VIRGINIA RESIDENTIAL PROPERTY DISCLOSURE STATEMENT

Property Address: [[Full Street Address, City, Virginia ZIP Code]]

Legal Description / Tax Parcel ID: [[Legal Description or Tax Map Parcel Number]]

Seller Name(s): [[Seller Full Legal Name(s)]]

Date Completed: [[Disclosure Statement Date]], -

NOTICE TO BUYER AND SELLER

This Residential Property Disclosure Statement is provided pursuant to Va. Code § 55.1-703. The owner of residential real property shall furnish to a purchaser a residential property disclosure statement. This statement is for the buyer to beware of certain matters that may affect the buyer's decision to purchase the property. The seller makes no representations or warranties as to the condition of the real property or any improvements thereon, or with regard to any covenants and restrictions, or as to any other matters. The buyer is advised to exercise necessary due diligence and obtain professional inspections.

Buyer Rescission Right: If this disclosure statement is delivered after ratification of the purchase contract, the buyer may terminate the contract without penalty by providing written notice to the seller within the earliest of: (i) three (3) days after personal or electronic delivery; (ii) five (5) days after postmark if mailed; (iii) settlement; (iv) occupancy by buyer; (v) mortgage application containing waiver language; or (vi) written waiver of the right signed separately by buyer. See Va. Code § 55.1-709.

This form is not a substitute for a professional home inspection. "Unknown" is an acceptable answer where the seller lacks actual knowledge., -

1. Structural Components

1. Has the foundation, slab, basement walls, or crawlspace shown any cracks, settling, shifting, water intrusion, or structural movement?

[[Yes / No / Unknown]]

If yes, describe: [[Foundation Structural Issues Description]]

2. Has the roof leaked, been repaired, or been replaced during your ownership or to your knowledge?

[[Yes / No / Unknown]]

Details (age, type, repairs, known issues): [[Roof Age Type History and Issues]]

3. Have exterior walls, siding, windows, or doors shown deterioration, water intrusion, rot, or required repairs beyond ordinary maintenance?

[[Yes / No / Unknown]]

Details: [[Exterior Wall Window Door Issues]]

4. Are you aware of any cracks, bowing, settlement, or structural concerns in load-bearing or interior walls, floors, or ceilings?

[[Yes / No / Unknown]]

Details: [[Interior Structural Issues]]

5. Have any additions, renovations, or structural alterations been made?

[[Yes / No / Unknown]]

If yes: Were required building permits obtained? [[Yes / No / Unknown]]

Were final inspections completed and approved? [[Yes / No / Unknown]]

Describe work and dates: [[Additions Renovations Description]], -

2. Mechanical Systems, Electrical, Plumbing, HVAC

1. Are you aware of any defects, deficiencies, or known problems with the electrical system (service panel, wiring, outlets, GFCI/AFCI, aluminum wiring, knob-and-tube, etc.)?

[[Yes / No / Unknown]]

Details including service size if known: [[Electrical System Details and Issues]]

2. Are you aware of any leaks, low pressure, drain problems, frozen pipes, or other plumbing defects?

[[Yes / No / Unknown]]

Details (supply material, drain material, known issues): [[Plumbing Details and Issues]]

3. Are you aware of any defects with the water heater or hot water system?

[[Yes / No / Unknown]]

Details (type, age, issues): [[Water Heater Details]]

4. Are you aware of any defects with the heating system (furnace, boiler, heat pump, etc.)?

[[Yes / No / Unknown]]

Primary heating type: [[Furnace / Boiler / Heat Pump / Electric / Other]]

Age and condition notes: [[Heating System Age Condition]]

5. Are you aware of any defects with the cooling system?

[[Yes / No / Unknown]]

Type and notes: [[AC Type and Condition Notes]]

6. Other mechanical (e.g., sump pump, generator, security system, smart home devices affecting systems):

[[Other Mechanical Systems Notes or None]], -

3. Water Supply and Sewer / Septic

1. Water Source:

[[Municipal / Public]] [[Private Well]] [[Other: [[Specify]]]]

If well:

Any known issues with water quality, quantity, pressure, or pump?

[[Yes / No / Unknown]]

Details and last testing date: [[Well Issues and Test Date]]

Is there a valid well permit or registration on file?

[[Yes / No / Unknown]]

2. Sewer / Wastewater:

[[Municipal / Public Sewer]] [[Private Septic System]] [[Other: [[Specify]]]]

If septic:

Any known failures, backups, odors, surfacing, or required repairs?

[[Yes / No / Unknown]]

Details (last pumped/inspected, permit info): [[Septic System Details and History]]

3. Water or Sewer Bills / Assessments:

Any known unpaid or special assessments?

[[Yes / No / Unknown]]

Details: [[Water Sewer Assessment Details]], -

4. Environmental and Hazardous Materials

1. Lead-Based Paint (pre-1978 dwellings):

[[Yes]] [[No]] [[N/A (built 1978 or later)]] Are you aware of the presence of lead-based paint or lead hazards?

Details or known reports: [[Lead Paint Details]]

2. Radon:

Has the property been tested for radon?

[[Yes / No / Unknown]]

Results if known and test date: [[Radon Test Results and Date]]

3. Asbestos:

Are you aware of asbestos-containing materials (pipe insulation, floor tiles, popcorn ceilings, siding, etc.)?

[[Yes / No / Unknown]]

Details and location: [[Asbestos Details and Location]]

4. Mold or Moisture:

Has there been any visible mold growth, musty odors, or water-damaged materials that were not fully remediated?

[[Yes / No / Unknown]]

Details: [[Mold History Details]]

5. Underground Storage Tanks (fuel oil, gasoline, propane, septic, other):

Are there or were there any underground storage tanks on the property?

