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If required under ORS 105.465, a seller shall deliver in substantially the following form the seller’s property disclosure statement to each buyer who makes a written offer to purchase real property in this state:

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INSTRUCTIONS TO THE SELLER

Please complete the following form. Do not leave any spaces blank. Please refer to the line number(s) of the question(s) when you provide your explanation(s). If you are not claiming an exclusion or refusing to provide the form under ORS 105.475 (4), you should date and sign each page of this disclosure statement and each attachment.

Each seller of residential property described in ORS 105.465 must deliver this form to each buyer who makes a written offer to purchase. Under ORS 105.475 (4), refusal to provide this form gives the buyer the right to revoke their offer at any time prior to closing the transaction. Use only the section(s) of the form that apply to the transaction for which the form is used. If you are claiming an exclusion under ORS 105.470, fill out only Section 1.

An exclusion may be claimed only if the seller qualifies for the exclusion under the law. If not excluded, the seller must disclose the condition of the property or the buyer may revoke their offer to purchase anytime prior to closing the transaction. Questions regarding the legal consequences of the seller’s choice should be directed to a qualified attorney.

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(DO NOT FILL OUT THIS SECTION UNLESS YOU ARE CLAIMING AN EXCLUSION UNDER ORS 105.470)

Section 1. EXCLUSION FROM ORS 105.462 TO 105.490:

You may claim an exclusion under ORS 105.470 only if you qualify under the statute. If you are not claiming an exclusion, you must fill out Section 2 of this form completely.

Initial only the exclusion you wish to claim.

_____This is the first sale of a dwelling never occupied. The dwelling is constructed or installed under building or installation permit(s) #_____, issued by________.

_____This sale is by a financial institution that acquired the property as custodian, agent or trustee, or by foreclosure or deed in lieu of foreclosure.

_____The seller is a court appointed receiver, personal representative, trustee, conservator or guardian.

_____This sale or transfer is by a governmental agency.

______________________

Signature(s) of Seller claiming exclusion

Date ________

______________________

Buyer(s) to acknowledge Seller’s claim

Date ________

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Section 2. SELLER’S PROPERTY DISCLOSURE STATEMENT

NOTICE TO THE BUYER: THE FOLLOWING REPRESENTATIONS ARE MADE BY THE SELLER(S) CONCERNING THE CONDITION OF THE PROPERTY LOCATED AT

_______________("THE PROPERTY").

DISCLOSURES CONTAINED IN THIS FORM ARE PROVIDED BY THE SELLER ON THE BASIS OF SELLER’S ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME OF DISCLOSURE. BUYER HAS FIVE DAYS FROM THE SELLER’S DELIVERY OF THIS SELLER’S DISCLOSURE STATEMENT TO REVOKE BUYER’S OFFER BY DELIVERING BUYER’S SEPARATE SIGNED WRITTEN STATEMENT OF REVOCATION TO THE SELLER DISAPPROVING THE SELLER’S DISCLOSURE STATEMENT, UNLESS BUYER WAIVES THIS RIGHT AT OR PRIOR TO ENTERING INTO A SALE AGREEMENT.

FOR A MORE COMPREHENSIVE EXAMINATION OF THE SPECIFIC CONDITION OF THIS PROPERTY, BUYER IS ADVISED TO OBTAIN AND PAY FOR THE SERVICES OF A QUALIFIED SPECIALIST TO INSPECT THE PROPERTY ON BUYER’S BEHALF INCLUDING, FOR EXAMPLE, ONE OR MORE OF THE FOLLOWING: ARCHITECTS, ENGINEERS, PLUMBERS, ELECTRICIANS, ROOFERS, ENVIRONMENTAL INSPECTORS, BUILDING INSPECTORS, CERTIFIED HOME INSPECTORS, OR PEST AND DRY ROT INSPECTORS.

Seller _____ is/ _____ is not occupying the property.

