EXAMPLE and Prepared by ABW Corporation
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www.abetterwaycorp.com www.realtydisclosure.com SELLERS' AND PURCHASERS' DISCLOSURE ACKNOWLEDGMENT The undersigned are the Sellers and Purchasers of that property commonly known as (property address) 1701 Enterprise Drive Santa Rosa, CA 95409 and further described in HAZChek Disclosure Packet No: EXAMPLE and prepared by ABW Corporation. Seller,James T Kirk hereby acknowledges, understands and accepts the mandatory NATURAL HAZARD DISCLOSURES including MELLO-ROOS CFD referred to in HAZChek® Disclosure Packet No: EXAMPLE Purchaser, hereby acknowledges, understands and accepts the mandatory NATURAL HAZARD DISCLOSURES including MELLO-ROOS CFD referred to in HAZChek® Disclosure Packet No: EXAMPLE Seller and Buyer hereby authorize their respective agents on the herein described property to deliver and release a copy of said Disclosure to any persons or entity that has an interest in said property. Seller hereby authorizes payment to ABW Corporation for the services provided in the HAZChek® Disclosure package. The cost for these services is: $ 37.00 (Note: refer to the accompanying Natural Hazard Disclosure Statement.) Seller's name (print): James T Kirk Signature of Seller(s): Date: Buyer's name (print): Signature of Buyer(s): Date: PO Box 9219 Tel: 707-573-7339 Santa Rosa, CA 95405 Fax:707-573-3094 www.realtydisclosure.com Toll Free: 800-750-9961 Toll Free Fax: 877-643-0030 NATURAL HAZARD DISCLOSURE STATEMENT This statement applies to the real property commonly known as: 1701 Enterprise Drive Santa Rosa, CA 95409 The seller and his or her agent(s) disclose 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 subject property. Seller hereby authorizes any agent(s) representing any principal(s) in this action to provide a copy of this statement to any person or entity in connection with any actual or anticipated sale of the property. The following are representations made by the seller and his or her agent(s) based on their knowledge and maps drawn by the state. This information is a disclosure and is not intended to be part of any contract between the buyer and seller. THIS REAL PROPERTY LIES WITHIN THE FOLLOWING HAZARDOUS AREA(S): A SPECIAL FLOOD HAZARD AREA: (Any type Zone "A" or "V") designed by the Federal Emergency Management Agency Yes No X Do not know and information not available from local jurisdiction AN AREA OF POTENTIAL FLOODING: shown on a dam failure inundation map pursuant to Section 8589.5 of the Government Code Yes No X Do not know and information not available from local jurisdiction A VERY HIGH FIRE HAZARD SEVERITY ZONE: Pursuant to Section 51178 or 51179 of the Government Code. The owner of this property is subject to the maintenance requirements of Section 51182 of the Government Code. Yes No X A WILDLAND AREA THAT MAY CONTAIN SUBSTANTIAL FOREST FIRE RISKS AND HAZARD: pursuant to Section 4125 of the Public Resources Code. The owner of this property is subject to the maintenance requirements of Section 4291 of the Public Resources Code. Additionally, it is not the state’s responsibility to provide fire protection services to any building or structure located within the wildlands unless the Department of Forestry and Fire Protection has entered into a cooperative agreement with a local agency for those purposes pursuant to Section 4142 of the Public Resources Code. Yes No X AN EARTHQUAKE FAULT ZONE: pursuant to Section 2622 of the Public Resources Code. Yes No X A SEISMIC HAZARD ZONE: pursuant to Section 2696 of the Public Resources Code Yes (Landslide Zone) No Map not yet released by the state X Yes (Liquefaction Zone) THESE HAZARDS MAY LIMIT YOUR ABILITY TO DEVELOP THE REAL PROPERTY, TO OBTAIN INSURANCE, OR TO RECEIVE ASSISTANCE AFTER A DISASTER. THE MAPS ON WHICH THESE DISCLOSURES ARE BASED ESTIMATE WHERE NATURAL HAZARDS EXIST. THEY ARE NOT DEFINITIVE INDICATORS OF WHETHER OR NOT A PROPERTY WILL BE AFFECTED BY A NATURAL DISASTER. BUYER(S) AND SELLER(S) MAY WISH TO OBTAIN PROFESSIONAL ADVICE REGARDING THOSE HAZARDS AND OTHER HAZARDS THAT MAY AFFECT THE PROPERTY. [NHDS Supplement: The representations made in this NHDS form and report are based upon information provided by an independent third party as a substitute disclosure pursuant to California Civil Code 1102.4. Neither the seller nor seller’s agent; 1) has independently verified the information contained herein; or 2) is personally aware of any errors or inaccuracies in the information contained on the form.] A MELLO-ROOS CFD: Mello-Roos Community Facilities Act C chapter 2.5, Div 2 of title 5, government code 53311etseq Yes No X Not Yet Assessed (Amount Unknown) AN INDUSTRIAL USE ZONE: examining availible zoning information within the various cities, and counties of California Yes No X A FORMER MILITARY ORDNANCE STORAGE FACILITY: examining available list of current