YES

NO

UNKN

I. TITLE/ZONING/BUILDING/INFORMATION

1. Seller/Owner ____________________________________
   How long owner? ______________________

2. How long occupied? ____________________
   Approximate year built? ___________________

3. Do you know of any title problems (for example, easements, use restrictions or lot line disputes)? If yes, please explain.
   _______________________________________________
   _______________________________________________

a) Do you know of any easements, common driveways, or rights of way pertaining to the property? If yes, explain
_______________________________________________

4. Zoning classification of property ______________________

5. Do you know of any zoning problems/violations? Explain
   _______________________________________________

a) Is the current use nonconforming in any way? Explain
_______________________________________________

6. Do you know of any variances or special permits? Explain
   _______________________________________________

7. Has any work been done on the property which required a permit? If yes, explain.
   _______________________________________________

a) Were permits obtained?
b) Was the work approved by inspector?

8. Is the property in a flood zone or wetlands? Explain
   _______________________________________________

YES

NO

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II. SYSTEM UTILITIES INFORMATION

Do you know of any current problems with the systems listed below?  Please explain any work you have had done.
 

9. Has there ever been an underground fuel tank? If yes, has it been removed? _________

10. HEATING SYSTEM: Problems? Explain
    _______________________________________________
    a) Approximate date of last service _____________
    b) Reason ________________________________
    c) Identify any unheated rooms ______________________

11. DOMESTIC HOT WATER: Type _____________________
    Age _______ Burners owned or rented? _______________
    Problems? Explain _______________________________

12. SEWAGE SYSTEM: Problems? Explain _______________________________________________
    Type: Municipal Sewer _____ Private _____ If private, describe type of system: (cesspool, septic tank, etc.)
    ___________________________________ Age ________
    Name of service company __________________________
    If private, date of last inspection _____________

Did system fail inspection?
Is system shared with other homes?
Date it was last pumped _____________
Frequency _______________________

13. PLUMBING SYSTEM: Problems/Leaks/Freezing? Explain
    _______________________________________________

a) Bathroom ventilation problems? Explain
_______________________________________________

14. DRINKING WATER SOURCE: Public ___ Private ___
    If private: a) Location _____________________________
    b) Age of pump __________________
    c) Date last tested ________________

d) Any known problems with water quailty/quantity?
_______________________________________________

e) Is there a filtration system? Age/Type of filtration system
_______________________________________________

f) Water quality problems? Explain
_______________________________________________

g) Flow rate (gal/min) _____________
Report: Attached _______ Not Attached _______

15. ELECTRICAL SYSTEM: Problems? Explain
    _______________________________________________

16. APPLIANCES: List appliances that are included
    _______________________________________________

Any known problems? If yes, explain
_______________________________________________

17. SECURITY SYSTEM: None ___ Type _________
    Age _____ Company _____________________

18. AIR CONDITIONING: Central ____ Window ____
    Other ____ None ____ Problems? Explain
    _______________________________________________

YES

NO

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III. BUILDING/STRUCTURAL IMPROVEMENTS INFORMATION

19. FOUNDATION: Problems? Explain
    _______________________________________________

20. BASEMENT: Water ____ Seepage ____ Dampness ____
    Explain amount, frequency, and location
    _______________________________________________

a) Sump Pump? If yes, age ____ location ___________
Problems? ___________________________________

21. ROOF: Problems? Explain
    ____________________________________________
    Location of leaks/problems _______________________

22. CHIMNEY/FIREPLACE: Date last cleaned _____________
    Problems? Explain
    _______________________________________________
    Wood/Coal/Pellet Stove in compliance with installation regulations/code/bylaws? ____________ If not, explain
    _______________________________________________

23. FIRE/SMOKE DAMAGE: History of damage, if any
    _______________________________________________

24. FLOORS: Type of floors under carpet/linoleum
    _______________________________________________

Problems with floors (buckling, sagging, etc.)? Explain
_______________________________________________

25. WALLS: a) INTERIOR Walls: Problems? Explain
    _______________________________________________

a) EXTERIOR Walls: Problems? Explain
_______________________________________________

26. WINDOWS: Original ____ Replacement ____
    If replacement, age __________

27. INSULATION: Does house have insulation?
    If yes, type _______________ Date installed ___________
    Location __________________

a) Has UFFI (Urea Formaldehyde Foam Insulation) ever been installed? If yes, location ________________________

b) Has testing for UFFI been performed? If yes attach report.

