Tenn. Code § 66-5-210
Following is the form prescribed by the general assembly which is necessary to comply with this part. The form used does not have to be the one included in this section, but it is the intent of the general assembly that any such form includes all items contained in the form below with all acknowledgement provisions of such form: .
Tennessee Residential Property Condition Disclosure
The Tennessee Residential Property Disclosure Act states that anyone transferring title to residential real property must provide information about the condition of the property. This completed form constitutes that disclosure by the seller. This is not a warranty, or a substitute for any professional inspections or warranties that the purchasers may wish to obtain.
Buyers and sellers should be aware that any sales agreement executed between the parties will supersede this form as to any obligations on the part of the seller to repair items identified below and/or the obligation of the buyer to accept such items “as is.”
Instructions to the Seller:
Complete this form yourself and answer each question to the best of your knowledge. If an answer is an estimate, clearly label it as such. The seller hereby authorizes any agent representing any party in this transaction to provide a copy of this statement to any person or entity in connection with any actual or anticipated sale of the subject property.
Property Address _____________________
City _____________________
Seller’s Name(s) _____________________
Property Age _____________________
Date Seller Acquired the Property _____________________
Do You Occupy the Property? _____________________
If Not Owner-Occupied, How Long Has It Been Since the Seller Occupied the Property? _____________________
The property is a
_____________________site-built home
_____________________nonsite built-home
(Check the one that applies)
A. The Subject Property Includes the Items Checked Below:
________Range
________Oven
_________Microwave
________Dishwasher
________Garbage Disposal
________Trash Compactor
________Water Softener
________220 Volt Wiring
________Washer/Dryer Hookups
________Central Heating
________Heat Pump
________Central Air Conditioning
________Wall/Window Air Conditioning
________Window Screens
________Rain Gutters
________Fireplace(s) (Number___)
________Gas Starter for Fireplace
________Smoke Detector/Fire Alarm
________Burglar Alarm
________Patio/Decking/Gazebo
________Irrigation System
________Sump Pump
________Garage Door Opener(s) (Number of openers ________)
________Intercom
________TV Antenna/Satellite Dish
________Pool Spa/Whirlpool Tub
________Hot Tub
________Sauna
________Current Termite Contract
________Access to Public Streets
________Other ________
___ Other ________
Garage: ________ Attached ________Not Attached ________Carport
Water Heater: ___Gas ___Solar ___Electric
Water Supply: ___City ___Well ___Private ___Utility ___Other
Waste Disposal: ___City Sewer ___Septic Tank ___Other
Gas Supply: ___Utility ___Bottled ___Other
Roof(s): Type ___ Age (approx.) ___
Other Items: ___ To the best of your knowledge, are any of the above NOT in operating condition?
___ YES ___NO
If YES, then describe (attach additional sheets if necessary):
B. Are You (Seller) Aware of Any Defects/Malfunctions in Any of the Following?
Interior Walls ___YES ___NO ___UNKNOWN
Ceilings ___YES ___NO ___UNKNOWN
Floors ___YES ___NO ___UNKNOWN
Windows ___YES ___NO ___UNKNOWN
Doors ___YES ___NO ___UNKNOWN
Insulation ___YES ___NO ___UNKNOWN
Plumbing ___YES ___NO ___UNKNOWN
Sewer/Septic ___YES ___NO ___UNKNOWN
Electrical System ___YES ___NO ___UNKNOWN
Exterior Walls ___YES ___NO ___UNKNOWN
Roof Y ___YES ___NO ___UNKNOWN
Basement ___YES ___NO ___UNKNOWN
Foundation ___YES ___NO ___UNKNOWN
Slab ___YES ___NO ___UNKNOWN
Driveway ___YES ___NO ___UNKNOWN
Sidewalks ___YES ___NO ___UNKNOWN
Central heat- ing ___YES ___NO ___UNKNOWN
Heat pump ___YES ___NO ___UNKNOWN
Central air conditioning ___YES ___NO ___UNKNOWN
If any of the above is/are marked YES, please explain: ___ ___ ___ ___ ___
C. Are You (Seller) Aware of Any of the Following?
1. Substances, materials or products which may be an environmental hazard such as, but not limited to: asbestos, radon gas, lead-based paint, fuel or chemical storage tanks and/or contaminated soil or water on the subject property?
