROR of
real property consisting of not less than one (1) nor more than four (4) dwelling units shall provide a Property Condition Disclosure Statement when
the transfer is by, or with the aid of, a duly licensed real estate broker or salesperson. The required Property Condition Disclosure Statement shall be
in the form promulgated by the Mississippi Real Estate Commission (MREC) or on another form that contains the identical information. The MREC
Form may be found at www.mrec.ms.gov.
RIGHTS OF PURCHASER AND CONSEQUENCES FOR FAILURE TO DISCLOSE
If the Property Condition Disclosure Statement is delivered after the Transferee has made an offer, the transferee may terminate any resulting real
estate contract or withdraw any offer for a time period of three (3) days after the delivery in person or five (5) days after the delivery by deposit in
mail. This termination or withdrawal will always be without penalty to the Transferee and any deposit or earnest money must be promptly returned to
the prospective purchaser (despite any agreement to the contrary).
DUTY OF LICENSEE AND CONSEQUENCES OF FAILURE TO FULFILL SUCH DUTIES
The Mississippi Statute requires real estate licensees to inform their clients of those clients’ duties and rights in connection with the Property
Condition Disclosure Statement. The failure of any licensee to inform their client of the clients’ responsibilities could subject the licensee
(salesperson and broker) to censure, suspension, or revocation of their respective real estate licenses. The licensee is not liable for any error,
inaccuracy or omission in a Property Condition Disclosure Statement unless the licensee has actual knowledge of the error, inaccuracy or omission
by the Transferor.
IMPORTANT PROVISIONS OF THE LAW
**The Property Condition Disclosure Statement should not be considered a warranty by the Transferor.
**The Property Condition Disclosure Statement is NOT intended to become a part of any contract between the Transferor(s) and the Transferee(s)
and it is for “disclosure” purposes only.
**The Property Condition Disclosure Statement may not be used as a substitute for an inspection by a licensed home inspector or for other home
warranties that the Transferor or Transferee may obtain.
**Any Appliances or Items deemed to be Personal Property should be negotiated by the Seller and the Buyer in the Contract for the Purchase and
Sale of Real Estate and all ownership rights should be transferred by a Bill of Sale or other appropriate contractual instrument. This Property
Condition Disclosure Statement is not part of the Contract of Sale.
**Nothing in this law precludes the rights and duties of the Transferee to inspect the property.
EXEMPTIONS
Section 89-1-501 (2) <a through i> stipulates specific exemptions from the requirement of providing a Property Condition Disclosure Statement by
the Transferor of residential property. They include:
**Transfers pursuant to a court order, a writ of execution, a foreclosure sale, a bankruptcy, an eminent domain proceeding, transfers from a decree
for specific performance, transfers by a mortgagor who is in default, any sale pursuant to a decree of foreclosure or by means of a deed in lieu of
foreclosure, transfer by the administration of a decedent’s estate, a guardianship, a conservatorship or a trust.
**Transfers from one co-owner to another, transfers from one spouse to another, transfers to a person in the lineal line of consanguinity, transfers to
or from governmental entities or transfers on which no dwelling is located.
If the Transferor has NOT OCCUPIED the dwelling but, during the period of ownership, the Transferor has requested or authorized any
repairs, replaced any of the mechanical equipment, has initiated any action or activity which could be documented on the Disclosure
Statement or has actual knowledge of information which might impact a transferee’s decision to purchase the residence, Transferors are
obligated to complete those specific portions of the Disclosure Statement which are applicable to that information.
The Transferor is REQUIRED to sign the Disclosure Statement when the transaction is finalized to confirm that there have been no material
changes to the property.
CONFIRMATION OF UNDERSTANDING
SELLER (UPON LISTING)
DATE
BUYER (BEFORE OFFER)
DATE
SELLER (UPON LISTING)
DATE
BUYER (BEFORE OFFER)
DATE
REPRESENTING THE SELLER(S)
REPRESENTING THE BUYER(S)
Page 1 of 4
PROPERTY CONDITION DISCLOSURE STATEMENT
The following is a Property Condition Disclosure required by Sections 89-1-507 through 89-1-527 of the Mississippi Real Estate
Brokers Act of 1954, as Amended, and made by the SELLER(S) concerning the condition of the RESIDENTIAL PROPERTY
located at:
Approximate Age of the Residence
SELLER(S):
This Disclosure is not a warranty of any kind by the Seller or any Real Estate Agent of the Seller in this transaction and is not a
substitute for any inspections or warranties the Purchaser may wish to obtain. This statement may be made available to other parties
and is to be attached to the Listing Agreement and signed by the SELLER(S).
