F. The affidavit of disclosure shall contain all of the following disclosures, be completed by the seller, meet the requirements of section 11-480 and follow substantially the following form: When recorded mail to:
__________________________
__________________________
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Affidavit of Disclosure
Pursuant to A.R.S. § 33-422
I, ______________________________________________ (seller(s)) being duly sworn, hereby make this affidavit of disclosure relating to the real property situated in the unincorporated area of:
_______________________, County, State of Arizona, located at:
______________________________________________________________
and legally described as:
(Legal description attached hereto as exhibit "A")
(property).
1. There [] is [] is not .... legal access to the property, as defined in A.R.S. § 11-831.... [] unknown Explain: ____________________________________________________
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2. There [] is [] is not .... physical access to the property. [] unknown Explain: ____________________________________________________
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3. There [] is [] is not .... a statement from a licensed surveyor or engineer available stating whether the property has physical access that is traversable by a two-wheel drive passenger motor vehicle.4. The legal and physical access to the property [] is [] is not .... the same....[] unknown [] not applicable. Explain: ____________________________________________________
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If access to the parcel is not traversable by emergency vehicles, the county and emergency service providers may not be held liable for any damages resulting from the inability to traverse the access to provide needed services.
5. The road(s) is/are [] publicly maintained [] privately maintained [] not maintained [] not applicable. If applicable, there [] is [] is not .... a recorded road maintenance agreement. If the roads are not publicly maintained, it is the responsibility of the property owner(s) to maintain the roads and roads that are not improved to county standards and accepted for maintenance are not the county's responsibility.
6. A portion or all of the property [] is [] is not .... located in a FEMA designated regulatory floodplain. If the property is in a floodplain, it may be subject to floodplain regulation.7. The property [] is [] is not subject to [] fissures or [] expansive soils. [] unknown Explain: ____________________________________________________
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8. The following services are currently provided to the property: [] water [] sewer [] electric [] natural gas [] single party telephone [] cable television services.9. The property [] is [] is not .... served by a water supply that requires the transportation of water to the property. If the property is served by a water supply that requires the transportation of water to the property, the seller shall disclose the name and contact information of the water hauler or water hauling company that is currently providing the transportation services to the property and the name and location of the water supply from which the water is currently being transported. Water hauler name: ______________ Phone:__________
Water supply: __________________ Location:_________
10. The property is served by [] a private water company [] a municipal water provider [] a private well [] a shared well [] no well. If served by a shared well, the shared well [] is [] is not .... a public water system, as defined by the safe drinking water act (42 United States Code § 300f). Notice to buyer: If the property is served by a well, a private water company or a municipal water provider the Arizona department of water resources may not have made a water supply determination. For more information about water supply, contact the water provider.
11. The property or the water used on the property [] is [] is not the subject of a statement of claimant for the use of water in a general adjudication of water rights. [] unknown. This is a lawsuit to determine the use of and relative priority of water rights. A map of adjudicated areas is available at the website of the department of water resources.
12. The property [] does have [] does not have .... an on-site wastewater treatment facility (i.e., standard septic or alternative system to treat and dispose of wastewater). [] unknown. If applicable: a) The property [] will [] will not .... require installation of an on-site wastewater treatment facility; b) The on-site wastewater treatment facility [] has [] has not been inspected.13. The property [] has been [] has not been .... subject to a percolation test. [] unknown.14. The property [] does have [] does not have one or more solar energy devices that are [] leased [] owned. If the solar energy devices are leased, the sellershall disclose the name and contact information of the leasing company.
Leasing company name: _______________ Phone: _______________
15. The property [] does have [] does not have one or more battery energy storage devices that are [] leased [] owned. If the battery energy storage devices are leased, the seller shall disclose the name and contact information of the leasing company.
Leasing company name: _________________ Phone: ____________
16. The property [] does [] does not .... meet the minimum applicable county zoning requirements of the applicable zoning designation.17. The sale of the property [] does [] does not ... meet the requirements of A.R.S. § 11-831 and § 32-2181 regarding land divisions. If those requirements are not met, the property owner may not be able to obtain a building permit. It is unlawful pursuant to § 11-831, subsection F and § 32-2181, subsection D for a person or group of persons to attempt to avoid the subdivision laws of this state by acting in concert to divide a parcel of land into six or more lots or parcels. The county where the land division occurred or the state real estate department may investigate and enforce the prohibition against acting in concert to unlawfully divide a parcel of land into six or more lots or parcels. The seller or property owner shall disclose each of the deficiencies to the buyer. Explain: ____________________________________________________
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18. The property [] is [] is not located in the clear zone of a military airport or ancillary military facility, as defined in A.R.S. § 28-8461. (Maps are available at the state real estate department's website.)19. The property [] is [] is not located in the high noise or accident potential zone of a military airport or ancillary military facility, as defined in A.R.S. § 28-8461. (Maps are available at the state real estate department's website.)20. Notice: If the property is located within the territory in the vicinity of a military airport or ancillary military facility, the property is required to comply with sound attenuation standards as prescribed by A.R.S. § 28-8482. (Maps are available at the state real estate department's website.)21. The property [] is [] is not located under military restricted airspace. [] unknown. (Maps are available at the state real estate department's website.)22. The property [] is [] is not located in a military electronics range as defined in A.R.S. § 9-500.28 and § 11-818. [] unknown. (Maps are available at the state real estate department's website.)23. The property [] is [] is not located within the influence area of a military installation or range or Arizona national guard site as defined in sections § 9-500.50 and § 11-818.01 (maps are available at the state real estate department website.) 24. Use of the property [] is [] is not limited in any way relating to an encumbrance of title due to a lis pendens, a court order or a state real estate department order or a pending legal action. If the use of the property is limited due to an encumbrance of title, the seller or property owner shall disclose the limitations to the buyer. Explain: ____________________________________________________
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This affidavit of disclosure supersedes any previously recorded affidavit of disclosure.
I certify under penalty of perjury that the information contained in this affidavit is true, complete and correct according to my best belief and knowledge.
Dated this (date) __ day of (year) by:
Seller's name (print): ______________ Signature: _____________
Seller's name (print): ______________ Signature: _____________
State of Arizona | ) | |
| ) | ss. |
County of ___________ | ) | |
Subscribed and sworn before me this _ (date) __ day of (year), by ____________________________________________.
__________________________
Notary public
My commission expires:
(date)
Buyer(s) hereby acknowledges receipt of a copy of this affidavit of disclosure this (date) day of (year)
Buyer's name (print): _______________ Signature: _____________
Buyer's name (print): _______________ Signature: _____________