... (MONTH) .... (DAY), .... (YEAR). IT IS NOT A WARRANTY OF ANY KIND BY THE OWNER OR ANY AGENTS REPRESENTING ANY PARTY IN THIS TRANSACTION AND IS NOT A SUBSTITUTE FOR ANY INSPECTIONS OR WARRANTIES THAT THE PARTIES MAY WISH TO OBTAIN. A buyer who does not receive a fully completed copy of this report within 10 days after the acceptance of the contract of sale or option contract for the above-described real property has the right to rescind that contract (Wis. Stat. s. 709.02), provided the owner is required to provide this report under Wisconsin Statutes chapter 709. NOTICE TO PARTIES REGARDING ADVICE OR INSPECTIONS Real estate licensees may not provide advice or opinions concerning whether or not an item is a defect for the purposes of this report or concerning the legal rights or obligations of parties to a transaction. The parties may wish to obtain professional advice or inspections of the property and to include appropriate provisions in a contract between them with respect to any advice, inspections, defects, or warranties. A. OWNER’S INFORMATION A1. In this form, “aware” means the “owner(s)” have notice or knowledge. A2. In this form, “defect” means a condition that would have a significant adverse effect on the value of the property; that would significantly impair the health or safety of future occupants of the property; or that if not repaired, removed, or replaced would significantly shorten or adversely affect the expected normal life of the premises. A3. In this form, “owner” means the person or persons, entity, or organization that is the owner of the above-described real property. An “owner” who transfers real estate that does not include any buildings is required to complete this report. Exceptions: An “owner” who is a personal representative, trustee, conservator, or fiduciary appointed by or subject to supervision by a court, and who has never occupied the property transferred is not required to complete this report. An “owner” who transfers property that has not been inhabited or who transfers property in a manner that is exempt from the real estate transfer fee is not required to complete this report. (Wis. Stat. s. 709.01) A4. The owner represents that to the best of the owner’s knowledge, the responses to the following questions have been accurately checked as “yes,” “no,” or “not applicable (N/A)” to the property being sold. If the owner responds to any question with “yes,” the owner shall provide, in the additional information area of this form, an explanation of the reason why the response to the question is “yes.” A5. If the transfer is of a condominium unit, the property to which this form applies is the condominium unit, the common elements of the condominium, and any limited common elements that may be used only by the owner of the condominium unit being transferred. A6. The owner discloses the following information with the knowledge that, even though this is not a warranty, prospective buyers may rely on this information in deciding whether and on what terms to purchase the property. The owner hereby authorizes the owner’s agents and the agents of any prospective buyer to provide a copy of this report, and to disclose any information in the report, to any person in connection with any actual or anticipated sale of the property. CAUTION: The lists of defects following each question below are examples only and are not the only defects that may properly be disclosed in response to each respective question. B. ENVIRONMENTAL YES NO N/A B1. Are you aware of a material violation of an environmental rule or other rule or agreement regulating the use of the property? .... .... .... B2. Are you aware of a defect caused by unsafe concentrations of, or unsafe conditions relating to, radon, radium in water supplies, high voltage electric (100 KV or greater) or steel natural gas transmission lines located on but not directly serving the property, lead in soil, or other potentially hazardous or toxic substances on the property? .... .... .... B3. Are you aware of the manufacture of methamphetamine or other hazardous or toxic substances on the property? .... .... .... B4. Are you aware of subsoil conditions that would significantly increase the cost of development, including, but not limited to, subsurface foundations or waste material; any type of fill; dumpsites where pesticides, herbicides, fertilizer, or other toxic or hazardous materials or containers for these materials were disposed of in violation of manufacturer or government guidelines or other laws regulating such disposal; high groundwater; adverse soil conditions, such as low load-bearing capacity, earth or soil movement, settling, upheavals, or slides; excessive rocks or rock formations; or other soil problems? .... .... .... B5. Are you aware of a defect caused by unsafe concentrations of, unsafe conditions relating to, or the storage of hazardous or toxic substances on neighboring properties? .... .... .... YES NO N/A B6. Are you aware of brownfields (abandoned, idled, or underused land that may be subject to environmental contamination) or other contaminated land on the property, or that contaminated soils on the property have been cleaned up under the Petroleum Environmental Cleanup Fund Act (PECFA), a Wisconsin Department of Natural Resources (DNR) remedial or cleanup program, the DATCP Agricultural Chemical