TO THE SELLER(S): Please complete the following form, including any past history of problems, if known. If the condition or
question does not apply to your property, mark with “N/A”.
IF THE RESIDENCE IS NEW/PROPOSED RESIDENTIAL CONSTRUCTION, the BUILDER should complete the Property
Condition Disclosure Statement and reference specific plans/specifications, materials lists and/or change orders.
DO NOT LEAVE ANY BLANK SPACES. ATTACH ADDITIONAL PAGES IF
NECESSARY. THIS FORM MAY BE DUPLICATED BUT NOT ALTERED
STRUCTURAL ITEMS:
A.
B.
C.
D.
E.
BUILDING CODE:
Was the residence built in conformity with an approved building code?
If yes, was it inspected by a City/County Code Enforcement Inspector?
Has a Mississippi Licensed Home Inspector completed a Home Inspection Report?
STRUCTURAL ITEMS:
Are you aware of any foundation repairs made in the past?
Are any foundation repairs currently needed?
Yes
Yes
No
No
Explain
Yes
Yes
Yes
No
No
No
Explain
HISTORY OF INFESTATION, IF ANY: TERMITES, CARPENTER ANTS, ETC:
Any evidence of rot, mildew, vermin, rodents, termites, carpenter ants, or other infestation?
Yes
Have you requested treatments for any type of infestations? Yes
No
Explain
Are you aware of any Repaired Damage? Yes
No
; If yes, please describe
Is there currently an outstanding termite contract? Yes
No
Who is the contractor?
ROOF:
Has the roof been replaced or repaired during your ownership?
Yes
No
; If yes, when?
During your ownership have there been any leaks, water back ups, or problems with the roof?
Yes
The roof is
years old.
LAND AND SITE DATA:
Is there an engineer’s survey available? Yes
No
Are you aware of the existence of any of the following, to wit:
Encroachments: Yes
No
Unknown
Easements:
Yes
No
Unknown
Soil Problems: Yes
No
Unknown
Standing Water: Yes
No
Unknown
Unknown
Unknown
No
No
Date the survey was completed
Flood Zone:
Yes
Soil/Erosion:
Yes
Subsoil Problem: Yes
Land Fill:
Yes
No
No
No
No
Unknown
Unknown
Unknown
Unknown
Are you aware of any current zoning regulations which will cause the residence to be considered a nonconforming usage
(lot size, set backs, etc) Yes
No
If Yes, please explain
Are there any rights-of-way, easements, eminent domain proceedings or similar matters which may negatively impact your
ownership interest in the residence? Yes
No
If YES, please explain
FOR ANY REASON, has any portion of the residence ever suffered water damage? Yes
No
If yes, please
explain in detail
. Is the residence currently located in a FEMA Designated Flood Hazard
Zone? Yes
No
Unknown
; Is Flood Insurance required? Yes
No
Unknown
Is any portion of the property designated as a WETLANDS AREA?
Yes
No
Unknown
F.
ADDITIONS/REMODELS:
During your period of ownership, have there been any additions, remodeling, structural changes or alterations to the residence?
Yes
No
If YES, please explain
Name of the Licensed Contractor
. Were all work permits and approvals in compliance
with the local building codes? Yes
No
Please Explain
SELLER’S INITIALS
Page 2 of 4
PURCHASER’S INITIALS
G.
STRUCTURE/WALLS/ WINDOWS:
Has there been any damage to the structure as a result of fire, windstorm, tornados, hurricane or any other natural disaster?
Yes
No
If YES, please explain
Have you ever experienced ANY problems with walls, siding or windows? Yes
No
Explain
H.
OTHER:
Are you aware of any problems which may exist with the property by virtue of prior usages such as, but not limited to,
Methamphetamine Labs, Hazardous/Toxic waste disposal, the presence of asbestos components, Lead-Based Paint,
Urea-Formaldehyde Insulation, Mold, Radon Gas, Underground Tanks or any past industrial uses of the premises?