[[Yes / No / Unknown]]

Details (location, capacity, status, in use / abandoned / removed, any leaks): [[UST Details]]

6. Other Environmental (contamination, prior industrial/agricultural use, PFAS, etc.):

Any other known or suspected environmental contamination or issues?

[[Yes / No / Unknown]]

Details: [[Other Environmental Issues]], -

5. Flooding, Moisture, Drainage, and Natural Hazards

1. Flooding / Water Intrusion History:

Has the property experienced flooding, standing water, water intrusion into living areas, or poor drainage?

[[Yes / No / Unknown]]

Details (frequency, areas affected, remediation): [[Flooding Moisture History Details]]

2. Flood Zone / Insurance:

Is the property located in a flood hazard area or has flood insurance ever been required or obtained?

[[Yes / No / Unknown]]

Details: [[Flood Zone Insurance Details]]

3. Moisture in Crawlspace / Basement / Attic:

Any ongoing or recurrent moisture problems?

[[Yes / No / Unknown]]

Details: [[Moisture Problems Details]]

4. Other Natural Hazards (sinkholes, landslides, erosion, wildfire, etc.):

[[Known Issues or None]], -

6. HOA / POA / Condominium / Common Interest Community

1. Is the property part of a homeowners association, property owners association, condominium, or common interest community?

[[Yes / No]]

If yes:

Association Name: [[HOA or POA Full Name]]

Unit / Lot Number: [[Unit or Lot Number]]

Are there any known special assessments, pending major repairs, or capital projects?

[[Yes / No / Unknown]]

Details: [[HOA Special Assessments or Projects]]

Are you current on all association dues, assessments, and fees?

[[Yes / No / Unknown]]

Monthly / Annual Fees: $[[HOA Fees Amount and Frequency]]

Contact for Association Documents: [[HOA Management Company or Contact]]

Buyer should obtain and review all governing documents, financials, reserves, and meeting minutes., -

7. Legal, Title, and Other Material Facts

1. Title / Encumbrances:

Are there any liens, judgments, easements, restrictive covenants, encroachments, or other title matters (other than standard mortgage to be paid off at closing)?

[[Yes / No / Unknown]]

Details: [[Title Encumbrances or Liens Details]]

2. Legal Proceedings / Disputes:

Are there any pending or threatened legal actions, boundary disputes, neighbor disputes, or claims affecting the property?

[[Yes / No / Unknown]]

Details: [[Legal Proceedings Details]]

3. Zoning / Use / Permits:

Are you aware of any zoning violations, unpermitted work, or restrictions on current or intended use?

[[Yes / No / Unknown]]

Details: [[Zoning or Permit Issues]]

4. Insurance Claims:

Have there been any insurance claims for property damage (fire, water, wind, hail, etc.)?

[[Yes / No / Unknown]]

Details: [[Insurance Claims History]]

5. Other Material Facts:

List any other known material facts, defects, or conditions (latent or otherwise) that a reasonable buyer would want to know when making a decision or determining price (including but not limited to: prior issues, neighbor conflicts, odors, noise, shared driveways, unrecorded easements, etc.).

[[Other Known Material Facts or None]], -

8. Seller Certification

I/we, the undersigned Seller(s), certify that the information in this disclosure statement is true and complete to the best of my/our actual knowledge. I/we have not knowingly concealed any material defect. I/we will disclose in writing any newly discovered material information prior to settlement. This disclosure is not a warranty.

Seller 1 Printed Name: [[Seller Full Legal Name 1]]

Seller 1 Signature: ________________________________ Date: [[Seller 1 Date]]

Seller 2 Printed Name: [[Seller Full Legal Name 2]]

Seller 2 Signature: ________________________________ Date: [[Seller 2 Date]], -

9. Buyer Acknowledgment and Receipt

I/we, the undersigned Buyer(s), acknowledge receipt of this Virginia Residential Property Disclosure Statement. I/we understand that it is based solely on the Seller's actual knowledge and is not a warranty or guarantee of any kind. I/we have been advised to conduct independent inspections and due diligence, including review of the property's physical condition, title, environmental matters, HOA documents (if applicable), and all other material facts. I/we understand my/our rescission rights under Virginia law as described above.

Buyer 1 Printed Name: [[Buyer Full Legal Name 1]]

Buyer 1 Signature: ________________________________ Date: [[Buyer 1 Receipt Date]]

Buyer 2 Printed Name: [[Buyer Full Legal Name 2]]

Buyer 2 Signature: ________________________________ Date: [[Buyer 2 Receipt Date]], -

*This form follows the structure and required disclosures under Va. Code § 55.1-703 and related provisions of the Virginia Residential Property Disclosure Act (Va. Code §§ 55.1-700 et seq.). The Real Estate Board provides the official form on its website; this template aligns with statutory elements. Sellers and licensees must ensure compliance with current law at time of use. Buyer due diligence and professional inspections are strongly recommended. This template is not legal advice.*

> ⚠️ Template example, not professional (legal/financial/medical) advice. All user inputs use [[Token Name]] placeholders. Verify the current official form and statutes with the Virginia Real Estate Board / DPOR and a qualified Virginia real estate attorney before use. As of June 2026.

Sources (as of June 2026):

• Va. Code § 55.1-703 (Residential property disclosure statement required)
• Va. Code §§ 55.1-700 et seq. (Virginia Residential Property Disclosure Act)
• Va. Code § 55.1-709 (Buyer rescission rights)
• Virginia Real Estate Board forms and guidance
• Federal lead-based paint disclosure requirements (42 U.S.C. 4852d) for pre-1978 housing