New York State Department of State (Division of Licensing Services) Property Condition Disclosure Statement (DOS-1614-f) Instructions

Check this box if the property is located in an agricultural district.

Check this box if the property is not located in an agricultural district.

Check this box if it is unknown whether the property is located in an agricultural district.

Check this box if the question regarding the property's location in an agricultural district is not applicable.

Provide details if the property is located in an agricultural district.

Check this box if there are known material defects in the air conditioner.

Check this box if there are no known material defects in the air conditioner.

Check this box if it is unknown whether there are material defects in the air conditioner.

Check this box if the air conditioner is not applicable or not present in the property.

Check this box if asbestos is present in the structure.

Check this box if asbestos is not present in the structure.

Check this box if it is unknown whether asbestos is present in the structure.

Check this box if the question regarding asbestos presence is not applicable.

Provide the specific location or locations within the structure where asbestos is present.

Check this box if there are known material defects in the carbon monoxide detector.

Check this box if there are no known material defects in the carbon monoxide detector.

Check this box if the presence or status of material defects in the carbon monoxide detector is unknown.

Check this box if the carbon monoxide detector is not applicable or not present.

Check this box if there are known material defects in the chimney, fireplace, or stove.

Check this box if there are no known material defects in the chimney, fireplace, or stove.

Check this box if the presence of material defects in the chimney, fireplace, or stove is unknown.

Check this box if the property does not have a chimney, fireplace, or stove, or if this category is not applicable.

Check this box if any or all of the property is located in a designated wetland.

Check this box if none of the property is located in a designated wetland.

Check this box if it is unknown whether any or all of the property is located in a designated wetland.

Check this box if the question regarding the property's location in a designated wetland is not applicable.

Provide a detailed explanation if any or all of the property is located in a designated wetland.

Check this box if there are known material defects in the driveway.

Check this box if there are no known material defects in the driveway.

Check this box if the material defect status of the driveway is unknown.

Check this box if the driveway status is not applicable.

Specify if the electric service uses private or public poles.

Provide the name of your electric service provider.

Enter the amperage of the electric service.

Indicate whether the electric service has circuit breakers or fuses.

Check this box if there are any known material defects related to the electric service.

Check this box if there are no known material defects related to the electric service.

Check this box if it is unknown whether there are any known material defects related to the electric service.

If there are any known material defects related to the electric service, explain them in detail.

Check this box if the question about known material defects related to the electric service is not applicable.

Check this box if there are known material defects in the exterior walls or siding.

Check this box if there are no known material defects in the exterior walls or siding.

Check this box if the status of material defects in the exterior walls or siding is unknown.

Check this box if exterior walls or siding are not applicable to this property disclosure.

Provide a detailed explanation if federal disaster flood assistance was received for the property.

Check this box if you or any previous owners have received federal disaster flood assistance from FEMA, SBA, or any other source for flood damage to the property.

Check this box if neither you nor any previous owners have received federal disaster flood assistance for flood damage to the property.

Check this box if you do not know whether federal disaster flood assistance has been received by you or any previous owners for flood damage to the property.

Check this box if the question regarding federal disaster flood assistance for flood damage to the property does not apply to your situation.

Check this box if a FEMA elevation certificate is available for the property.

Check this box if a FEMA elevation certificate is not available for the property.

Check this box if it is unknown whether a FEMA elevation certificate is available for the property.

Check this box if a FEMA elevation certificate is not applicable for the property.

Check this box if there is fire or smoke damage to the structure or structures.

Check this box if there is no fire or smoke damage to the structure or structures.

Check this box if it is unknown whether there is fire or smoke damage to the structure or structures.

Check this box if the question about fire or smoke damage to the structure or structures is not applicable.

Provide a detailed explanation of any fire or smoke damage to the structure or structures.

Check this box if there is a known material defect in the fire sprinkler system.

Check this box if there are no known material defects in the fire sprinkler system.

Check this box if the status or presence of material defects in the fire sprinkler system is unknown.

Check this box if a fire sprinkler system is not present or the question is not applicable.

Check this box if you have ever filed a claim for flood damage to the property with any insurance provider, including the National Flood Insurance Program (NFIP).

