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SELLER’S PROPERTY DISCLOSURE STATEMENT

EXHIBIT “________”
C

2023 Printing

This Seller’s Property Disclosure Statement (“Statement”) is an exhibit to the Purchase and Sale Agreement with an Offer Date of
_____________________ for the Property (known as or located at: 1695
08/30/2023 _____________________________________________________
Hampton Oaks Drive
__________________________________, Georgia, 30004
Alpharetta _________________). This Statement is intended to make it easier for Seller to
fulfill Seller’s legal duty to disclose hidden defects in the Property of which Seller is aware. Seller is obligated to disclose such defects
even when the Property is being sold “as-is.”

A. INSTRUCTIONS TO SELLER IN COMPLETING THIS STATEMENT.

In completing this Statement, Seller agrees to:
(1) answer all questions in reference to the Property and the improvements thereon;
(2) answer all questions fully, accurately and to the actual knowledge and belief of all Sellers;
(3) provide additional explanations to all “yes” answers in the corresponding Explanation section below each group of questions
(including providing to Buyer any additional documentation in Seller’s possession), unless the “yes” answer is self-evident;
(4) promptly revise the Statement if there are any material changes in the answers to any of the questions prior to closing and
provide a copy of the same to the Buyer and any Broker involved in the transaction.

B. HOW THIS STATEMENT SHOULD BE USED BY BUYER. Caveat emptor or “buyer beware” is the law in Georgia. Buyer should
conduct a thorough inspection of the Property. If Seller has not occupied the Property recently, Seller’s knowledge of the
Property’s condition may be limited. Buyer is expected to use reasonable care to inspect the Property and confirm that is suitable
for Buyer’s purposes. If an inspection of the Property reveals problems or areas of concern that would cause a reasonable Buyer
to investigate further, Buyer should investigate further. A “yes” or “no” answer to a question means “yes” or “no” to the actual
knowledge and belief of all Sellers of the Property.

C. SELLER DISCLOSURES.

1. GENERAL: YES NO
(a) What year was the main residential dwelling constructed? 2016
_________________
(b) Is the Property vacant?
If yes, how long has it been since the Property has been occupied? ________________
(c) Is the Property or any portion thereof leased?
(d) Has the Property been designated as historic or in a historic district where permission must be
received to make modifications and additions?
EXPLANATION:

2. COVENANTS, FEES, and ASSESSMENTS: YES NO

(a) Is the Property subject to a recorded Declaration of Covenants, Conditions, and Restrictions
(“CC&Rs”) or other similar restrictions?
(b) Is the Property part of a condominium or community in which there is a community association?
IF YES, SELLER TO COMPLETE AND PROVIDE BUYER WITH A “COMMUNITY
ASSOCIATION DISCLOSURE EXHIBIT” GAR F322.
EXPLANATION:

3. LEAD-BASED PAINT: YES NO

(a) Was any part of the residential dwelling on the Property or any painted component, fixture, or
material used therein constructed or manufacture prior to 1978? IF YES, THE “LEAD-BASED
PAINT EXHIBIT” GAR F316 MUST BE EXECUTED BY THE PARTIES AND THE “LEAD-
BASED PAINT PAMPHLET” GAR CB04 MUST BE PROVIDED TO THE BUYER.

THIS FORM IS COPYRIGHTED AND MAY ONLY BE USED IN REAL ESTATE TRANSACTIONS IN WHICH Lakshmi
_____________________________
Thirunavu IS INVOLVED AS A
REAL ESTATE LICENSEE. UNAUTHORIZED USE OF THE FORM MAY RESULT IN LEGAL SANCTIONS BEING BROUGHT AGAINST THE USER AND SHOULD BE
REPORTED TO THE GEORGIA ASSOCIATION OF REALTORS® AT (770) 451-1831.
Copyright© 2023 by Georgia Association of REALTORS®, Inc. F301, Seller’s Property Disclosure Statement Exhibit, Page 1 of 7, 01/01/23
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4. STRUCTURAL ITEMS, ADDITIONS AND ALTERATIONS: YES NO

(a) Has there been any settling, movement, cracking or breakage of the foundations or structural
supports of the improvements?
(b) Have any structural reinforcements or supports been added?
(c) Have there been any additions, structural changes, or any other major alterations to the original
improvements or Property, including without limitation pools, carports or storage buildings?
(d) Has any work been done where a required building permit was not obtained?
(e) Are there violations of building codes, housing codes, or zoning regulations (not otherwise
grandfathered)?
(f) Have any notices alleging such violations been received?
(g) Is any portion of the main dwelling a mobile, modular or manufactured home?
(h) Was any dwelling or portion thereof (excluding mobile, modular and manufactured dwelling)
moved to the site from another location?
EXPLANATION:

