S. 10426 2
APARTMENTS OR (C) PROPERTY ON A HOMEOWNERS' ASSOCIATION THAT IS NOT
OWNED IN FEE SIMPLE BY THE SELLER.
INSTRUCTIONS TO THE SELLER:
(a) ANSWER ALL QUESTIONS BASED UPON YOUR ACTUAL KNOWLEDGE.
(b) ATTACH ADDITIONAL PAGES WITH YOUR SIGNATURE IF ADDITIONAL SPACE IS
REQUIRED.
(c) COMPLETE THIS FORM YOURSELF.
(d) IF SOME ITEMS DO NOT APPLY TO YOUR PROPERTY, CHECK "NA" (NON-AP-
PLICABLE). IF YOU DO NOT KNOW THE ANSWER CHECK "UNKN" (UNKNOWN).
SELLER'S STATEMENT: THE SELLER MAKES THE FOLLOWING REPRESENTATIONS TO
THE BUYER BASED UPON THE SELLER'S ACTUAL KNOWLEDGE AT THE TIME OF SIGN-
ING THIS DOCUMENT. THE SELLER AUTHORIZES [HIS OR HER] THEIR AGENT, IF
ANY, TO PROVIDE A COPY OF THIS STATEMENT TO A PROSPECTIVE BUYER OF THE
RESIDENTIAL REAL PROPERTY. THE FOLLOWING ARE REPRESENTATIONS MADE BY THE
SELLER AND ARE NOT THE REPRESENTATIONS OF THE SELLER'S AGENT.
GENERAL INFORMATION
1. HOW LONG HAVE YOU OWNED THE PROPERTY?
2. HOW LONG HAVE YOU OCCUPIED THE PROPERTY?
3. WHAT IS THE AGE OF THE STRUCTURE OR STRUCTURES? NOTE TO BUYER--IF
THE STRUCTURE WAS BUILT BEFORE 1978 YOU ARE ENCOURAGED TO INVESTI-
GATE FOR THE PRESENCE OF LEAD BASED PAINT.
4. DOES ANYBODY OTHER THAN YOURSELF HAVE A LEASE, EASEMENT OR ANY
OTHER RIGHT TO USE OR OCCUPY ANY PART OF YOUR PROPERTY OTHER THAN
THOSE STATED IN DOCUMENTS AVAILABLE IN THE PUBLIC RECORD, SUCH AS
RIGHTS TO USE A ROAD OR PATH OR CUT TREES OR CROPS. YES NO UNKN NA
5. DOES ANYBODY ELSE CLAIM TO OWN ANY PART OF YOUR PROPERTY? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
6. HAS ANYONE DENIED YOU ACCESS TO THE PROPERTY OR MADE A FORMAL LEGAL
CLAIM CHALLENGING YOUR TITLE TO THE PROPERTY? YES NO UNKN NA (IF
YES, EXPLAIN BELOW)
7. ARE THERE ANY FEATURES OF THE PROPERTY SHARED IN COMMON WITH
ADJOINING LAND OWNERS OR A HOMEOWNERS ASSOCIATION, SUCH AS WALLS,
FENCES OR DRIVEWAYS? YES NO UNKN NA (IF YES DESCRIBE BELOW)
8. ARE THERE ANY ELECTRIC OR GAS UTILITY SURCHARGES FOR LINE EXTEN-
SIONS, SPECIAL ASSESSMENTS OR HOMEOWNER OR OTHER ASSOCIATION FEES
THAT APPLY TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
9. ARE THERE CERTIFICATES OF OCCUPANCY RELATED TO THE PROPERTY? YES
NO UNKN NA (IF NO, EXPLAIN BELOW)
ENVIRONMENTAL
NOTE TO SELLER - IN THIS SECTION, YOU WILL BE ASKED QUESTIONS REGARD-
ING PETROLEUM PRODUCTS AND HAZARDOUS OR TOXIC SUBSTANCES THAT YOU KNOW
TO HAVE BEEN SPILLED, LEAKED OR OTHERWISE BEEN RELEASED ON THE PROPERTY
OR FROM THE PROPERTY ONTO ANY OTHER PROPERTY. PETROLEUM PRODUCTS MAY