Check this box if you have never filed a claim for flood damage to the property with any insurance provider, including the National Flood Insurance Program (NFIP).

Check this box if it is unknown whether a claim for flood damage to the property has ever been filed.

Check this box if the question about filing a claim for flood damage is not applicable to the property.

Provide a detailed explanation of any claims filed for flood damage to the property with any insurance provider, including the National Flood Insurance Program (NFIP).

Check this box if there is flood insurance on the property.

Check this box if there is no flood insurance on the property.

Check this box if the flood insurance status for the property is unknown.

Check this box if the question regarding flood insurance status is not applicable.

Provide a detailed explanation of any flooding, drainage, or grading problems that resulted in standing water on the property, including specific locations.

Check this box if there are flooding, drainage, or grading problems that resulted in standing water on any portion of the property.

Check this box if there are no flooding, drainage, or grading problems that resulted in standing water on any portion of the property.

Check this box if it is unknown whether there are flooding, drainage, or grading problems that resulted in standing water on any portion of the property.

Check this box if the question about flooding, drainage, or grading problems is not applicable to the property.

Check this box if there are known material defects in the floors.

Check this box if there are no known material defects in the floors.

Check this box if the status of material defects in the floors is unknown.

Check this box if the question regarding material defects in the floors is not applicable.

Check this box if there are known material defects in the foundation/slab.

Check this box if there are no known material defects in the foundation/slab.

Check this box if the status of material defects in the foundation/slab is unknown.

Check this box if the foundation/slab status is not applicable.

Check this box if there are or have ever been fuel storage tanks above or below the ground on the property.

Check this box if there are no fuel storage tanks and never have been any above or below the ground on the property.

Check this box if it is unknown whether there are or have ever been fuel storage tanks above or below the ground on the property.

Check this box if the question about fuel storage tanks on the property is not applicable.

Check this box if fuel storage tanks on the property are currently in use.

Check this box if fuel storage tanks on the property are not currently in use.

Check this box if it is unknown whether fuel storage tanks on the property are currently in use.

Check this box if the question about the current use of fuel storage tanks is not applicable.

Provide the location(s) of the fuel storage tank(s) on the property.

Check this box if fuel storage tanks on the property are currently leaking or have ever leaked.

Provide an explanation if the fuel storage tank(s) are currently leaking or have ever leaked.

Check this box if fuel storage tanks on the property are not leaking and have never leaked.

Check this box if it is unknown whether fuel storage tanks on the property are currently leaking or have ever leaked.

Check this box if the question about fuel storage tanks leaking is not applicable.

Provide further explanation for any item mentioned above, and if applicable, indicate the number of additional pages attached.

Enter how long you have owned the property (for example, the number of years, months, or a brief phrase describing the duration).

Enter how long you have occupied the property (for example, the number of years, months, or a brief phrase describing the duration).

Enter the age of the structure(s) on the property (for example, the year built or the number of years since construction).

Check this box if somebody other than you currently has a lease, easement or any other right to use or occupy any part of the property (beyond rights shown in public records).

Check this box if nobody other than you has any lease, easement or other right to use or occupy any part of the property.

Check this box if you do not know whether anyone other than you has a lease, easement or other right to use or occupy any part of the property.

Check this box if the question is not applicable to this property or circumstance.

Check this box if someone other than you claims to own any part of the property; also provide the explanation below.

Check this box if no one else claims to own any part of the property.

Check this box if you do not know whether anyone else claims to own any part of the property.

Check this box if this question is not applicable to your property or your situation.

Provide a clear, brief explanation describing any other person or entity who claims to own or have an interest in any part of the property, including names, nature of the claim, dates, and any document references; if there are no such claims, leave blank or write 'None'. Fill only if 'Q5 - Yes' is 'Yes'.

Check this box if, to your knowledge, anyone has denied you access to the property or has made a formal legal claim challenging your title.

Check this box if, to your knowledge, no one has denied you access to the property and no one has made a formal legal claim challenging your title.

Check this box if you do not know whether anyone has denied you access or made a formal legal claim challenging your title.

Check this box if this question does not apply to your situation (for example, if you never owned or occupied the property).