Cleanup Program, or other similar program? .... .... .... B7. Explanation of “yes” responses .................................................. .................................................................................................... .................................................................................................... C. WELLS, SEPTIC SYSTEMS, STORAGE TANKS YES NO N/A C1. Are you aware of underground storage tanks presently or previously on the property for storage of flammable or combustible liquids, including, but not limited to, gasoline or heating oil? (If “yes,” the owner, by law, may have to register the tanks with the Wisconsin Department of Agriculture, Trade and Consumer Protection at P.O. Box 8911, Madison, Wisconsin, 53708, whether the tanks are in use or not. Wisconsin Department of Agriculture, Trade and Consumer Protection regulations may require the closure or removal of unused tanks.) .... .... .... C2. Are you aware of defects in the underground or aboveground fuel storage tanks on or previously located on the property? Defects in underground or aboveground fuel storage tanks may include items such as abandoned tanks not closed in conformance with applicable local, state, and federal law; leaking; corrosion; or failure to meet operating standards. .... .... .... C3. Are you aware of defects in a well on the property or a well that serves the property, including unsafe well water due to contaminants such as coliform, nitrates, or atrazine, or any out-of-service wells or cisterns that are required to be abandoned (see s. NR 812.26, Wis. Adm. Code) but that are not closed or abandoned according to applicable regulations? .... .... .... C4. Are you aware of a joint well serving this property? .... .... .... C5. Are you aware of a defect relating to a joint well serving this property? .... .... .... C6. Are you aware of defects in any septic system or other private sanitary disposal system on the property or any out-of-service septic system that serves the property and that is not closed or abandoned according to applicable regulations? .... .... .... C7. Explanation of “yes” responses .................................................. .................................................................................................... .................................................................................................... D. TAXES, SPECIAL ASSESSMENTS, PERMITS, ETC. YES NO N/A D1. Have you received notice of a property tax increase, other than normal annual increases, or are you aware of a pending property tax reassessment? .... .... .... D2. Are you aware of pending special assessments? .... .... .... D2m. Are you aware of an existing neighborhood improvement special assessment? .... .... .... YES NO N/A D3. Are you aware of the property being located within a special purpose district, such as a drainage district, that has the authority to impose assessments against the real property located within the district? .... .... .... D4. Are you aware of any land division involving the property for which required state or local permits were not obtained? .... .... .... D5. Are you aware of impact fees or another condition or occurrence that would significantly increase development costs or reduce the value of the property to a reasonable person with knowledge of the nature and scope of the condition or occurrence? .... .... .... D6. Are you aware of proposed, planned, or commenced public improvements or public construction projects that may result in special assessments or that may otherwise materially affect the property or the present use of the property? .... .... .... D7. Explanation of “yes” responses .................................................. .................................................................................................... .................................................................................................... E. LAND USE YES NO N/A E1. Are you aware of the property being part of or subject to any subdivision homeowners’ associations? .... .... .... E2. If the property is not a condominium unit, are you aware of common areas associated with the property that are co-owned with others? .... .... .... E3. Are you aware that all or a portion of the property is in a floodplain, wetland, or shoreland zoning area under local, state, or federal regulations? .... .... .... E4. Are you aware of any zoning code violations with respect to the property? .... .... .... E5. Are you aware of nonconforming uses of the property? A nonconforming use is a use of land that existed lawfully before the current zoning ordinance was enacted or amended, but that does not conform to the use restrictions in the current ordinance. .... .... .... E6. Are you aware of conservation easements on the property? A conservation easement is a legal agreement in which a property owner conveys some of the rights associated with ownership of the property to an easement holder such as a governmental unit or a qualified nonprofit organization to protect the natural habitat of fish, wildlife, or plants or a similar ecosystem, preserve areas for outdoor recreation or education, or for similar purposes. .... .... .... E7. Are you aware of restrictive covenants or deed restrictions on the property? .... .... .... E8. Other than public rights-of-way, are