Yes
No
If YES, please explain
MECHANICAL ITEMS:
ELECTRICAL SYSTEM/PLUMBING SYSTEM:
Are you aware of any problems or conditions that affect the desirability or functionality of the Heating, Cooling, Electrical,
Plumbing, or Mechanical Systems? Yes
No
If yes, please explain all known problems in complete detail
WATER, SEWER, & SEPTIC ITEMS:
WATER:
The water supply is: Public
Private
On-site Well
Neighbor's Well
Community
If your drinking water is from a well, when was the water quality last checked for safety, what were the results of the test and
who conducted the test?
Is the water supply equipped with a water softener? Yes
No
Unknown
The Sewage System is: Public
Private
Septic
Cesspool
Treatment Plant
Other
Is there a sewage pump installed? Yes
No
Date of the last Septic Inspection
Are you aware of any leaks, back-ups, or other problems relating to any of the plumbing, water, sewage, or related items during
your ownership? Yes
No
. If yes, please explain
OTHER MATTERS/ITEMS:
MISCELLANEOUS:
Is the residence situated on Leasehold or Sixteenth Section land? Yes
No
Explain
Is there any existing or threatening legal action affecting the property? Yes
No
Explain
Are you aware of any violations of local/state/federal laws/regulations relating to the property? Yes
No
Are you aware of any hidden defects or needed repairs about which the purchaser should be informed PRIOR to their purchase?
Yes
No
. If yes, please explain in detail
What is the APPROXIMATE SQUARE FOOTAGE of the Heated and Cooled Living Area
How was this approximation of square footage determined?
Are there any finished wood floors beneath the floor coverings? Yes
No
Where
Are there any Homeowner’s Association Fees associated with ownership? Yes
No
Amount
If the property is a Condominium, how much is the YEARLY Maintenance Fees $
What is the YEARLY Real Estate Tax Bill? $
Homestead Exemption has been filed for
Is the property subject to ANY special real property tax assessments Yes
No
Explain
Is the property located in a Public Improvement (tax) District (PID) Yes
No
Unknown
What is the average YEARLY Electric Bill? $
What is the average YEARLY Gas Bill? $
If the residence is serviced by Propane (LP) Gas, what is the average YEARLY Propane Bill? $
The Propane Tank is: Owned
Leased
If Leased, how much is the lease payment? $
Is Cable Television Service available at the site? Yes
No
Service Provider
Are any items remaining with the residence financed separately from the mortgages? Yes
No
APPLIANCES/SYSTEMS REMAINING WITH RESIDENCE:
ITEM
Cook-top
Dishwasher
Garbage Disposal
Ice-maker
Microwave
Oven(s)
Trash Compactor
Vent-Fan
Other Items
SELLER’S INITIALS
YES
NO
GAS/ELECTRIC AGE LIST REPAIRS COMPETED IN LAST TWO (2) YEARS
Page 3 of 4
PURCHASER’S INITIALS
MECHANICAL EQUIPMENT CONSIDERED PERSONAL PROPERTY SHOULD BE NEGOTIATED IN THE CONTRACT OF SALE
OR OTHER SUCH INSTRUMENT IF THE ITEMS REMAIN WITH THE RESIDENCE.
To the extent of the Seller’s knowledge as a property owner, the Seller(s) acknowledges that the information contained above is true and accurate for
those areas of the property listed. The owner(s) agree to save and hold the Broker harmless from all claims, disputes, litigation and/or judgments
arising from any incorrect information supplied by the owner(s) or from any material fact known by the owner(s) which owner(s) fail to disclose
except the Broker is not held harmless to the owner(s) in claims, disputes, litigation, or judgments arising from conditions of which the Broker had
actual knowledge.
SELLER (UPON LISTING)
DATE
SELLER (UPON LISTING)
DATE
SELLER (AT CLOSING)
DATE
SELLER (AT CLOSING)
DATE
PROSPECTIVE PURCHASER’S SIGNATURE
PURCHASER(S) ACKNOWLEDGE RECEIPT OF REPORT
MREC FORM #0100
Page 4 of 4
DATE
EFFECTIVE DATE: JULY 1, 2008