State of Alaska
Prepared in compliance with Alaska Statute (AS) 34.70.010 – 34.70.200
.
AS 34.70.010 requires that before the Transferee/Buyer (hereafter referred to as Buyer) of an interest in residential real property makes a written offer, the Transferor/Seller (hereafter referred to as Seller) must deliver a completed written disclosure form. This disclosure statement is in compliance with AS 34.70.010. It concerns the residential real property* located in the __________________________ Recording District, ________________________ Judicial District, State of Alaska.
Legal Description: ______________________________________________________________
Property Address/City/Other: ______________________________________________________
______________________________________________________________________________
* Residential real property means any single family dwelling, or two single family dwelling units under one roof, or any individual unit in a multi-unit structure or common interest ownership community whose primary purpose is to provide housing. AS 34.70.200(2) and (3).

All disclosures made in this statement are required to be made in good faith (AS 34.70.060). The Seller is required to disclose defects or other conditions in the real property or the real property interest being transferred. To comply, disclosure need not include a search of the public records, nor does it require a professional inspection of the property.
If the information supplied in this disclosure statement becomes inaccurate as a result of an act or agreement after the disclosure statement is delivered to the Buyer, the Seller is required to deliver an amendment to the disclosure statement to the Buyer. An addendum/amendment form for that purpose may be attached to this disclosure statement.
Exemption for First Sale: Under AS 34.70.120, the first transfer of an interest in residential real property that has never been occupied is exempt from the requirement for the Seller to complete the Disclosure Statement.
Waiver by Agreement: Under AS 34.70.110, completion of this disclosure statement may be waived when transferring an interest in residential real property if the Seller and Buyer agree in writing. Signing this waiver does not affect other obligations for disclosure.
Violation or Failure to Comply: A person who negligently violates or fails to perform a duty required by AS34.70.010 – AS 34.70.200 is liable to the Buyer for actual damaged suffered by the Buyer as a result of the violation or failure. If the person willfully violates or fails to perform a duty required by AS 34.70.010 – AS 34.70.200, the Seller is liable to the Buyer for up to three times the actual damages. In addition to the damages, a court may also award the Buyer costs and attorney fees to the extent allowed under the rules of court.
____________ ___/___/___ ________________________________________________ __________ ___/___/___
Seller’s Initials Date Property Address Buyer’s Initials Date
08-4229 (Rev. 11/02)
(1)
Seller’s Information Regarding Property
Property Type (check one):
ð Single Family ð Zero Lot Line/Town House ð Condominium ð Townhome/PUD
ð Duplex* (Including Single Family with an Apartment) *Please complete one form for each unit.
ð Other (please specify) ____________________________________________________________________
Do you currently occupy the property? ð Yes ð No. If Yes, how long? _________________________
If not a current occupant, have you ever occupied the property? ð Yes ð No.
If so, when? ___________________
Year Property Built: _____________. If property was built prior to 1978, or if Seller has any knowledge of lead-based paint, Seller must complete Disclosure of Information and Acknowledgment of Lead-Based Paint and/or Lead-Based Paint Hazards in accordance with Section 1018 of the Residential Lead-Based Paint Hazard Reduction Act of 1992 (also known as Title X) and provide Buyer with the “Protect Your Family From Lead in Your Home” pamphlet. The pamphlet can be found on the Internet at http://www.epa.gov/lead/leadprot.htm.
Construction Overview: ð Wood Frame ð Manufactured or Modular Construction ð Other:______________
Foundation: ð Masonry Block ð Poured Concrete ð Piling ð Treated Wood ð Other:______________
Name of original builder (if known):___________________________________________________________
Property Features:
Check all items that are built-in and will remain with the property. Also…
Circle those checked items that have known defects or malfunctions. Also…
Describe the defect or malfunction on the Addendum/Amendment(s) To The Disclosure Statement.
ð Cooktop ð Jetted Tub ð Satellite Dish
ð Oven(s) # of ______ ð Hot Tub ð Cover ð Built-in Rods & Blinds
ð Range/Oven ð Sauna ð Window Screens
ð Built-in Microwave(s) # of _____ ð Steam Shower Room ð Security System
ð Dishwasher ð Water Softener ð Smoke Detector(s) # of _______________
ð Trash Compactor ð Water Filtering System ð Fire Alarms
ð Garbage Disposal ðGreenhouseðAttachedð Detached ð Auto Garage Door Opener(s)
ð Instant Hot Water Dispenser ð Ventilating System # of Opener(s) _________________
ð Central Vacuum Installed ð Heating System # of Remote Control(s)___________
ð Intercom ð Storage Shed ð Other _____________________________
ð Paddle Fan(s) # of _____ ð Barbecue ð Other _____________________________
ð Wood Stove(s) # of _____ ð T.V. Antenna ð Other _____________________________
Comments: ________________________________________________________________________________
__________________________________________________________________________________________
Structural Components:
Circle only those items that have known defects, malfunctions, or have had major repairs performed within the last five years.
Also… Describe the defect, malfunction, or repair on the Addendum/Amendment(s) To The Disclosure Statement.
· Fences · Rain Gutters · Insulation · Electrical Systems · Electronic Air Cleaner
· Driveways · Exterior Walls · Woodstove(s) · Sewage Systems · Heat Recovery
# of _____
· Private · Interior Walls · Water Supply · Ventilator System
Walkways
· Floors · Fireplace(s) · Garage · Swimming Pool
· Retaining Walls · Ceilings · Gas Starter · Garage Floor Drain · Mechanical
· Foundation · Doors · Chimneys · Carport · Filtration · Pool Cover
· Crawl Space · Windows · Plumbing Systems · Washer/Dryer Hook-ups · Hot Water Heater
· Roof · Skylights · Heating Systems · Humidifier
· Patio/Decking · Venting · Air Conditioner
·
Slabs
·
Other items not covered above? _____________________________________________·
Not Completed
More to Come!!!!!!!!!!!!!!!!!!!!!!!!!