you aware of nonowners having rights to use part of the property, including, but not limited to, private rights-of-way and easements other than recorded utility easements? .... .... .... E9. Are you aware of the property being subject to a mitigation plan required under administrative rules of the Wisconsin Department of Natural Resources related to county shoreland zoning ordinances, which obligates the owner of the property to establish or maintain certain measures related to shoreland conditions and which is enforceable by the county? .... .... .... YES NO N/A E10. The use value assessment system values agricultural land based on the income that would be generated from its rental for agricultural use rather than its fair market value. When a person converts agricultural land to a non agricultural use (e.g., residential or commercial development), that person may owe a conversion charge. For more information visit https://www.revenue.wi.gov/Pages/FAQS/slf-useassmt.aspx or (608) 266-2486. a. Are you aware of all or part of the property having been assessed as agricultural land under Wis. Stat. s. 70.32 (2r) (use value assessment)? b. Are you aware of the property having been assessed a use value assessment conversion charge relating to this property? (Wis. Stat. s. 74.485 (2)) c. Are you aware of the payment of a use value assessment conversion charge having been deferred relating to this property? (Wis. Stat. s. 74.485 (4)) .... .... .... .... .... .... .... .... .... E11. Is all or part of the property subject to or in violation of a farmland preservation agreement? Early termination of a farmland preservation agreement or removal of land from such an agreement can trigger payment of a conversion fee equal to 3 times the class 1 “use value” of the land. Visit https://datcp.wi.gov/Pages/Programs_Services/FarmlandPreservation.aspx for more information. .... .... .... E12. Is all or part of the property subject to, enrolled in, or in violation of the Forest Crop Law, Managed Forest Law, the Conservation Reserve Program, or a comparable program? .... .... .... E13. Are you aware of a dam that is totally or partially located on the property or that an ownership in a dam that is not located on the property will be transferred with the property because it is owned collectively by members of a homeowners’ association, lake district, or similar group? (If “yes,” contact the Wisconsin Department of Natural Resources to find out if dam transfer requirements or agency orders apply.) .... .... .... E14. Are you aware of boundary or lot line disputes, encroachments, or encumbrances (including a joint driveway) affecting the property? Encroachments often involve some type of physical object belonging to one person but partially located on or overlapping on land belonging to another, such as, without limitation, fences, houses, garages, driveways, gardens, and landscaping. Encumbrances include, without limitation, a right or claim of another to a portion of the property or to the use of the property such as a joint driveway, liens, and licenses. .... .... .... E15. Are you aware there is not legal access to the property? .... .... .... E16. Are you aware of a pier attached to the property that is not in compliance with state or local pier regulations? See http://dnr.wi.gov/topic/waterways for more information. .... .... .... E17. Are you aware of a written agreement affecting riparian rights related to the property? .... .... .... E18. Are you aware that the property abuts the bed of a navigable waterway that is owned by a hydroelectric operator? Under Wis. Stat. s. 30.132, the owner of a property abutting the bed of a navigable waterway that is owned by a hydroelectric operator, as defined in s. 30.132 (1) (b), may be required to ask the permission of the hydroelectric operator to place a structure on the bed of the waterway. .... .... .... YES NO N/A E19. Are you aware of one or more burial sites on the property? (For information regarding the presence, preservation, and potential disturbance of burial sites, contact the Wisconsin Historical Society at 800-342-7834 or www.wihist.org/burial-information.) .... .... .... E20. Are you aware of archeological artifacts, mineral rights, orchards, or endangered species on the property? .... .... .... E21. Are you aware of existing or abandoned manure storage facilities located on the property? .... .... .... E22. Are you aware that all or part of the property is enrolled in the managed forest land program? The managed forest land program is a landowner incentive program that encourages sustainable forestry on private woodlands by exempting the landowner from the payment of property taxes in exchange for the payment of a lower acreage share payment and compliance with certain conservation practices. Orders designating lands as managed forest lands remain in effect for 25 or 50 years. When ownership of land enrolled in the managed forest land program changes, the new owner must sign and file a report of the change of ownership on a form provided by the Wisconsin Department of Natural Resources (DNR) and pay a fee. By filing this form, the new owner agrees to comply with the management plan for the land and the managed forest land program rules. The DNR Division of Forestry monitors forest management plan compliance. Changes that a landowner makes to property that