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<br /> Authentlelgn to:760D14FE-BB14-4CA0-BE2D-1A236B46CB63
<br /> Form 17 SELLER DISCLOSURE STATEMENT ©Copyright 2012
<br /> Seller Disclosure Statement IMPROVED PROPERTY Northwest Multiple Listing Service
<br /> Rev.06112 ALL RIGHTS RESERVED
<br /> Page 4 of 5 (Continued)
<br /> *C. Are any of the following kinds of wood burning appliances present at the property? YES NO DON'T 167
<br /> ,KiNOW 168
<br /> (I) Woodstove? CI O 169
<br /> (2) Fireplace insert? ❑ Fd' CI
<br /> (3) Pellet stove? 0 IlV' ❑ 171
<br /> (.4) Fireplace? CI a- CI
<br /> If yes,are all of the(1)woodstoves or(2)fireplace inserts certified by the U.S.Environmental 173
<br /> Protection Agency as clean burning appliances to improve air quality and public health? CIIW ❑ 174
<br /> D. Is the property located within a city,county,or district or within a department of natural resources 175
<br /> fire protection zone that provides fire protection services? !t�'/ ❑ 0 176
<br /> E. Is the property equipped with carbon monoxide alarms? (Note: Pursuant to RCW 19.27.530,Seller 177
<br /> must equip the residence with carbon monoxide alarms as required by the state building code.) ❑ ❑ 178
<br /> F. Is the property equipped with smoke alarms? ❑ ., 179
<br /> 6. HOMEOWNERS'ASSOCIATION/COMMON INTERESTS 180
<br /> A. Is there a Homeowners'Association?. ❑ I� ❑ 181
<br /> Name of Association and contact information for an officer,director,employee,or other authorized 182
<br /> agent,if any,who may provide the association's financial statements,minutes,bylaws,fining policy, 183
<br /> and other information that is notpublicly available: 184
<br /> B. Are there regular periodic assessments? ❑ Ife ❑ 185
<br /> S per❑month CI year 186
<br /> 0 Other 187
<br /> 'C. Are there any pending•special assessments? ❑ iTd ❑ 188
<br /> *D. Are there any shared"common areas"or any joint maintenance agreements(facilities 189
<br /> such as walls,fences,landscaping,pools,tennis courts,walkways,or other areas co-owned ,/ 190
<br /> in undivided interest with others)? ❑ (H" ❑ 191
<br /> 7. ENVIRONMENTAL 192
<br /> *A. Have there been any flooding,standing water,or drainage problems on the property . / 193
<br /> that affect the property or access to the property? ❑ 1E O 194
<br /> *B. Does any part of the property contain fill dirt,waste,or other fill material? CI Er ❑ 195
<br /> *C. Is there any material damage to the property from fire,wind,floods,beach movements, 196
<br /> earthquake,expansive soils,or landslides? ❑ , ' ❑ 197
<br /> D. Are there any shorelines,wetlands,floodplains,or critical areas on the property? CI 198
<br /> *E. Me there any substances,materials,or products in or on the property that may be environmental 199
<br /> concerns,such as asbestos,formaldehyde,radon gas,lead-based paint,fuel or chemical storage 200
<br /> tanks,or contaminated soil or water? ❑ ❑ Er- 201
<br /> *F.. Has the property been used for commercial or industrial purposes? ❑ fie: ❑ 202
<br /> •(3. Is there any soil or groundwater contamination? ❑ t ❑ 203
<br /> *H. Are there transmission poles or other electrical utility equipment installed,maintained, / 204
<br /> or buried on the property that do not provide utility service to the structures on the property? CIo7 ❑ 205
<br /> *I. Has the property been used as a legal or illegal dumping site? ❑ lit': ❑ 206
<br /> *I Has the property been used as an illegal drug manufacturing site? ❑ ❑ 207
<br /> *K. Are there any radio towers in the area that cause interference with cellular telephone reception? ❑ QY ❑ 208
<br /> 8. LEAD BASED PAINT(Applicable if the house was built before 1978.) 209
<br /> A. Presence of lead-based paint and/or lead-based paint hazards(check one below): 210
<br /> ❑ Known lead-based paint and/or lead-based paint hazards are present in the housing 211
<br /> explain). 212
<br /> Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. 213
<br /> B. Records and reports available to the Seller(check one below): 214
<br /> ❑ Seller has provided the purchaser with all available records and reports pertaining to 215
<br /> lead-based paint and/or lead-based paint hazards in the housing(list documents below). 216
<br /> 217
<br /> eller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing. 218
<br /> 9. MANUFACTURED AND MOBILE HOMES 219
<br /> If the property includes a manufactured or mobile home, 220
<br /> *A. Did you make any alterations to the home? ❑ ❑ ❑ 221
<br /> If yes,please describe the alterations: 222
<br /> *B. Did any previous owner make any alterations to the home? ❑ ❑ 0 223
<br /> *C. If alterations were made,were permits or variances for these alterations obtained? ❑ ❑ ❑ 224
<br /> SEL ER'S IN1I�IALS Date SELLER'S INITIALS, Date
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