I. SELLER’S REPRESENTATIONS:

The following are representations made by the seller and are not the representations of any financial institution that may have made or may make a loan pertaining to the property, or that may have or take a security interest in the property, or any real estate licensee engaged by the seller or the buyer.

*If you mark yes on items with *, attach a copy or explain on an attached sheet.

1. TITLE

A. Do you have legal authority to sell the property? [ ]Yes [ ]No [ ]Unknown

*B. Is title to the property subject to any of the

following: [ ]Yes [ ]No [ ]Unknown

(1) First right of refusal

(2) Option

(3) Lease or rental agreement

(4) Other listing

(5) Life estate?

*C. Is the property being transferred an

unlawfully established unit of land? [ ]Yes [ ]No [ ]Unknown

*D. Are there any encroachments, boundary

agreements, boundary disputes or recent

boundary changes? [ ]Yes [ ]No [ ]Unknown

*E. Are there any rights of way, easements,

licenses, access limitations or claims that

may affect your interest in the property? [ ]Yes [ ]No [ ]Unknown

*F. Are there any agreements for joint

maintenance of an easement or right of way? [ ]Yes [ ]No [ ]Unknown

*G. Are there any governmental studies, designations,

zoning overlays, surveys or notices that would

affect the property? [ ]Yes [ ]No [ ]Unknown

*H. Are there any pending or existing governmental

assessments against the property? [ ]Yes [ ]No [ ]Unknown

*I. Are there any zoning violations or

nonconforming uses? [ ]Yes [ ]No [ ]Unknown

*J. Is there a boundary survey for the

property? [ ]Yes [ ]No [ ]Unknown

*K. Are there any covenants, conditions,

restrictions or private assessments that

affect the property? [ ]Yes [ ]No [ ]Unknown

*L. Is the property subject to any special tax

assessment or tax treatment that may result

in levy of additional taxes if the property

is sold? [ ]Yes [ ]No [ ]Unknown

2. WATER

A. Household water

(1) The source of the water is (check ALL that apply):

[ ]Public [ ]Community [ ]Private

[ ]Other ________

(2) Water source information:

*a. Does the water source require a water permit? [ ]Yes [ ]No [ ]Unknown

If yes, do you have a permit? [ ]Yes [ ]No

b. Is the water source located on the property? [ ]Yes [ ]No [ ]Unknown

*If not, are there any written agreements for

a shared water source? [ ]Yes [ ]No [ ]Unknown [ ]NA

*c. Is there an easement (recorded or unrecorded)