INCLUDE, BUT ARE NOT LIMITED TO, GASOLINE, DIESEL FUEL, HOME HEATING
FUEL, AND LUBRICANTS. HAZARDOUS OR TOXIC SUBSTANCES ARE PRODUCTS OR
OTHER MATERIAL THAT COULD POSE SHORT- OR LONG-TERM DANGER TO PERSONAL
HEALTH OR THE ENVIRONMENT IF THEY ARE NOT PROPERLY DISPOSED OF, APPLIED
OR STORED. THESE INCLUDE, BUT ARE NOT LIMITED TO, FERTILIZERS, PESTI-
CIDES AND INSECTICIDES, PAINT INCLUDING PAINT THINNER, VARNISH REMOVER
AND WOOD PRESERVATIVES, TREATED WOOD, CONSTRUCTION MATERIALS SUCH AS
ASPHALT AND ROOFING MATERIALS, ANTIFREEZE AND OTHER AUTOMOTIVE PRODUCTS,
BATTERIES, CLEANING SOLVENTS INCLUDING SEPTIC TANK CLEANERS, HOUSEHOLD
S. 10426 3
CLEANERS, POOL CHEMICALS, PRODUCTS CONTAINING MERCURY AND LEAD AND
INDOOR MOLD.
NOTE TO BUYER - IF CONTAMINATION OF THIS PROPERTY FROM PETROLEUM
PRODUCTS AND/OR HAZARDOUS OR TOXIC SUBSTANCES IS A CONCERN TO YOU, YOU
ARE URGED TO CONSIDER SOIL AND GROUNDWATER TESTING OF THIS PROPERTY.
10. IS ANY OR ALL OF THE PROPERTY LOCATED IN A FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA) DESIGNATED FLOODPLAIN? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
11. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN THE
SPECIAL FLOOD HAZARD AREA ("SFHA"; "100-YEAR FLOODPLAIN") ACCORD-
ING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY'S (FEMA'S) CURRENT
FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO UNKN NA (IF YES,
EXPLAIN BELOW)
12. IS ANY OR ALL OF THE PROPERTY LOCATED WHOLLY OR PARTIALLY IN A
MODERATE RISK FLOOD HAZARD AREA ("500-YEAR FLOODPLAIN") ACCORDING
TO FEMA'S CURRENT FLOOD INSURANCE RATE MAPS FOR YOUR AREA? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
13. IS THE PROPERTY SUBJECT TO ANY REQUIREMENT UNDER FEDERAL LAW TO
OBTAIN AND MAINTAIN FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN
NA (IF YES, EXPLAIN BELOW)
HOMES IN THE SPECIAL FLOOD HAZARD AREA, ALSO KNOWN AS HIGH RISK
FLOOD ZONES, ON FEMA'S FLOOD INSURANCE RATE MAPS WITH MORTGAGES
FROM FEDERALLY REGULATED OR INSURED LENDERS ARE REQUIRED TO OBTAIN
AND MAINTAIN FLOOD INSURANCE. EVEN WHEN NOT REQUIRED, FEMA ENCOUR-
AGES HOMEOWNERS IN HIGH RISK, MODERATE RISK, AND LOW RISK FLOOD
ZONES TO PURCHASE FLOOD INSURANCE THAT COVERS THE STRUCTURE(S) AND
THE PERSONAL PROPERTY WITHIN THE STRUCTURE(S). ALSO NOTE THAT
HOMES IN COASTAL AREAS MAY BE SUBJECT TO INCREASED RISK OF FLOOD-
ING OVER TIME DUE TO PROJECTED SEA LEVEL RISE AND INCREASED
EXTREME STORMS CAUSED BY CLIMATE CHANGE WHICH MAY NOT BE REFLECTED
IN CURRENT FLOOD INSURANCE RATE MAPS.