Provide a clear, concise explanation describing any instance where someone denied you access to the property or made a formal legal claim challenging your title, including relevant dates, names of parties involved, nature of the claim or denial, and the current status or outcome if known. Fill only if 'Q6 - Yes' is 'Yes'.

Check this box if motor fuel, motor oil, home heating fuel, lubricating oil, any other petroleum product, methane gas, or any hazardous or toxic substance has spilled, leaked, or otherwise been released on or from the property.

Check this box if motor fuel, motor oil, home heating fuel, lubricating oil, any other petroleum product, methane gas, or any hazardous or toxic substance has not spilled, leaked, or otherwise been released on or from the property.

Check this box if it is unknown whether motor fuel, motor oil, home heating fuel, lubricating oil, any other petroleum product, methane gas, or any hazardous or toxic substance has spilled, leaked, or otherwise been released on or from the property.

Check this box if the question regarding hazardous substance spills is not applicable to the property.

Provide details regarding any hazardous substance spills, leaks, or releases on or from the property.

Check this box if the property has been tested for the presence of motor fuel, petroleum products, methane gas, or any hazardous or toxic substance, and a report can be attached.

Check this box if the property has not been tested for the presence of motor fuel, petroleum products, methane gas, or any hazardous or toxic substance.

Check this box if it is unknown whether the property has been tested for the presence of motor fuel, petroleum products, methane gas, or any hazardous or toxic substance.

Check this box if the question regarding testing for hazardous or toxic substances is not applicable to this property.

Enter details or refer to the attached report(s) regarding any hazardous substance testing conducted on the property.

Check this box if there are known material defects in the heating system.

Check this box if there are no known material defects in the heating system.

Check this box if the presence of material defects in the heating system is unknown.

Check this box if the heating system is not applicable to the property.

Check this box if there are known material defects with the hot water heater.

Check this box if there are no known material defects with the hot water heater.

Check this box if the status of material defects with the hot water heater is unknown.

Check this box if the hot water heater is not applicable to this property.

Check this box if the property has been tested for indoor mold.

Check this box if the property has not been tested for indoor mold.

Check this box if the indoor mold test status of the property is unknown.

Check this box if there are known material defects in the interior walls or ceilings.

Check this box if there are no known material defects in the interior walls or ceilings.

Check this box if the status of material defects in the interior walls or ceilings is unknown.

Check this box if the question regarding material defects in the interior walls or ceilings is not applicable.

Check this box if the property was never the site of a landfill.

Check this box if it is unknown whether the property was ever the site of a landfill.

Check this box if the question about the property being a landfill site is not applicable.

Provide a detailed explanation if the property was ever the site of a landfill.

Check this box if lead plumbing is present in the property.

Check this box if lead plumbing is not present in the property.

Check this box if it is unknown whether lead plumbing is present in the property.

Check this box if the question regarding lead plumbing presence is not applicable.

State the location or locations where lead plumbing is present in the structure.

Check this box if there are known material defects in the patio/deck.

Check this box if there are no known material defects in the patio/deck.

Check this box if the presence of material defects in the patio/deck is unknown.

Check this box if a patio/deck is not present or applicable to the property.

Check this box if there is any termite, insect, rodent, or pest infestation or damage to the property.

Check this box if there is no termite, insect, rodent, or pest infestation or damage to the property.

Check this box if it is unknown whether there is any termite, insect, rodent, or pest infestation or damage to the property.

Check this box if the question regarding termite, insect, rodent, or pest infestation or damage is not applicable.

Provide a detailed explanation of any termite, insect, rodent, or pest infestation or damage found on the property.

Check this box if the property has been tested for termite, insect, rodent, or pest infestation or damage.

Check this box if the property has not been tested for termite, insect, rodent, or pest infestation or damage.

Check this box if the test status for termite, insect, rodent, or pest infestation or damage is unknown.

Check this box if the question about termite, insect, rodent, or pest infestation testing is not applicable.

Check this box if there are known material defects in the plumbing system.

Check this box if there are no known material defects in the plumbing system.

Check this box if the presence of material defects in the plumbing system is unknown.

Check this box if the plumbing system is not applicable to this disclosure.

Check this box if any or all of the property is located in a FEMA-designated floodplain.