for your access to or maintenance of the water

source? [ ]Yes [ ]No [ ]Unknown

d. If the source of water is from a well or spring,

have you had any of the following in the past

12 months? [ ]Flow test [ ]Bacteria test

[ ]Chemical contents test [ ]Yes [ ]No [ ]Unknown [ ]NA

*e. Are there any water source plumbing problems

or needed repairs? [ ]Yes [ ]No [ ]Unknown

(3) Are there any water treatment systems for

the property? [ ]Yes [ ]No [ ]Unknown

[ ]Leased [ ]Owned

B. Irrigation

(1) Are there any [ ] water rights or [ ] other

irrigation rights for the property? [ ]Yes [ ]No [ ]Unknown

*(2) If any exist, has the irrigation water been

used during the last five-year period? [ ]Yes [ ]No [ ]Unknown [ ]NA

*(3) Is there a water rights certificate or other

written evidence available? [ ]Yes [ ]No [ ]Unknown [ ]NA

C. Outdoor sprinkler system

(1) Is there an outdoor sprinkler system for the

property? [ ]Yes [ ]No [ ]Unknown

(2) Has a back flow valve been installed? [ ]Yes [ ]No [ ]Unknown [ ]NA

(3) Is the outdoor sprinkler system operable? [ ]Yes [ ]No [ ]Unknown [ ]NA

3. SEWAGE SYSTEM

A. Is the property connected to a public or

community sewage system? [ ]Yes [ ]No [ ]Unknown

B. Are there any new public or community sewage

systems proposed for the property? [ ]Yes [ ]No [ ]Unknown

C. Is the property connected to an on-site septic

system? [ ]Yes [ ]No [ ]Unknown

(1) If yes, when was the system installed? ________ [ ]Unknown [ ]NA

(2) *If yes, was the system installed by permit? [ ]Yes [ ]No [ ]Unknown [ ]NA

(3) *Has the system been repaired or altered? [ ]Yes [ ]No [ ]Unknown

(4) *Has the condition of the system been

evaluated and a report issued? [ ]Yes [ ]No [ ]Unknown

(5) Has the septic tank ever been pumped? [ ]Yes [ ]No [ ]Unknown

If yes, when? ________ [ ]NA

(6) Does the system have a pump? [ ]Yes [ ]No [ ]Unknown

(7) Does the system have a treatment unit such

as a sand filter or an aerobic unit? [ ]Yes [ ]No [ ]Unknown

(8) *Is a service contract for routine

maintenance required for the system? [ ]Yes [ ]No [ ]Unknown

(9) Are all components of the system located on

the property? [ ]Yes [ ]No [ ]Unknown

D. *Are there any sewage system problems or

needed repairs? [ ]Yes [ ]No [ ]Unknown

E. Does your sewage system require on-site

pumping to another level? [ ]Yes [ ]No [ ]Unknown

4. DWELLING INSULATION

A. Is there insulation in the:

(1) Ceiling? [ ]Yes [ ]No [ ]Unknown

(2) Exterior walls? [ ]Yes [ ]No [ ]Unknown

(3) Floors? [ ]Yes [ ]No [ ]Unknown

B. Are there any defective insulated doors or

windows? [ ]Yes [ ]No [ ]Unknown

5. DWELLING STRUCTURE

*A. Has the roof leaked? [ ]Yes [ ]No [ ]Unknown

If yes, has it been repaired? [ ]Yes [ ]No [ ]Unknown [ ]NA

B. Are there any additions, conversions or

remodeling? [ ]Yes [ ]No [ ]Unknown

If yes, was a building permit required? [ ]Yes [ ]No [ ]Unknown [ ]NA

If yes, was a building permit obtained? [ ]Yes [ ]No [ ]Unknown [ ]NA

If yes, was final inspection obtained? [ ]Yes [ ]No [ ]Unknown [ ]NA

C. Are there smoke alarms or detectors? [ ]Yes [ ]No [ ]Unknown

D. Are there carbon monoxide alarms? [ ]Yes [ ]No [ ]Unknown

E. Is there a woodstove or fireplace

insert included in the sale? [ ]Yes [ ]No [ ]Unknown

*If yes, what is the make? ________

*If yes, was it installed with a permit? [ ]Yes [ ]No [ ]Unknown

*If yes, is a certification label issued by the

United States Environmental Protection

Agency (EPA) or the Department of

Environmental Quality (DEQ) affixed to it? [ ]Yes [ ]No [ ]Unknown

*F. Has pest and dry rot, structural or

"whole house" inspection been done

within the last three years? [ ]Yes [ ]No [ ]Unknown

*G. Are there any moisture problems, areas of water

penetration, mildew odors or other moisture

conditions (especially in the basement)? [ ]Yes [ ]No [ ]Unknown

*If yes, explain on attached sheet the frequency

and extent of problem and any insurance claims,

repairs or remediation done.

H. Is there a sump pump on the property? [ ]Yes [ ]No [ ]Unknown

I. Are there any materials used in the

construction of the structure that are or

have been the subject of a recall, class

action suit, settlement or litigation? [ ]Yes [ ]No [ ]Unknown

If yes, what are the materials? ________

(1) Are there problems with the materials? [ ]Yes [ ]No [ ]Unknown [ ]NA

(2) Are the materials covered by a warranty? [ ]Yes [ ]No [ ]Unknown [ ]NA

(3) Have the materials been inspected? [ ]Yes [ ]No [ ]Unknown [ ]NA

(4) Have there ever been claims filed for these

materials by you or by previous owners? [ ]Yes [ ]No [ ]Unknown [ ]NA

If yes, when? ________

(5) Was money received? [ ]Yes [ ]No [ ]Unknown [ ]NA

(6) Were any of the materials repaired or

replaced? [ ]Yes [ ]No [ ]Unknown [ ]NA

6. DWELLING SYSTEMS AND FIXTURES

If the following systems or fixtures are included

in the purchase price, are they in good working

order on the date this form is signed?

