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Thank you for completing the Maryland Residential Disclosure Form. Please answer each question to the best of your knowledge.

Seller and Property Information

First Name *
Email *
Last Name *
Phone Number *
Property Address *
How long have you owned the property? *

Property System: Water, Sewage, Heating & Air Conditioning

Water Supply *
Septic system approved for _____ (# of bedrooms)
Sewage Disposal *
Garbage Disposal *
Heating *
Age of Heating System *
Dishwasher *
Air Conditioning *
Age of Air Conditioning System *
Hot Water *
Electric Capacity *
Age of Electric System *

Please indicate your actual knowledge with respect to the following

1. Foundation: Any settlement or other problems? *
Comments about the Foundation
2. Basement: Any leaks or evidence of moisture? *
Comments about the Basement
3. Roof: Any leaks or evidence of moisture? *
Type of Roof? (ex. slate, asphalt shingle, composite shingle, etc) *
Age of Roof *
Comments about the Roof
Roof: Is there any existing fire retardant treated plywood? *
Comments about existing fire retardant treated plywood
4. Other Structural Systems, including exterior walls and floors: Any defects (structural or otherwise)? *
Comments about structural systems, including exterior walls and floors
5. Plumbing System: Is the system in operating condition? *
Comments about plumbing system
6. Heating Systems: Is heat supplied to all finished rooms? *
Is the heating system in operating condition? *
Comments about Heating Systems
7. Air Conditioning System: Is cooling supplied to all finished rooms? *
Comments about Air Conditioning Systems
Is the Air Conditioning system in operating condition? *
Comments about Air Conditioning operating condition

Safety, Septic, Water, Insulation, Drainage, and Environmental

8. Will the smoke alarms provide an alarm in the event of a power outage? *
Are the smoke alarms over 10 years old? *
If the smoke alarms are battery operated, are they sealed, tamper resistant units incorporating a silence/hush button, with long-life batteries? *
Comments about smoke alarms
9. Septic Systems: Is the septic system functioning properly? *
When was the septic system last pumped? (approximate date if known)
Comments about septic system
10. Water Supply: Any problem with water supply? *
Comments about Water Supply
Home water treatment system *
Comments about home water treatment system
Fire sprinkler system *
Comments about fire sprinkler system
Are the water systems in operating condition? *
Comments about water systems
11. Insulation in exterior walls? *
11. Insulation in any other areas? *
11. Insulation in ceiling/attic? *
Where is the additional insulation located?
Comments about insulation
12. Exterior Drainage: Does water stand on the property for more than 24 hours after a heavy rain? *
Comments about exterior drainage
Are gutters and downspouts in good repair? *
Comments about gutters and downspouts
13. Wood-Destroying Insects (WDI): Any infestation and/or prior damage? *
Any WDI warranties? *
Any WDI treatments or repairs? *
Comments about wood destroying insects
14. Are there any hazardous or regulated materials on the property? *
If yes, specify

Additional Property Restrictions and Material Defects

15. If property relies on fossil fuel for heat, ventilation, hot water, or clothes dryer operation, is a carbon monoxide alarm installed? *
Comments about carbon monoxide alarm
16. Are there any zoning violations, nonconforming uses, restriction violations, or easements affecting the property? *
If yes, specify below
16A. If improvements were made, were required permits pulled from the county or local permitting office? *
Comments about permits
17. Is the property located in a flood zone, conservation area, wetland area, Chesapeake Bay critical area or Designated Historic District? *
If yes, specify below
18. Is the property subject to any restriction imposed by a Home Owners Association or any other type of community association? *
If yes, specify below
19. Are there any other material defects, including latent defects, affecting the physical condition of the property? *
If yes, specify below

Certification

I confirm the information contained herein is true, to the best of my knowledge *
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