Check this box if none of the property is located in a FEMA-designated floodplain.

Check this box if you do not know whether any or all of the property is located in a FEMA-designated floodplain.

Check this box if the question about FEMA-designated floodplain does not apply to this property or transaction.

If any or all of the property is located in a FEMA-designated floodplain, provide a clear explanation here (for example: whether all or part of the property is affected, map panel or zone if known, relevant parcel locations or addresses, and any other details about the floodplain designation). Fill only if 'Question 10 - Yes' is 'Yes'.

Check this box if any or all of the property is located wholly or partly in the Special Flood Hazard Area (SFHA) / 100-year floodplain per FEMA's current flood insurance rate maps.

Check this box if none of the property is located in the SFHA / 100-year floodplain on FEMA's current flood insurance rate maps.

Check this box if you do not know whether any part of the property is located in the SFHA / 100-year floodplain.

Check this box if the question is not applicable to this property (for example, FEMA mapping does not apply).

If any or all of the property is located wholly or partially in the Special Flood Hazard Area (SFHA or 100‑year floodplain) per FEMA flood insurance rate maps, describe the situation here (for example: whether the building/lot is within the SFHA, relevant map panel number(s), effective date, and any other details that explain the basis for your answer). Fill only if 'Question 11 - Yes' is 'Yes'.

Check this box if any or all of the property is located wholly or partially in a Moderate Risk Flood Hazard Area ("500-year floodplain") according to FEMA's current flood insurance rate maps.

Check this box if none of the property is located in a Moderate Risk Flood Hazard Area ("500-year floodplain") according to FEMA's current flood insurance rate maps.

Check this box if the seller does not know whether the property is located in a Moderate Risk Flood Hazard Area ("500-year floodplain").

Check this box if the question about location in a Moderate Risk Flood Hazard Area ("500-year floodplain") is not applicable to this property or transaction.

If any or all of the property is located wholly or partially in a Moderate Risk Flood Hazard Area (500‑year floodplain), provide a brief explanation including details such as the portion of the property affected, relevant map or source (FEMA), dates or map panel numbers, and any other pertinent facts; if not applicable, leave blank or enter 'None'. Fill only if 'Q12 - Yes (Moderate Risk Flood Hazard Area / 500-year floodplain)' is 'Yes'.

Check this box if the property is subject to a federal law requirement to obtain and maintain flood insurance.

Check this box if the property is not subject to any federal law requirement to obtain and maintain flood insurance.

Check this box if the seller does not know whether federal law requires the property to obtain and maintain flood insurance.

Check this box if the question is not applicable to this property or transaction and a federal flood insurance requirement does not apply.

If the property is subject to any federal requirement to obtain or maintain flood insurance, provide a clear explanation here including whether the property is in a Special or Moderate Flood Hazard Area, any relevant flood zone or FEMA map reference, and any lender or policy details that apply; if not, enter 'No' or explain why not. Fill only if 'Question 13: Yes' is 'Yes'.

Check this box if the property has features shared in common with adjoining landowners or a homeowners association (for example walls, fences, driveways).

Check this box if the property does not have any features shared in common with adjoining landowners or a homeowners association.

Check this box if you do not know whether the property has any features shared with adjoining landowners or a homeowners association.

Check this box if the question is not applicable to this property (for example when shared features or an HOA relationship are irrelevant).

Describe any features of the property that are shared in common with adjoining landowners or a homeowners association (for example walls, fences, driveways), including who is responsible for maintenance; if there are none, enter 'None'. Fill only if 'Question 7 - Yes' is 'Yes'.

Check this box if there are electric or gas utility surcharges, line-extension charges, special assessments, or homeowner/association fees that apply to the property.

Check this box if there are no electric or gas utility surcharges, line-extension charges, special assessments, or homeowner/association fees that apply to the property.

Check this box if it is unknown whether any electric or gas utility surcharges, line-extension charges, special assessments, or homeowner/association fees apply to the property.

Check this box if the question about electric or gas utility surcharges, line-extension charges, special assessments, or homeowner/association fees is not applicable to the property.