14. HAVE YOU EVER RECEIVED ASSISTANCE, OR ARE YOU AWARE OF ANY PREVI-
OUS OWNERS RECEIVING ASSISTANCE, FROM THE FEDERAL EMERGENCY
MANAGEMENT AGENCY (FEMA), THE U.S. SMALL BUSINESS ADMINISTRATION
(SBA), OR ANY OTHER FEDERAL DISASTER FLOOD ASSISTANCE FOR FLOOD
DAMAGE TO THE PROPERTY? YES NO UNKN NA (IF YES, EXPLAIN BELOW) FOR
PROPERTIES THAT HAVE RECEIVED FEDERAL DISASTER ASSISTANCE, THE
REQUIREMENT TO OBTAIN FLOOD INSURANCE PASSES DOWN TO ALL FUTURE
OWNERS. FAILURE TO OBTAIN AND MAINTAIN FLOOD INSURANCE CAN RESULT
IN AN INDIVIDUAL BEING INELIGIBLE FOR FUTURE ASSISTANCE.
15. IS THERE FLOOD INSURANCE ON THE PROPERTY? YES NO UNKN NA (IF YES,
ATTACH A COPY OF THE POLICY)
A STANDARD HOMEOWNER'S INSURANCE POLICY TYPICALLY DOES NOT COVER
FLOOD DAMAGE. YOU ARE ENCOURAGED TO EXAMINE YOUR POLICY TO DETER-
MINE WHETHER YOU ARE COVERED.
16. IS THERE A FEMA ELEVATION CERTIFICATE AVAILABLE FOR THE PROPERTY?
YES NO UNKN NA (IF YES, ATTACH A COPY OF THE CERTIFICATE)
AN ELEVATION CERTIFICATE IS A FEMA FORM, COMPLETED BY A LICENSED
SURVEYOR OR ENGINEER. THE FORM PROVIDES CRITICAL INFORMATION ABOUT
THE FLOOD RISK OF THE PROPERTY AND IS USED BY FLOOD INSURANCE
PROVIDERS UNDER THE NATIONAL FLOOD INSURANCE PROGRAM (NFIP) TO
HELP DETERMINE THE APPROPRIATE FLOOD INSURANCE RATING FOR THE
PROPERTY. A BUYER MAY BE ABLE TO USE THE ELEVATION CERTIFICATE
FROM A PREVIOUS OWNER FOR THEIR FLOOD INSURANCE POLICY.
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17. HAVE YOU EVER FILED A CLAIM FOR FLOOD DAMAGE TO THE PROPERTY WITH
ANY INSURANCE PROVIDER, INCLUDING THE NATIONAL FLOOD INSURANCE
PROGRAM (NFIP)? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
18. IS ANY OR ALL OF THE PROPERTY LOCATED IN A DESIGNATED WETLAND?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
19. IS THE PROPERTY LOCATED IN AN AGRICULTURAL DISTRICT? YES NO
UNKN NA (IF YES, EXPLAIN BELOW)
20. WAS THE PROPERTY EVER THE SITE OF A LANDFILL? YES NO UNKN NA
(IF YES, EXPLAIN BELOW)
21. ARE THERE OR HAVE THERE EVER BEEN FUEL STORAGE TANKS ABOVE OR
BELOW THE GROUND ON THE PROPERTY? YES NO UNKN NA IF YES,
ARE THEY CURRENTLY IN USE? YES NO UNKN NA LOCATION(S) ARE THEY
LEAKING OR HAVE THEY EVER LEAKED? YES NO UNKN NA (IF YES,
EXPLAIN BELOW)
22. IS THERE ASBESTOS IN THE STRUCTURE? YES NO UNKN NA (IF YES, STATE
LOCATION OR LOCATIONS BELOW)
23. IS LEAD PLUMBING PRESENT? YES NO UNKN NA (IF YES, STATE LOCATION
OR LOCATIONS BELOW)
24. HAS A RADON TEST BEEN DONE? YES NO UNKN NA (IF YES, ATTACH A COPY
OF THE REPORT)
25. HAS MOTOR FUEL, MOTOR OIL, HOME HEATING FUEL, LUBRICATING OIL OR