5. SYSTEMS and COMPONENTS: YES NO

(a) Has any part of the HVAC system(s) been replaced during Seller’s ownership?
(b) Date of last HVAC system(s) service: 2022
_________________________________________
(c) Is any heated and cooled portion of the main dwelling not served by a central heating and cooling
system?
(d) Is any portion of the heating and cooling system in need of repair or replacement?
(e) Does any dwelling or garage have aluminum wiring other than in the primary service line?
(f) Are any fireplaces decorative only or in need of repair?
(g) Have there been any reports of damaging moisture behind exterior walls constructed of synthetic
stucco?
(h) Are any systems/components subject to a lease or rental payment plan (i.e. HVAC, security
system, appliances, alternate energy source systems, etc.)?
EXPLANATION:

6. SEWER/PLUMBING RELATED ITEMS: YES NO

(a) Approximate age of water heater(s): 6_______________ years
(b) What is the drinking water source:  public  private  well
(c) If the drinking water is from a well, give the date of last service: _______________________
(d) If the drinking water is from a well, has there ever been a test the results of which indicate that
the water is not safe to drink? If yes, date of testing: ___________________________
(e) What is the sewer system:  public  private  septic tank
(f) If the Property is served by a septic system, how many bedrooms was the septic system
approved for by local government authorities? ____________
(g) Is the main dwelling served by a sewage pump?
(h) Has any septic tank or cesspool on Property ever been professionally serviced?
If yes, give the date of last service: ______________________________
(i) Are there any leaks, backups, or other similar problems with any portion of the plumbing, water,
or sewage systems or damage therefrom?
(j) Is there presently any polybutylene plumbing, other than the primary service line?
(k) Has there ever been any damage from a frozen water line, spigot, or fixture?
EXPLANATION:

Copyright© 2023 by Georgia Association of REALTORS® F301, Seller’s Property Disclosure Statement Exhibit, Page 2 of 7, 01/01/23
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7. ROOFS, GUTTERS, and DOWNSPOUTS: YES NO

(a) Approximate age of roof on main dwelling: 6_________ years.
(b) Has any part of the roof been repaired during Seller’s ownership?
(c) Are there any roof leaks or other problems with the roof, roof flashing, gutters, or downspouts?
EXPLANATION:

8. FLOODING, DRAINING, MOISTURE, and SPRINGS: YES NO

(a) Is there now or has there been any water intrusion in the basement, crawl space or other parts of
any dwelling or garage or damage therefrom?
(b) Have any repairs been made to control water intrusion in the basement, crawl space, or other
parts of any dwelling or garage?
(c) Is any part of the Property or any improvements thereon presently located in a Special Flood
Hazard Area?
(d) Has there ever been any flooding?
(e) Are there any streams that do not flow year round or underground springs?
(f) Are there any dams, retention ponds, storm water detention basins, or other similar facilities?
EXPLANATION:

9. SOIL AND BOUNDARIES: YES NO

(a) Are there any landfills (other than foundation backfill), graves, burial pits, caves, mine shafts, trash
dumps or wells (in use or abandoned)?
(b) Is there now or has there ever been any visible soil settlement or movement?
(c) Are there presently any encroachments, unrecorded easements or boundary line disputes with a
neighboring property owner?
(d) Do any of the improvements encroach onto a neighboring property?
(e) Is there a shared driveway, alleyway, or private road servicing the Property?
EXPLANATION:

10. TERMITES, DRY ROT, PESTS, and WOOD DESTROYING ORGANISMS: YES NO
(a) Are you aware of any wildlife accessing the attic or other interior portions of the residence?
(b) Is there any damage or hazardous condition resulting from such wildlife intrusion; from insects
(such as termites, bees and ants); or by fungi or dry rot?
(c) Is there presently a bond, warranty or service contract for termites or other wood destroying
organisms by a licensed pest control company?
If yes, what is the cost to transfer? $ ___________ What is the annual cost? 476
_____________
If yes, company name/contact: Moxie
__________________________________________________
Pest Control

Coverage:  re-treatment and repair  re-treatment  periodic inspections only

Expiration Date 09/30/2023
_______________________ Renewal Date _______________________
EXPLANATION:

Copyright© 2023 by Georgia Association of REALTORS® F301, Seller’s Property Disclosure Statement Exhibit, Page 3 of 7, 01/01/23
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11. ENVIRONMENTAL, HEALTH, and SAFETY CONCERNS: YES NO

(a) Are there any underground tanks or toxic or hazardous substances such as asbestos?
(b) Has Methamphetamine (“Meth”) ever been produced on the Property?
(c) Have there ever been adverse test results for radon, lead, mold or any other potentially toxic or
environmentally hazardous substances?
EXPLANATION:

12. LITIGATION and INSURANCE: YES NO

(a) Is there now or has there been any litigation therein alleging negligent construction or defective
building products?
(b) Has there been any award or payment of money in lieu of repairs for defective building products
or poor construction?
(c) Has any release been signed regarding defective products or poor construction that would limit a
future owner from making any claims?
(d) During Seller’s ownership have there been any insurance claims for more than 10% of the value of
the Property?
(e) Is the Property subject to a threatened or pending condemnation action?
(f) How many insurance claims have been filed during Seller’s ownership? _________________
EXPLANATION:

