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Seller's Disclosure Statement

SELLER'S DISCLOSURE STATEMENT

Property Address: _______________________________________________________

Street _________________________________________________________,Michigan
City, Village, or Township

Purpose of Statement:

This statement is a disclosure of the condition of
the property in compliance with the seller disclosure act. This statement
is a disclosure of the condition and information concerning the property,
known by the seller. Unless otherwise advised, the seller does not
possess any expertise in construction, architecture, engineering, or
any other specific area related to the construction or condition of the
improvements on the property or the land. Also, unless otherwise advised,
the seller has not conducted any inspection of generally inaccessible
areas such as the foundation or roof. This statement is not a warranty
of any kind by the seller or by any agent representing the seller in
this transaction, and is not a substitute for any inspections or
warranties the buyer may wish to obtain.

Seller's Disclosure:

The seller discloses the following information with
the knowledge that even though this is not a warranty, the seller
specifically makes the following representations based on the seller's
knowledge at the signing of this document. Upon receiving this statement
from the seller, the seller's agent is required to provide a copy to the
buyer or the agent of the buyer. The seller authorizes its agent(s) to
provide a copy of this statement to any prospective buyer in connection
with any actual or anticipated sale of property. The following are
representations made solely by the seller and are not the representations
of the seller's agent(s), if any. This information is a disclosure only
and is not intended to be a part of any contract between buyer and
seller.

Instructions to seller: (1) Answer ALL questions. (2) Report known
conditions affecting the property. (3) Attach additional pages with your
signature if additional space is required. (4) Complete this form
yourself. (5) If some items do not apply to your property check N/A
(nonapplicable). If you do not know the facts, check UNKNOWN. FAILURE TO
PROVIDE A PURCHASER WITH A SIGNED DISCLOSURE STATEMENT WILL ENABLE A
PURCHASER TO TERMINATE AN OTHERWISE BINDING PURCHASE AGREEMENT.

Appliances/Systems/Services: The items below are in working order:

Yes No Unknown N/A (Does not apply)

Range/Oven ___________ ___________ ___________ ___________

Dishwasher ___________ ___________ ___________ ___________

Refrigerator ___________ ___________ ___________ ___________

Hood/Fan ___________ ___________ ___________ ___________

Disposal ___________ ___________ ___________ ___________

TV Antenna,
TV rotor &
controls ___________ ___________ ___________ ___________

Electrical
System ___________ ___________ ___________ ___________

Garage door opener
& remote control
___________ ___________ ___________ ___________

Alarm system ___________ ___________ ___________ ___________

Intercom ___________ ___________ ___________ ___________

Central Vac ___________ ___________ ___________ ___________

Attic fan ___________ ___________ ___________ ___________

Pool heater,
Wall liner &
Equipment ___________ ___________ ___________ ___________

Microwave ___________ ___________ ___________ ___________

Trash Comp ___________ ___________ ___________ ___________

Ceiling fan ___________ ___________ ___________ __________

Sauna/HotTb ___________ ___________ ___________ ___________

Lawn sprinkler
___________ ___________ ___________ ___________

Water heater ___________ ___________ ___________ ___________

Plumbing Sys ___________ ___________ ___________ ___________

Water softener / conditioner
___________ ___________ ___________ ___________

Well & Pump ___________ ___________ ___________ ___________

Septic tank &
drain field ___________ ___________ ___________ ___________

Sump pump ___________ ___________ ___________ ___________

City Water ___________ ___________ ___________ ___________

City Sewer ___________ ___________ ___________ ___________

Central Air ___________ ___________ ___________ ___________

Central Heat ___________ ___________ ___________ ___________

Furnace ___________ ___________ ___________ ___________

Humidifier ___________ ___________ ___________ ___________

Air filter ___________ ___________ ___________ ___________

SolarHeating ___________ ___________ ___________ ___________

Fireplace ___________ ___________ ___________ ___________

Wood burning
system ___________ ___________ ___________ ___________

Explanations (attach additional sheets if necessary):

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UNLESS OTHERWISE AGREED, ALL HOUSEHOLD APPLIANCES ARE SOLD IN WORKING
ORDER EXCEPT AS NOTED, WITHOUT WARRANTY BEYOND DATE OF CLOSING.

Property conditions, improvements & additional information:

1. Basement: Has there been evidence of water? If yes, please explain:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

2. Insulation: Describe, if known _________________________________ Urea
Formaldehyde Foam Insulation (UFFI) is installed?

3. Roof: Leaks? Approximate age if known _____________________________

4. Well: Type of well (depth/diameter, age and repair history, if known
___________________________________________________________ Has the
water been tested?

5. Septic tanks/drain fields: Condition, if known ____________________
______________________________________________________________________

6. Heating system: Type/approximate age: _____________________________

7. Plumbing system: Type: copper _____ galvanized _____ other _____ Any
known problems? ______________________________________________________

8. Electrical system: Any known problems?_____________________________
______________________________________________________________________

9. History of infestation, if any: (termites, carpenter ants, etc.) __
______________________________________________________________________

10. Environmental Problems: Substances, materials or products that may
be an environmental hazard such as, but not limited to, asbestos, radon
gas, formaldehyde, lead-based paint, fuel or chemical storage tanks and
contaminated soil on the property. If yes, please explain:_____________
_______________________________________________________________________
_______________________________________________________________________

Other Items: Are you aware of any of the following:
1. Features of the property shared in common with the adjoining
landowners, such as walls, fences, roads and driveways, or other
features whose use or responsibility for maintenance may have an effect
on the property?

2. Any encroachments, easements, zoning violations, or nonconforming
uses?

3. Any "common areas" (facilities like pools, tennis courts, walkways,
or other areas co-owned with others), or a homeowners' association that
has any authority over the property?

4. Structural modifications, alterations, or repairs made without
necessary permits or licensed contractors?

5. Settling, flooding, drainage, structural, or grading problems?

6. Major damage to the property from fire, wind, floods, or landslides?

7. Any underground storage tanks?

8. Any area environmental concerns (i.e., proximity to a landfill,
airport, shooting range, etc.)?

If the answer to any of these questions is yes, please explain. Attach
additional sheets, if necessary:

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The most recent state equalized valuation of the property provided by
the local taxing unit to the seller was $___________ as of _____________
(date). The seller has lived in the residence on the property from
__________ (date) to __________ (date). The seller has owned the property
since _________ (date) and makes representation only since that date.
The seller has indicated above the history and condition of all the
items based on that information known to the seller. If any changes
occur in the structural/mechanical/appliance systems of this property
from the date of this form to the date of closing, seller will
immediately disclose the changes to buyer. In no event shall the parties
hold the broker liable for any representations not directly made by the
broker or broker's agent.


Seller certifies that the information in this statement is true and
correct to the best of seller's knowledge as of the date of seller's
signature.

BUYER SHOULD OBTAIN PROFESSIONAL
ADVICE AND INSPECTIONS OF THE
PROPERTY TO MORE FULLY DETERMINE
THE CONDITION OF THE PROPERTY


Seller ______________________________________________ Date _____________

Seller ______________________________________________ Date _____________

Buyer has read and acknowledges receipt of this statement.

Buyer _______________________________________________ Date _____________

Buyer _______________________________________________ Date _____________

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