1. South Carolina Code of Laws Title 27 Chapter 50 Article I requires that beginning January 1,

2003, an owner of residential real estate (single-family homes and buildings with up to four dwelling

units) shall provide to a purchaser this property condition disclosure statement which must be completed

prior to signing a contract of sale. This disclosure statement must be provided in connection with the

sale, exchange, option and sale under a lease with an option to purchase. This disclosure statement is

not required for some transactions, including the first sale of a dwelling which has never been inhabited.

A complete list of exemptions may be found in Section 27-50-30.

2. You must check one of the boxes for each of the 24 questions on pages 2 and 3 of this form.

a. If you check “Yes” for any question, you must explain the problem or attach a descriptive report

from an engineer, contractor, pest control operator or other expert or public agency. If you attach a

report, you will not be liable for any inaccurate or incomplete information contained in the report as

long as you were not grossly negligent in obtaining or transmitting the information.

b. If you check “No” for any question, you are stating that you have no actual knowledge of any

problem. If you check “No” and you know there is a problem, you may be liable for making an

intentional misrepresentation.

c. If you check “No Representation” for any question, you are stating that you are making no

representation regarding the conditions or characteristics of the property, but you may have a duty

to disclose even if you know or should have known of them. Please consult with an attorney to

determine any potential liability you may have for checking this answer.

d. If you check “Yes” or “No” for any question and subsequently something happens to the property to

render your statement incorrect or inaccurate (for example, the roof begins to leak), you must

promptly provide the purchaser a corrected statement or you may correct the problem.

3. If you are assisted in the sale of your property by a licensed real estate broker or salesperson, you

remain solely responsible for completing and delivering this statement to the purchaser. The broker or

salesperson must disclose any material facts about your property which he/she knows or reasonably

should know, regardless of your responses on this statement. You are to complete this form yourself

and answer all questions truthfully and as fully as possible. By signing below you acknowledge that the

failure to disclose known material information about the property may result in liability.

4. You must provide the completed statement to the purchaser prior to the time you and the purchaser sign

a contract to purchase your property or as otherwise agreed to in the contract. You should provide the

purchaser a copy of this statement containing your signature and keep a copy signed by the purchaser

for your records.

Rev. 1/03

No

Yes* No Representation

1. Foundation, slab, fireplaces/chimneys, floors, windows

(including storm windows and screens), doors, ceilings,

interior and exterior walls, attached garage, patio, deck

or other structural components including any modifications?

a. Siding: masonry ___ wood___ composition/hardwood___

vinyl ___ synthetic stucco ___

b. Approximate age of structure ____________

2. Roof (leakage or other problem)?

a. Approximate age of roof covering ___________

3. Water seepage, leakage, dampness or standing water

or water intrusion from any source in any area of the

structure?

4. Electrical system (outlets, wiring, panel, switches,

fixtures, etc)?

5. Plumbing system (pipes, fixtures, water heater, etc.)?

6. Heating and/or air conditioning?

a. Heat source: furnace___ heat pump___ baseboard ___

b. Cooling source: central ___ wall/window unit(s) ___

c. Fuel source: electricity ___ natural gas___ propane ___ oil ___

d. Approximate age of heating unit ___/cooling unit ____

7. Water supply (including water quality, quantity and water pressure?

a. water supply is: city/county__community system__private well__

b. water pipes are: copper__galvanized__PVC/CPVC__polybutelene__

8. Septic system?

a. Type system: septic tank__community system__

connected to city/county system__ city/county system available ___

b. Does the system require a pump? Yes __ No __

c. Has the septic system been serviced/pumped during your ownership?

9. Appliances (range/oven, attached microwave, hood/fan, dishwasher,

disposal, etc.)?

organisms?

a. Is there a transferable termite bond? Yes ___ No____

11. Drainage, grading or stability of soil or retaining structure?

12. Other built-in systems and fixtures?

central vacuum __ pool__ hot tub __ spa __ attic fan __

exhaust fan __ ceiling fan__ sump pump __ irrigation system __

cable tv wiring or satellite dish ___ security system __ or other systems ___

Rev. 1/03

No

Yes* No Representation

13. Room additions or other structural changes?

14. Environmental hazards (substances, materials or products)

including asbestos, formaldehyde, radon gas, methane gas,

lead-based paint, underground storage tank, toxic mold or

other hazardous or toxic material (whether buried or covered),

contaminated soil or water, or other environmental contamination?

15. Nuisances (noise, odor, smoke, etc.) affecting the property?

16. Previous damage caused by fire?

17. Violations or variances of building codes or zoning ordinances?

18. Restrictions to property use? (covenants or deed)

19. Utility or other easements, shared driveways, party walls or

encroachments from or on adjacent property?

20. Lawsuits, foreclosures, bankruptcy, tenancies, judgments, tax

or other liens, proposed assessments or notice from any

governmental agency that could affect title to the property?

21. Owners’ association fees or “common area” expenses or

assessments?

22. Flood hazards or that the property is in a federally-designated

flood plain?

23. Rental, rental management, vacation rental or other lease contracts

in place on the property at the time of closing?

24. Any outstanding charges owed by the tenant for gas, electric,

water, sewerage, or garbage services provided to the property?

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Rev. 1/03

“Yes” explanations continued:

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Property Address: _______________________________________________________________________

The property is currently: owner-occupied ____leased ____in an estate ____ in foreclosure ____

vacant ____(If vacant, how long? ) _______________

Owner’s Name(s): ____________________________________________________________________

Owner(s) acknowledge having examined this statement before signing and that all information is true and

correct as of the date signed.

Owner Signature: ____________________________________________ Date: __________________

Owner Signature: ____________________________________________ Date: __________________

Purchaser(s) acknowledge receipt of a copy of this disclosure statement; that he/she has examined it before

signing; that he/she understands that this is not a warranty by owner or owner’s agent; that it is not a substitute

for any inspections he/she may wish to obtain; and that the representations are made by the owner and not the

owner’s agent(s) or subagent(s). Purchaser(s) are encouraged to obtain his/her own inspection by a licensed

home inspector or other professional.

Purchaser Signature: ________________________________________ Date: _____________________

Purchaser Signature: _______________________________________ Date: _____________________