Provide a clear description of any electric or gas utility surcharges (such as line extension charges), special assessments, or homeowner/other association fees that apply to the property, including relevant amounts, who is responsible for payment, frequency, and any special terms or conditions. Fill only if 'Question 8 - Yes' is 'Yes'.

Check this box if there are certificates of occupancy related to the property.

Check this box if there are no certificates of occupancy related to the property (if checked, explain below).

Check this box if you do not know whether there are certificates of occupancy related to the property.

Check this box if the question about certificates of occupancy does not apply to this property.

Enter details about any certificates of occupancy related to the property, or if there are none, explain why and provide any relevant information or circumstances. Fill only if 'Question 9 - No' is 'Yes'.

Describe the status of any radon test performed on the property and provide any relevant details.

Indicate the type of material used for the roof covering, such as slate or asphalt.

Describe any known material defects present in the roof.

Provide the current age of the roof.

If there is a transferable warranty on the roof, provide details.

Check this box if there is no transferable warranty on the roof currently in effect.

Check this box if it is unknown whether there is a transferable warranty on the roof currently in effect.

Check this box if the question about a transferable roof warranty is not applicable.

Provide a detailed explanation of any rot or water damage to the structure or structures.

Enter the name of the school district where the property is located.

Check this box if there are known material defects in the security system.

Check this box if there are no known material defects in the security system.

Check this box if the presence of material defects in the security system is unknown.

Check this box if the security system is not applicable to this property.

Enter the full legal name or names of the seller or sellers of the property as they should appear on the disclosure.

Enter the full street address of the property being sold, including street number, street name, unit or apartment number (if any), city, state, and ZIP code.

Check this box if the property uses a private sewer system.

Check this box if the property uses a public sewer system.

Check this box if the property uses a septic system.

Check this box if the property uses a cesspool system.

Enter the age of the septic or cesspool system.

Provide the date the septic or cesspool system was last pumped.

Describe the frequency at which the septic or cesspool system is pumped.

Check this box if there are any known material defects with the sewage system.

Check this box if there are no known material defects with the sewage system.

Check this box if it is unknown whether there are any material defects with the sewage system.

Explain any known material defects of the sewage system.

Check this box if the question regarding known material defects with the sewage system is not applicable.

Check this box if there are known material defects in the smoke detector system.

Check this box if there are no known material defects in the smoke detector system.

Check this box if the status of material defects in the smoke detector system is unknown.

Check this box if the smoke detector system is not applicable to this property.

Check this box if there are known material defects in any of the structural systems mentioned, such as footings, beams, girders, lintels, columns, or partitions.

Check this box if there are no known material defects in any of the structural systems mentioned, such as footings, beams, girders, lintels, columns, or partitions.

Check this box if it is unknown whether there are any material defects in the structural systems mentioned.

Check this box if the question regarding material defects in the structural systems is not applicable to the property.

Provide a detailed explanation of any known material defects found in structural systems such as footings, beams, girders, lintels, columns, or partitions.

Check this box if there is no known material defect with the sump pump.

Check this box if the status of material defects with the sump pump is unknown.

Check this box if the sump pump is not applicable or not present.

Provide a detailed explanation of any water penetration or damage due to seepage or natural flood events that the structure(s) experienced.

Check this box if the question about water penetration or damage is not applicable.

Check this box if the structure has not experienced water penetration or damage due to seepage or a natural flood event.

Check this box if it is unknown whether the structure has experienced water penetration or damage due to seepage or a natural flood event.

Check this box if the question about water quality and/or flow rate testing is not applicable.

Provide details about the water quality and/or flow rate test conducted, if applicable.

Check this box if the status of whether the water quality and/or flow rate has been tested is unknown.

Check this box if the water quality and/or flow rate has been tested.

Check this box if the water quality and/or flow rate has not been tested.

Check this box if the property's water source is a well.

Provide the details for the other water source.

Check this box if the property's water source is a private system.

Check this box if the property's water source is municipal.

Check this box if the property's water source is other than well, private, or municipal, and specify the source in the space provided.

Check this box if the municipal water source for the property is metered.

Check this box if the municipal water source for the property is not metered.

Check this box if it is unknown whether the municipal water source for the property is metered.

Check this box if the question regarding whether the municipal water source is metered is not applicable.