:_______ YES:_______ NO :_______UNKNOWN
2. Features shared in common with adjoining land owners, such as walls, but not limited to, fences, and/or driveways, with joint rights and obligations for use and maintenance? YES NO UNKNOWN
3. Any authorized changes in roads, drainage or utilities affecting the property, or contiguous to the property?
_______ YES:_______ NO :_______UNKNOWN
4. Any changes since the most recent survey of the property was done? YES NO UNKNOWN Most recent survey of the property: (check here if unknown.)
5. Any encroachments, easements, or similar items that may affect your ownership interest in the property?
_____ YES:_____ NO :_____UNKNOWN
6. Room additions, structural modifications or other alterations or repairs made without necessary permits?
_____ YES:_____ NO :_____UNKNOWN
7. Room additions, structural modifications or other alterations or repairs not in compliance with building codes?
_____ YES:_____ NO :_____UNKNOWN
8. Landfill (compacted or otherwise) on the property or any portion thereof?
_______ YES:_______ NO :_______UNKNOWN
9. Any settling from any cause, or slippage, sliding or other soil problems?
_______ YES:_______ NO :_______UNKNOWN
10. Flooding, drainage or grading problems?
_____ YES:_____ NO :_____UNKNOWN
11. Any requirement that flood insurance be maintained on the property?
_____ YES:_____ NO :_____UNKNOWN
12. Property or structural damage from fire, earthquake, floods or landslides?
_____ YES:_____ NO :_____UNKNOWN
13. Any zoning violations, nonconforming uses and/or violations of “setback” requirements?
:_______ YES:_______ NO :_______UNKNOWN
14. Neighborhood noise problems or other nuisances?
:_______ YES:_______ NO :_______UNKNOWN
15. Subdivision and/or deed restrictions or obligations?
:_______ YES:_______ NO :_______UNKNOWN
16. A Homeowners Association (HOA) which has any authority over the subject property?
:_______ YES:_______ NO :_______UNKNOWN
Name of HOA: HOA Address: Monthly Dues: Special Assessments:
17. Is the location of the property within an improvement district that is subject to special assessment:
Rate of Special Assessment:________________
:_______ YES:_______ NO :_______UNKNOWN
18. Any “common area” (facilities such as, but not limited to, pools, tennis courts, walkways, or other areas co-owned in undivided interest with others)?
:_______ YES:_______ NO :_______UNKNOWN
19. Any notices of abatement or citations against the property?
_____ YES:_____ NO :_____UNKNOWN
20. Any lawsuits or proposed lawsuits by or against the seller which affects or will affect the property?
_____ YES:_____ NO :_____UNKNOWN
21. Is any system, equipment or part of the property being leased?
_____ YES:_____ NO :_____UNKNOWN
If yes, please explain, and include a written statement regarding payment information.
22. Any exterior wall covering of the structures covered with exterior insulation and finish systems (EIFS), also known as “synthetic stucco”?
_____ YES:_____ NO :_____UNKNOWN
If yes, has there been a recent inspection to determine whether the structure has excessive moisture accumulation and/or moisture related damage? (The Tennessee Real Estate Commission urges any buyer or seller who encounters this product to have a qualified professional inspect the structure in question for the preceding concern and provide a written report of the professional’s finding.)
YES NO UNKNOWN
If yes, please explain. If necessary, please attach an additional sheet.
D. Certification: I/We certify that the information herein, concerning the real property located at____________, is true and correct to the best of my/our knowledge as of the date signed. Should any of these conditions change prior to conveyance of title to this property, these changes will be disclosed in addendum to this document.
Transferor (Buyer) Date
Transferor (Buyer) Date
Parties may wish to obtain professional advice and/or inspections of the property and to negotiate appropriate provisions in the purchase agreement regarding advice, inspections or defects.
Transferee/Buyer’s Acknowledgement:
I/We understand that this disclosure statement is not intended as a substitute for any inspection, and that I/we have a responsibility to pay diligent attention to and inquire about those material defects which are evident by careful observation.
I/We acknowledge receipt of a copy of this disclosure.
Transferee (Buyer) Date
Transferee (Buyer) Date
If the property being purchased is a condominium, the transferee/buyer is hereby given notice that the transferee/buyer is entitled, upon request, to receive certain information regarding the administration of the condominium from the developer or the condominium association, as applicable, pursuant to Tennessee Code Annotated, § 66-27-502.
T.C.A. § 66-5-210