ANY OTHER PETROLEUM PRODUCT, METHANE GAS, OR ANY HAZARDOUS OR
TOXIC SUBSTANCE SPILLED, LEAKED OR OTHERWISE BEEN RELEASED ON
THE PROPERTY OR FROM THE PROPERTY ONTO ANY OTHER PROPERTY? YES
NO UNKN NA (IF YES, DESCRIBE BELOW)
26. HAS THE PROPERTY BEEN TESTED FOR THE PRESENCE OF MOTOR FUEL, MOTOR
OIL, HOME HEATING FUEL, LUBRICATING OIL, OR ANY OTHER PETROLEUM
PRODUCT, METHANE GAS, OR ANY HAZARDOUS OR TOXIC SUBSTANCE? YES
NO UNKN NA (IF YES, ATTACH REPORT(S))
27. HAS THE PROPERTY BEEN TESTED FOR INDOOR MOLD? YES NO UNKN (IF YES,
ATTACH A COPY OF THE REPORT)
27-A. IF THE PROPERTY IS LOCATED WITHIN OR IN THE SAME ZIP CODE AS AN
ENVIRONMENTAL PROTECTION AGENCY-DESIGNATED SUPERFUND SITE OR A
BROWNFIELD SITE, HAVE ANY TESTING, MITIGATION, OR REMEDIATION
EFFORTS BEEN MADE? YES NO UNKN NA (IF YES, ATTACH A
COPY OF REPORT(S))
STRUCTURAL
28. IS THERE ANY ROT OR WATER DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
29. IS THERE ANY FIRE OR SMOKE DAMAGE TO THE STRUCTURE OR STRUCTURES?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
30. IS THERE ANY TERMITE, INSECT, RODENT OR PEST INFESTATION OR
DAMAGE? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
31. HAS THE PROPERTY BEEN TESTED FOR TERMITE, INSECT, RODENT OR PEST
INFESTATION OR DAMAGE? YES NO UNKN NA (IF YES, PLEASE ATTACH
REPORT(S))
32. WHAT IS THE TYPE OF ROOF/ROOF COVERING (SLATE, ASPHALT, OTHER.)?
ANY KNOWN MATERIAL DEFECTS? HOW OLD IS THE ROOF? IS THERE A TRANS-
FERABLE WARRANTY ON THE ROOF IN EFFECT NOW? YES NO UNKN NA (IF
YES, EXPLAIN BELOW)
33. ARE THERE ANY KNOWN MATERIAL DEFECTS IN ANY OF THE FOLLOWING
STRUCTURAL SYSTEMS: FOOTINGS, BEAMS, GIRDERS, LINTELS, COLUMNS OR
PARTITIONS? YES NO UNKN NA (IF YES, EXPLAIN BELOW)
MECHANICAL SYSTEMS & SERVICES
S. 10426 5
34. WHAT IS THE WATER SOURCE (CIRCLE ALL THAT APPLY - WELL, PRIVATE,
MUNICIPAL, OTHER)? IF MUNICIPAL, IS IT METERED? YES NO UNKN NA
35. HAS THE WATER QUALITY AND/OR FLOW RATE BEEN TESTED? YES NO UNKN NA
(IF YES, DESCRIBE BELOW)
36. WHAT IS THE TYPE OF SEWAGE SYSTEM (CIRCLE ALL THAT APPLY - PUBLIC
SEWER, PRIVATE SEWER, SEPTIC OR CESSPOOL)? IF SEPTIC OR CESSPOOL,
AGE? ________ DATE LAST PUMPED? ________ FREQUENCY OF PUMPING?
________ ANY KNOWN MATERIAL DEFECTS? YES NO UNKN NA (IF YES,
EXPLAIN BELOW)
More information on "septic system operation and maintenance" can be
found on the NYS Department of Health website in the informational
health pamphlet made available by the Department of Health pursuant to
section 396-s of NYS general business law.