of former military installation, facilities published by the US DOD. Yes No X Seller represents that the information herein is true and correct to the best of the seller’s knowledge as of the date signed below. Signature of Seller(s) Date: Agent represents that the information herein is true and correct to the best of the agent’s knowledge, as of the date signed by the agent. Signature of Seller's Date: Agent Signature of Buyer's Date: Agent Buyer represents that he/she has read and understands this document. Signature of Buyer(s) Date: DATE: 1/1/2001 Expires within 90 days. Copyright 1999-2003 ABW Corp/HAZChek NOTICE OF SPECIAL ASSESSMENT ASSESSMENT DISTRICT NO.N/A OF , CALIFORNIA TO: THE PROSPECTIVE PURCHASER OF THE REAL PROPERTY KNOWN AS: Assessor's Parcel Number: 123-456-789 Street Address: 1701 Enterprise Drive Santa Rosa, CA 95409 THIS IS A NOTIFICATION TO YOU PRIOR TO YOUR PURCHASING THIS PROPERTY: This property is within the above-named assessment district. The assessment district has issued bonds to finance the acquisition or construction of certain public improvements that are of direct and special benefit to property within the assessment district. The bonds will be repaid from annual assessment installments on property within the assessment district. This property is subject to annual assessment installments of the assessment district that will appear on your property tax bills, but which are in addition to the regular property taxes and any other charges and levies that will be listed on the property tax bill. If you fail to pay assessment installments when due each year, the property may be foreclosed upon and sold. The annual assessment installments against this property as show on the most recent tax bill for the2002-2003 tax year is$ - . Assessment installments will be collected each year until the assessment bonds are repaid. The public facilities that are being paid for by the money received from the sale of bonds that are being repaid by the assessments are: NO SPECIAL ASSESSMENT(S) FOUND ON RECORD. These facilities may not yet have all been constructed or acquired and it is possible that some may never be constructed or acquired. YOU SHOULD TAKE THIS ASSESSMENT AND THE BENEFITS FROM THE PUBLIC FACILITIES FOR WHICH IT PAYS INTO ACCOUNT IN DECIDING WHETHER TO BUY THIS PROPERTY. YOU MAY OBTAIN A COPY OF THE RESOLUTION CONFIRMING ASSESSMENTS THAT SPECIFIES MORE PRECISELY HOW THE ASSESSMENTS ARE APPORTIONED AMONG PROPERTIES IN THE ASSESSMENT DISTRICT FROM THE: Sonoma County Tax Collector BY CALLING: 707-565-3220 THERE MAY BE A CHARGE FOR THIS DOCUMENT NOT TO EXCEED THE ESTIMATED REASONABLE COST OF PROVIDING THE DOCUMENT. I (WE) ACKNOWLEDGE THAT I (WE) HAVE RECEIVED A COPY OF THIS NOTICE. I (WE) UNDERSTAND THAT I (WE) MAY TERMINATE THE CONTRACT TO PURCHASE OR DEPOSIT RECEIPT AFTER RECEIVING THIS NOTICE FROM THE OWNER OR AGENT SELLING THE PROPERTY. THE CONTRACT MAY BE TERMINATED WITHIN THREE DAYS IF THE NOTICE WAS RECEIVED IN PERSON OR WITHIN FIVE DAYS AFTER IT WAS DEPOSITED IN THE MAIL BY GIVING WRITTEN NOTICE OF THAT TERMINATION TO THE OWNER OR AGENT SELLING THE PROPERTY. Buyer represents that he/she has read and understands this document. Signature of Buyer(s) Date: Signature of Buyer(s) Date: DATE: 1/1/2001 Expires within 90 days. Copyright 2002-2003 ABW Corp/HAZChek FEDERAL EMERGENCY MANAGEMENT AGENCY See The Attached O.M.B. No 3067-0264 STANDARD FLOOD HAZARD DETERMINATION Instructions SECTION 1 - LOAN INFORMATION 1. LENDER NAME, ADDRESS AND PHONE 2. COLLATERAL(Building/Mobile Home/Personal Property) PROPERTY ADDRESS 1701 Enterprise Drive Santa Rosa, CA 95409 APN 123-456-789 SITUS N/A OWNER NAME James T Kirk 3. LENDER ID. NO. 4. LOAN IDENTIFIER 5. AMOUNT OF FLOOD INSURANCE REQUIRED N/A N/A N/A SECTION 2 A. NATIONAL FLOOD INSURANCE PROGRAM (NFIP) COMMUNITY JURISDICTION 1. NFIP Community County 3. State 4. NFIP Community Name Number City of Santa Rosa SonomaCA 060381 B. NATIONAL FLOOD INSURANCE PROGRAM (NFIP) DATA AFFECTING BUILDING/MOBILE HOME NFIP Map Number or Community-Panel Number NFIP Map Panel Effective 3. LOAN/LOMR 4. 5. No NFIP (Community Name, If not the same as "A") Revised Date Flood Zone Map 1. 2. C 060381 0006B 3-Aug-81 NO Date C. FEDERAL FLOOD INSURANCE AVAILABILITY (Check one's that apply) xxxx Federal Flood Insurance is available (community participates in NFIP) xxxx Regular Prog. Emergency Program of NFIP Federal Flood Insurance is not available because community is not participating in the NFIP Building/Mobile Home is in a Coast Barrier Resources Area (CBRA), Federal Flood insurance may not be available D. DETERMINATION IS BUILDING/MOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONES BEGINNING WITH THE LETTERS "A" OR "V")? If yes, flood insurance is required by the Flood Disaster Protection Act of 1973 Yes xxxx No If no, flood insurance is not required by the Flood Act of 1973 E.