A. Electrical system, including wiring, switches,

outlets and service [ ]Yes [ ]No [ ]Unknown

B. Plumbing system, including pipes, faucets,

fixtures and toilets [ ]Yes [ ]No [ ]Unknown

C. Water heater tank [ ]Yes [ ]No [ ]Unknown

D. Garbage disposal [ ]Yes [ ]No [ ]Unknown [ ]NA

E. Built-in range and oven [ ]Yes [ ]No [ ]Unknown [ ]NA

F. Built-in dishwasher [ ]Yes [ ]No [ ]Unknown [ ]NA

G. Sump pump [ ]Yes [ ]No [ ]Unknown [ ]NA

H. Heating and cooling systems [ ]Yes [ ]No [ ]Unknown [ ]NA

I. Security system [ ]Owned [ ]Leased [ ]Yes [ ]No [ ]Unknown [ ]NA

J. Are there any materials or products used in

the systems and fixtures that are or have

been the subject of a recall, class action

suit settlement or litigation? [ ]Yes [ ]No [ ]Unknown

If yes, what product? _______________

(1) Are there problems with the product? [ ]Yes [ ]No [ ]Unknown

(2) Is the product covered by a warranty? [ ]Yes [ ]No [ ]Unknown

(3) Has the product been inspected? [ ]Yes [ ]No [ ]Unknown

(4) Have claims been filed for this product

by you or by previous owners? [ ]Yes [ ]No [ ]Unknown

If yes, when? _______________

(5) Was money received? [ ]Yes [ ]No [ ]Unknown

(6) Were any of the materials or products repaired

or replaced? [ ]Yes [ ]No [ ]Unknown

7. COMMON INTEREST

A. Is there a Home Owners’ Association

or other governing entity? [ ]Yes [ ]No [ ]Unknown

Name of Association or Other Governing

Entity _______________

Contact Person __________________

Address ______________________

Phone Number __________________

B. Regular periodic assessments: $_____

per [ ]Month [ ]Year [ ]Other _____

*C. Are there any pending or proposed special

assessments? [ ]Yes [ ]No [ ]Unknown

D. Are there shared "common areas" or joint

maintenance agreements for facilities like

walls, fences, pools, tennis courts, walkways

or other areas co-owned in undivided interest

with others? [ ]Yes [ ]No [ ]Unknown

E. Is the Home Owners’ Association or other

governing entity a party to pending litigation

or subject to an unsatisfied judgment? [ ]Yes [ ]No [ ]Unknown [ ]NA

F. Is the property in violation of recorded

covenants, conditions and restrictions or in

violation of other bylaws or governing rules,

whether recorded or not? [ ]Yes [ ]No [ ]Unknown [ ]NA

8. SEISMIC

Was the house constructed before 1974? [ ]Yes [ ]No [ ]Unknown

If yes, has the house been bolted to its

foundation? [ ]Yes [ ]No [ ]Unknown

9. GENERAL

A. Are there problems with settling, soil,

standing water or drainage on the property

or in the immediate area? [ ]Yes [ ]No [ ]Unknown

B. Does the property contain fill? [ ]Yes [ ]No [ ]Unknown

C. Is there any material damage to the property or

any of the structure(s) from fire, wind, floods,

beach movements, earthquake, expansive soils

or landslides? [ ]Yes [ ]No [ ]Unknown

D. Is the property in a designated floodplain? [ ]Yes [ ]No [ ]Unknown

Note: Flood insurance may be required for

homes in a floodplain.