37. WHO IS YOUR ELECTRIC SERVICE PROVIDER? ________ WHAT IS THE AMPER-
AGE? ________ DOES IT HAVE CIRCUIT BREAKERS OR FUSES? ________
PRIVATE OR PUBLIC POLES? ________ ANY KNOWN MATERIAL DEFECTS? YES
NO UNKN NA (IF YES, EXPLAIN BELOW)
38. ARE THERE ANY FLOODING, DRAINAGE OR GRADING PROBLEMS THAT RESULTED
IN STANDING WATER ON ANY PORTION OF THE PROPERTY? YES NO UNKN NA
(IF YES, STATE LOCATIONS AND EXPLAIN BELOW)
39. HAS THE STRUCTURE(S) EXPERIENCED ANY WATER PENETRATION OR DAMAGE
DUE TO SEEPAGE OR A NATURAL FLOOD EVENT, SUCH AS FROM HEAVY RAIN-
FALL, COASTAL STORM SURGE, TIDAL INUNDATION OR RIVER OVERFLOW?
YES NO UNKN NA (IF YES, EXPLAIN BELOW)
ARE THERE ANY KNOWN MATERIAL DEFECTS IN ANY OF THE FOLLOWING (IF YES,
EXPLAIN BELOW. USE ADDITIONAL SHEETS IF NECESSARY.):
40. PLUMBING SYSTEM? YES NO UNKN NA
41. SECURITY SYSTEM? YES NO UNKN NA
42. CARBON MONOXIDE DETECTOR? YES NO UNKN NA
43. SMOKE DETECTOR? YES NO UNKN NA
44. FIRE SPRINKLER SYSTEM? YES NO UNKN NA
45. SUMP PUMP? YES NO UNKN NA
46. FOUNDATION/SLAB? YES NO UNKN NA
47. INTERIOR WALLS/CEILINGS? YES NO UNKN NA
48. EXTERIOR WALLS OR SIDING? YES NO UNKN NA
49. FLOORS? YES NO UNKN NA
50. CHIMNEY/FIREPLACE OR STOVE? YES NO UNKN NA
51. PATIO/DECK? YES NO UNKN NA
52. DRIVEWAY? YES NO UNKN NA
53. AIR CONDITIONER? YES NO UNKN NA
54. HEATING SYSTEM? YES NO UNKN NA
55. HOT WATER HEATER? YES NO UNKN NA
56. THE PROPERTY IS LOCATED IN THE FOLLOWING SCHOOL DISTRICT UNKN
NOTE: BUYER IS ENCOURAGED TO CHECK PUBLIC RECORDS CONCERNING THE
PROPERTY (E.G. TAX RECORDS AND WETLAND AND FEMA'S CURRENT FLOOD
INSURANCE RATE MAPS AND ELEVATION CERTIFICATES)
THE SELLER SHOULD USE THIS AREA TO FURTHER EXPLAIN ANY ITEM ABOVE. IF
NECESSARY, ATTACH ADDITIONAL PAGES AND INDICATE HERE THE NUMBER OF ADDI-
TIONAL PAGES ATTACHED.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
SELLER'S CERTIFICATION: SELLER CERTIFIES THAT THE INFORMATION IN THIS
PROPERTY CONDITION DISCLOSURE STATEMENT IS TRUE AND COMPLETE TO THE
SELLER'S ACTUAL KNOWLEDGE AS OF THE DATE SIGNED BY THE SELLER. IF A
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SELLER OF RESIDENTIAL REAL PROPERTY ACQUIRES KNOWLEDGE WHICH RENDERS
MATERIALLY INACCURATE A PROPERTY CONDITION DISCLOSURE STATEMENT PROVIDED
PREVIOUSLY, THE SELLER SHALL DELIVER A REVISED PROPERTY CONDITION
DISCLOSURE STATEMENT TO THE BUYER AS SOON AS PRACTICABLE. IN NO EVENT,
HOWEVER, SHALL A SELLER BE REQUIRED TO PROVIDE A REVISED PROPERTY CONDI-
TION DISCLOSURE STATEMENT AFTER THE TRANSFER OF TITLE FROM THE SELLER TO
THE BUYER OR OCCUPANCY BY THE BUYER, WHICHEVER IS EARLIER.