is subject to an order designating it as managed forest land, or to its use, may jeopardize benefits under the program or cause the property to be withdrawn from the program and may result in the assessment of penalties. For more information, call your local DNR forester or visit http://dnr.wi.gov/topic/forestry.html. .... .... .... E23. Explanation of “yes” responses .................................................. .................................................................................................... .................................................................................................... F. ADDITIONAL INFORMATION YES NO N/A F1. Are you aware of high voltage electric (100 kilo volts or greater) or steel natural gas transmission lines located on, but not directly serving, the property? .... .... .... F2. Are you aware of flooding, standing water, drainage problems, or other water problems on or affecting the property? .... .... .... F3. Are you aware of material damage from fire, wind, flood, earthquake, expansive soil, erosion, or landslide? .... .... .... F4. Are you aware of significant odor, noise, water diversion, water intrusion, or other irritants emanating from neighboring property? .... .... .... F5. Are you aware of significant crop damage from disease, insects, soil contamination, wildlife, or other causes; diseased or dying trees or shrubs; or substantial injuries or disease in livestock on the property or neighboring property? .... .... .... F6. Utility Connections. Are you aware that the property is connected to the following utilities on the property or at the lot line? (If “yes,” indicate where the utility is located.) a. Electricity ............................................................... b. Municipal water ..................................................... c. Telephone ............................................................... d. Cable television ..................................................... e. Natural gas ............................................................. f. Municipal sewer ..................................................... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... YES NO N/A F7. Are you aware of any agreements that bind subsequent owners of the property, such as a lease agreement or an extension of credit from an electric cooperative? .... .... .... F8. Are you aware of other defects affecting the property? Other defects may include items such as animal, reptile, or insect infestation; drainage easement or grading problems; excessive sliding; or any other defect or material condition. .... .... .... F9. Are you aware of a government agency, court order, or federal, state, or local regulations requiring repair, alteration, or correction of an existing condition? .... .... .... F10. Is the owner a foreign person, as defined in 26 USC 1445 (f)? (E.g., a nonresident alien individual, foreign corporation, foreign partnership, foreign trust, or foreign estate.) .... .... .... Section 1445 of the Internal Revenue Code (26 USC 1445), also known as the Foreign Investment In Real Property Tax Act or FIRPTA, provides that a transferee (buyer) of a U.S. real property interest must be notified in writing and must withhold tax if the transferor (seller) is a foreign person, unless an exception under FIRPTA applies to the transfer. F11. The owner has owned the property for .... years. F12. Explanation of “yes” responses .................................................. .................................................................................................... .................................................................................................... OWNER’S CERTIFICATION The owner certifies that the information in this report is true and correct to the best of the owner’s knowledge as of the date on which the owner signs this report. Owner ................................................ Date .............. Owner ................................................ Date .............. Owner ................................................ Date .............. CERTIFICATION BY PERSON SUPPLYING INFORMATION A person other than the owner certifies that the person supplied information on which the owner relied for this report and that the information is true and correct to the best of the person’s knowledge as of the date on which the person signs this report. Person ..................................... Items ....................................... Date ................. Person ..................................... Items ....................................... Date ................. Person ..................................... Items ....................................... Date ................. BUYER’S ACKNOWLEDGEMENT The prospective buyer acknowledges that technical knowledge such as that acquired by professional inspectors may be required to detect certain defects such as the presence of asbestos, building code violations, and floodplain status. I acknowledge receipt of a copy of this statement. Prospective buyer ........................................... Date ................. Prospective buyer ........................................... Date ................. Prospective buyer ........................................... Date .................
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