AB391,2,2323
1. .... .... .... I am aware of defects in the roof.
AB391,2,2524
2. .... .... .... I am aware of defects in the electrical
25
system.
AB391,3,4
13. .... .... .... I am aware of defects in part of the
2
plumbing system (including the water
3
heater, water softener and swimming
4
pool) that is included in the sale.
AB391,3,85
4. .... .... .... I am aware of defects in the heating
6
and air conditioning system
7
(including the air filters
8
and humidifiers).
AB391,3,109
5. .... .... .... I am aware of defects in the well,
10
including unsafe well water.
AB391,3,1211
6. .... .... .... I am aware that this property is served
12
by a joint well.
AB391,3,1513
7. .... .... .... I am aware of defects in the septic
14
system or other sanitary disposal
15
system.
AB391,3,2216
8. .... .... .... I am aware of underground fuel storage
17
tanks on the property. (If correct,
18
the owner, by law, must report the
19
location to the department of
20
industry, labor and human relations
21
at P.O. Box 7969, Madison,
22
Wisconsin, 53707.)
AB391,4,323
9. .... .... .... I am aware of an "LP" tank on the
24
property. (If correct, specify
25
in the additional information
1 space whether or not the owner
2
of the property either owns or
3
leases the tank.)
AB391,4,64
10. .... .... .... I am aware of defects in the basement
5
or foundation (including cracks,
6
seepage and bulges).
AB391,4,97
11. .... .... .... I am aware that the property is located
8
in a floodplain, wetland or
9
shoreland zoning area.
AB391,4,1110
12. .... .... .... I am aware of defects in the structure
11
of the property.
AB391,4,1512
13. .... .... .... I am aware of defects in mechanical
13
equipment included in the sale
14
either as fixtures or personal
15
property.
AB391,4,1916
14. .... .... .... I am aware of boundary or lot line
17
disputes, encroachments or
18
encumbrances (including a joint
19
driveway).
AB391,5,320
15. .... .... .... I am aware of a defect caused by
21
unsafe concentrations of, or
22
unsafe conditions relating to,
23
radon, radium in water supplies,
24
lead in paint, lead in soil, lead
25
in water supplies or plumbing
1 system or other potentially
2
hazardous or toxic substances
3
on the premises.
AB391,5,64
16. .... .... .... I am aware of the presence of asbestos
5
or asbestos-containing materials
6
on the premises.
AB391,5,117
17. .... .... .... I am aware of a defect caused by unsafe
8
concentrations of, unsafe conditions
9
relating to, or the storage of
10
hazardous or toxic substances on,
11
neighboring properties.
AB391,5,15
1218. .... .... .... I am aware that a structure on the
13property is designated as a historic
14building or that a part of the
15property is in a historic district.
AB391,5,1816
19. .... .... .... I am aware of current or previous
17
termite, powder-post beetle or
18
carpenter ant infestations.
AB391,5,2019
20. .... .... .... I am aware of defects in a
20
woodburning stove or fireplace.
AB391,6,221
21. .... .... .... I am aware either that remodeling
22
affecting the property's structure
23
or mechanical systems was done or
24
that additions to this property
25
were made during my period of
1 ownership without the required
2
permits.
AB391,6,63
22. .... .... .... I am aware of federal, state or
4
local regulations requiring repairs,
5
alterations or corrections of an
6
existing condition.
AB391,6,97
23. .... .... .... I have received notice of property
8
tax increases, other than normal
9
annual increases.
AB391,6,1210
24. .... .... .... I am aware that remodeling that may
11
increase the property's assessed
12
value was done.
AB391,6,1413
25. .... .... .... I am aware of proposed or pending
14
special assessments.
AB391,6,1815
26. .... .... .... I am aware of the proposed
16
construction of a public project
17
that may affect the use of the
18
property.
AB391,7,219
27. .... .... .... I am aware of subdivision homeowners'
20
associations, common areas coowned
21
with others, zoning violations
22
or nonconforming uses,
23
rights-of-way, easements or another
24
use of a part of the property by
1 nonowners, other than recorded
2
utility easements.
AB391,7,43
28. .... .... .... I am aware of other defects affecting
4
the property.
AB391,7,5
5additional information ....
AB391,7,86
.... (yes) .... (no) .... (not applicable)
I am aware that a structure on the property 7is designated as a historic building or that a part of the property is in a historic
8district.
AB391,7,99
The owner has lived on the property for.... years.
AB391,7,10
10ADDITIONAL INFORMATION ....
AB391,7,1211
The owner certifies that the information in this report is true and correct to the
12best of the owner's knowledge as of the date on which the owner signs this report.
AB391,7,1413
Owner .... Date....
14
Owner .... Date ....
AB391,7,1815
A person other than the owner certifies that he or she has supplied information
16on which the owner relied for this report and that that information is true and correct
17to the best of that person's knowledge as of the date on which the person signs this
18report.
AB391,7,2119
Person .... Items .... Date ....
20
Person .... Items .... Date ....
21
Person .... Items .... Date ....
AB391,8,522
THE PROSPECTIVE BUYER AND THE OWNER MAY WISH TO OBTAIN
23PROFESSIONAL ADVICE OR INSPECTIONS OF THE PROPERTY AND TO
24PROVIDE FOR APPROPRIATE PROVISIONS IN A CONTRACT BETWEEN
25THEM WITH RESPECT TO ANY ADVICE, INSPECTIONS, DEFECTS OR
1WARRANTIES. THE PROSPECTIVE BUYER ACKNOWLEDGES THAT
2TECHNICAL KNOWLEDGE SUCH AS THAT ACQUIRED BY PROFESSIONAL
3INSPECTORS MAY BE REQUIRED TO DETECT CERTAIN DEFECTS SUCH AS
4THE PRESENCE OF ASBESTOS, BUILDING CODE VIOLATIONS AND
5FLOODPLAIN STATUS.
AB391,8,66
I ACKNOWLEDGE RECEIPT OF A COPY OF THIS STATEMENT
AB391,8,97
Prospective buyer .... Date ....
8
Prospective buyer .... Date ....
9
Prospective buyer .... Date ....