SELLER__________ DATE___________
SELLER__________ DATE___________
BUYER'S ACKNOWLEDGMENT: BUYER ACKNOWLEDGES RECEIPT OF A COPY OF THIS
STATEMENT AND BUYER UNDERSTANDS THAT THIS INFORMATION IS A STATEMENT OF
CERTAIN CONDITIONS AND INFORMATION CONCERNING THE PROPERTY KNOWN TO THE
SELLER. IT IS NOT A WARRANTY OF ANY KIND BY THE SELLER OR SELLER'S AGENT
AND IS NOT A SUBSTITUTE FOR ANY HOME, PEST, RADON OR OTHER INSPECTIONS
OR TESTING OF THE PROPERTY OR INSPECTION OF THE PUBLIC RECORDS.
BUYER__________ DATE__________
BUYER__________ DATE _________
§ 2. The real property law is amended by adding a new section 235-k
to read as follows:
§ 235-K. NOTICE TO INFORM OF SUPERFUND OR BROWNFIELD PROXIMITY. 1. FOR
THE PURPOSES OF THIS SECTION:
A. "SUPERFUND SITE" SHALL MEAN A CONTAMINATED SITE AS DESIGNATED BY
THE ENVIRONMENTAL PROTECTION AGENCY DUE TO HAZARDOUS WASTE BEING DUMPED,
LEFT OUT IN THE OPEN, OR OTHERWISE IMPROPERLY MANAGED.
B. "BROWNFIELD SITE" SHALL MEAN ANY REAL PROPERTY WHERE A CONTAMINANT
IS PRESENT AT LEVELS EXCEEDING THE SOIL CLEANUP OBJECTIVES OR OTHER
HEALTH-BASED OR ENVIRONMENTAL STANDARDS, CRITERIA OR GUIDANCE ADOPTED BY
THE DEPARTMENT THAT ARE APPLICABLE BASED ON THE REASONABLY ANTICIPATED
USE OF THE PROPERTY, IN ACCORDANCE WITH APPLICABLE REGULATIONS.
2. EVERY OPERATOR, OWNER, OR MANAGER OF A MULTIPLE DWELLING, HOUSING
COOPERATIVE, OR RESIDENTIAL BUILDING WITHIN THE ZIP CODE BOUNDARIES OF
AN ENVIRONMENTAL PROTECTION AGENCY (EPA) DESIGNATED SUPERFUND SITE OR
BROWNFIELD SITE SHALL PROVIDE WRITTEN NOTICE OF THE FOLLOWING INFORMA-
TION, AS FOLLOWS:
A. THE PREMISES IS LOCATED IN AN EPA DESIGNATED SUPERFUND SITE OR
BROWNFIELD SITE AND THAT THESE SITES ARE THE PRODUCT OF SUSPECTED OR
CONFIRMED ENVIRONMENTAL CONTAMINATION;
B. PROLONGED EXPOSURE TO CONTAMINANTS RESULTS IN HEALTH RISKS INCLUD-
ING BUT NOT LIMITED TO CANCER, TUMORS, IMPACTS TO THE IMMUNE SYSTEM AND
CENTRAL NERVOUS SYSTEM, AMONG OTHERS;
C. THE LOCATION OF THE SUPERFUND OR BROWNFIELD SITE IN PROXIMITY TO
THE RESIDENCE AND HOW BASEMENT AND GROUND FLOOR UNITS ARE MOST LIKELY TO
BE IMPACTED BY CONTAMINANTS;
D. THE DATE ON WHICH THE BUILDING HAS LAST BEEN INSPECTED FOR POSSIBLE
CONTAMINATION BY THE EPA OR THEIR APPOINTEE;
E. A LINK TO THE EPA'S WEBSITE FOR SUCH SUPERFUND OR BROWNFIELD SITE;
3. SUCH INFORMATION SHALL BE SHARED VIA NOTICE IN A LEASE OR DRAFT
LEASE TO PROSPECTIVE TENANTS AND VIA LEASE RENEWAL, MAIL, OR ELECTRONIC
MAIL TO CURRENT TENANTS.
§ 3. This act shall take effect immediately.