E. Is the property in a designated slide or

other geologic hazard zone? [ ]Yes [ ]No [ ]Unknown

*F. Has any portion of the property been tested

or treated for asbestos, formaldehyde, radon

gas, lead-based paint, mold, fuel or chemical

storage tanks or contaminated soil or water? [ ]Yes [ ]No [ ]Unknown

G. Are there any tanks or underground storage

tanks (e.g., septic, chemical, fuel, etc.)

on the property? [ ]Yes [ ]No [ ]Unknown

H. Has the property ever been used as an illegal

drug manufacturing or distribution site? [ ]Yes [ ]No [ ]Unknown

*If yes, was a Certificate of Fitness issued? [ ]Yes [ ]No [ ]Unknown

*I. Has the property been classified as

forestland-urban interface? [ ]Yes [ ]No [ ]Unknown

10. FULL DISCLOSURE BY SELLERS

*A. Are there any other material defects affecting

this property or its value that a prospective

buyer should know about? [ ]Yes [ ]No

*If yes, describe the defect on attached sheet and

explain the frequency and extent of the problem

and any insurance claims, repairs or remediation.

B. Verification:

The foregoing answers and attached explanations (if any) are complete and correct to

the best of my/our knowledge and I/we have received a copy of this disclosure statement.

I/we authorize my/our agents to deliver a copy of this disclosure statement to all

prospective buyers of the property or their agents.

Seller(s) signature:

SELLER ______________________ DATE _______________

SELLER ______________________ DATE _______________

______________________________________________________________________________

II. BUYER’S ACKNOWLEDGMENT

A. As buyer(s), I/we acknowledge the duty to pay diligent attention to any material defects that are known to me/us or can be known by me/us by utilizing diligent attention and observation.

B. Each buyer acknowledges and understands that the disclosures set forth in this statement and in any amendments to this statement are made only by the seller and are not the representations of any financial institution that may have made or may make a loan pertaining to the property, or that may have or take a security interest in the property, or of any real estate licensee engaged by the seller or buyer. A financial institution or real estate licensee is not bound by and has no liability with respect to any representation, misrepresentation, omission, error or inaccuracy contained in another party’s disclosure statement required by this section or any amendment to the disclosure statement.

C. Buyer (which term includes all persons signing the "buyer’s acknowledgment" portion of this disclosure statement below) hereby acknowledges receipt of a copy of this disclosure statement (including attachments, if any) bearing seller’s signature(s).

DISCLOSURES, IF ANY, CONTAINED IN THIS FORM ARE PROVIDED BY THE SELLER ON THE BASIS OF SELLER’S ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME OF DISCLOSURE. IF THE SELLER HAS FILLED OUT SECTION 2 OF THIS FORM, YOU, THE BUYER, HAVE FIVE DAYS FROM THE SELLER’S DELIVERY OF THIS DISCLOSURE STATEMENT TO REVOKE YOUR OFFER BY DELIVERING YOUR SEPARATE SIGNED WRITTEN STATEMENT OF REVOCATION TO THE SELLER DISAPPROVING THE SELLER’S DISCLOSURE UNLESS YOU WAIVE THIS RIGHT AT OR PRIOR TO ENTERING INTO A SALE AGREEMENT.

BUYER HEREBY ACKNOWLEDGES RECEIPT OF A COPY OF THIS SELLER’S PROPERTY DISCLOSURE STATEMENT.

BUYER ______________________ DATE _______________

BUYER ______________________ DATE _______________

Agent receiving disclosure statement on buyer’s behalf to sign and date:

______________________Real Estate Licensee

______________________Real Estate Firm

Date received by agent ________

______________________________________________________________________________

[2003 c.328 §3; 2007 c.30 §13; 2007 c.866 §8; 2009 c.387 §18; 2009 c.591 §14a; 2013 c.435 §1; 2017 c.147 §1; 2019 c.584 §1]