28. ASBESTOS: Do you know whether asbestos is present in exterior shingles, pipe covering or boiler insulation?
    _______________________________________________

a) Has material been encapsulated?  If yes, explain how and when materials were encapsulated
_______________________________________________

29. LEAD PAINT: Is lead paint present? If yes, locations (attach copy of inspection reports) __________________________
    If yes, describe abatement plan/interim controls, if any
    _______________________________________________

a) Has paint been encapsulated? If yes, when and by whom?
_______________________________________________

30. RADON: Has test for radon been performed? If yes attach copy
    _______________________________________________

31. INSECTS: History of Termite/Insect/Pest Problems? If yes explain treatment and dates
    _______________________________________________

32. OTHER: Building/structural problems, explain
    _______________________________________________

YES

NO

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IV. CONDOMINIUM INFORMATION

33. If converting to condominium, are documents approved and recorded (Master/Unit deed etc.)?

34. PARKING: Is parking space(s) included? If yes, are they deeded or common? ____________________

35. CONDO FEES: Current fees for Unit are $______________
    Heat included?
    Electricity included?

36. RESERVE FUND: Has an advance payment been made to a condo reserve fund? If yes, how much $__________

Is reimbursement expected?

37. CONDO ASSOC. INFO: Is ownersī association currently involved in any litigation?  If yes, explain
    _______________________________________________

YES

NO

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V. RENTAL PROPERTY INFORMATION

38. NUMBER OF UNITS: ___________

Have units been added/subdivided since original construction?
If yes, have permits for new/added units been obtained?

39. RENTS: Number of units occupied ______
    Rents paid $__________

Any tenants without leases?
Is owner holding last monthīs rent __________ security deposit? __________ If yes, had interest been paid? _____
a) If security deposit held, attach a copy of statements. Attached _____ Not attached _____

YES

NO

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VI. MISCELLANEOUS INFORMATION

40. Water drainage problems? Explain __________________
    ______________________________________________

41. Do you know of any other problems which may affect the value or use of the property which may not be obvious to a prospective buyer? _______________________________
    ______________________________________________
    ______________________________________________
    ______________________________________________
    ______________________________________________
    ______________________________________________
    ______________________________________________

A. Flood Hazard Insurance Disclosure Clause

The lender may require Flood Hazard Insurance as a condition of the mortgage loan if the lender determines that the premises is in a flood hazard zone.

B. Chlordane Disclosure Clause (Question 47)

Pesticide products containing chlordane were banned in Massachusetts on June 11, 1985, following a determination by the Department of Food and Agriculture that the use of chlordane may cause unreasonable adverse effects on the environment including a risk of cancer. Although existing data does not conclusively prove that significant health effects have occurred as a direct result of chlordane use, the long-term potential health risks are such that it is prudent public health policy, according to the Department, to eliminate the further introduction of chlordane into the environment.

C. Urea-Formaldehyde Foam Insulation Disclosure Clause

The buyer acknowledges that he has been advised that Urea Formaldehyde Foam Insulation (UFFI) has been declared by the Massachusetts Department of Public Health (DPH) to be a banned hazardous substance and that new installation is prohibited. Where UFFI was previously installed, the seller is required to advise the buyer (1) where such UFFI is located and, if known, when it was installed; (2) a copy of test results concerning the air level of formaldehyde, and (3) a copy of information from the DPH concerning UFFI and formaldehyde levels. Under certain circumstances the cost of removal may be reimbursed. Exposure to hazardous levels of formaldehyde may cause personal injuries, including headaches, nausea or cancer. The buyer acknowledges that he has been advised to consult the DPH or his attorney for further information.

D. Asbestos Disclosure Clause

The United States Consumer Product Safety Commission has maintained that asbestos materials are hazardous if they release separate fibers which can be inhaled. Asbestos is a common insulation material on heating pipes, boilers, and furnaces. It may also be present in certain types of floor and ceiling materials, shingles, plaster products, cements and other building materials. The buyer may have the property professionally inspected for the presence of asbestos and if repair or removal of asbestos is desired, proper safety guidelines must be observed.

E. Lead Paint Disclosure Clause

Whenever a child under six years of age resides in any residential premises in which any paint, plaster or other accessible material contains dangerous levels of lead, the owner is required by law, to remove all said paint, plaster or cover with appropriate materials so as to make in inaccessible to a child under six years of age. Consumption of lead is poisonous and may cause serious personal injury. Whenever such residential premises containing dangerous levels of lead undergoes a change of ownership, as a result, a child under six years of age will become a resident, the new owner is required by law to remove said paint, plaster or cover with appropriate materials so as to make it inaccessible to such child.

F. Hazardous Materials Disclosure Clause

In certain circumstances Massachusetts law can hold an owner of real estate liable to pay for the cost of removing hazardous or toxic materials from real estate and for damages resulting from the release of such materials, according to the Massachusetts Oil and Hazardous Material Release and Response Act, General Laws, Chapter 21E. The buyer acknowledges that he may have the property professionally inspected for the presence of, or the substantial likelihood of release of oil or hazardous material and such proof of inspection may be required as a prerequisite for financing the property.

G. Radon Disclosure Clause

Radon is an odorless, colorless, tasteless gas produced naturally, in the ground by the normal decay of uranium and radium. Radon can lead to the development of radioactive particles which can be inhaled. Studies indicate the result of extended exposure to high levels of radon may increase the risk of developing lung cancer.