13. OTHER HIDDEN DEFECTS: YES NO

(a) Are there any other hidden defects that have not otherwise been disclosed?
EXPLANATION:

14. AGRICULTURAL DISCLOSURE: YES NO

(a) Is the Property within, partially within, or adjacent to any property zoned or identified on an
approved county land use plan as agricultural or forestry use?
(b) Is the Property receiving preferential tax treatment as an agricultural property?
It is the policy of this state and this community to conserve, protect, and encourage the development and improvement of
farm and forest land for the production of food, fiber, and other products, and also for its natural and environmental value.
This notice is to inform prospective property owners or other persons or entities leasing or acquiring an interest in real
property that property in which they are about to acquire an interest lies within, partially within, or adjacent to an area
zoned, used, or identified for farm and forest activities and that farm and forest activities occur in the area. Such farm and
forest activities may include intensive operations that cause discomfort and inconveniences that involve, but are not limited
to, noises, odors, fumes, dust, smoke, insects, operations of machinery during any 24-hour period, storage and disposal of
manure, and the application by spraying or otherwise of chemical fertilizers, soil amendments, herbicides, and pesticides.
One or more of these inconveniences may occur as the result of farm or forest activities which are in conformance with
existing laws and regulations and accepted customs and standards.

Copyright© 2023 by Georgia Association of REALTORS® F301, Seller’s Property Disclosure Statement Exhibit, Page 4 of 7, 01/01/23
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ADDITIONAL EXPLANATIONS (If needed):

Copyright© 2023 by Georgia Association of REALTORS® F301, Seller’s Property Disclosure Statement Exhibit, Page 5 of 7, 01/01/23
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D. FIXTURES CHECKLIST
Directions on HOW TO USE: It is often unclear what constitutes a fixture which remains with the Property versus personal
property which does not remain with the Property. To avoid disputes, Seller shall have the right to remove all items on the
checklist below that are left blank. THE ITEMS ON THE CHECKLIST BELOW THAT ARE CHECKED OR MARKED SHALL
REMAIN WITH THE PROPERTY. All items remaining with Property shall include remotes and/or all accessories necessary for
use. Unless otherwise indicated, if an item is left blank, the Seller may remove all of that item from the Property. For example, if
“Refrigerator” is left blank, Seller may remove all Refrigerators on the Property. This checklist is intended to supersede the
common law of fixtures with regard to the items below. The common law of fixtures shall apply to all items not on this checklist.
Seller shall remove all items left blank below prior to closing or the transfer of possession, whichever is later. Seller shall lose the
right to remove those items not timely removed but shall remain liable for the cost of Buyer having to dispose of such items
provided that Buyer disposes of them within 30 days after Closing. In removing items, Seller shall use reasonable care to prevent
and repair damage to the area where the item was removed.
Items identified as remaining with the Property shall mean those specific items as they existed in the Property as of the Offer Date.
No such item shall be removed from the Property unless it is broken or destroyed. In the event such item is removed, it shall be
replaced with a substantially identical item, if reasonably available. If not reasonably available, it shall be replaced with a
substantially similar item of equal quality and value, or better. The same or newer model of the item being replaced in the same
color and size and with the same functions or better shall be considered substantially identical. Once the Seller’s Property is under
contract, the items that may be removed and taken by the Seller, as reflected in this Seller’s Property Disclosure Statement, may
only be amended with the written consent of the Buyer of the Property. This section entitled “Fixtures Checklist” shall survive
Closing.
Appliances  Television (TV)  Birdhouses  Fire Sprinkler System
 Clothes Dryer  TV Antenna  Boat Dock  Gate
 Clothes Washing  TV Mounts/Brackets  Fence - Invisible  Safe (Built-In)
Machine  TV Wiring  Dog House  Smoke Detector
 Dishwasher  Flag Pole  Window Screens
 Garage Door Interior Fixtures  Gazebo
Opener  Ceiling Fan  Irrigation System Systems
 Garbage Disposal  Chandelier  Landscaping Lights  A/C Window Unit
 Ice Maker  Closet System  Mailbox  Air Purifier
 Microwave Oven  Fireplace (FP)  Out/Storage Building  Whole House Fan
 Oven  FP Gas Logs  Porch Swing  Attic Ventilator Fan
 Refrigerator w/o Freezer  FP Screen/Door  Statuary  Ventilator Fan
 Refrigerator/Freezer  FP Wood Burning Insert  Stepping Stones  Car Charging Station
 Free Standing Freezer  Light Bulbs  Swing Set  Dehumidifier
 Stove  Light Fixtures  Tree House  Generator
 Surface Cook Top  Mirrors  Trellis  Humidifier
 Trash Compactor  Wall Mirrors  Weather Vane  Propane Tank
 Vacuum System  Vanity (hanging)  Propane Fuel in Tank
 Vent Hood Mirrors Recreation  Fuel Oil Tank
 Warming Drawer  Shelving Unit & System  Aboveground Pool  Fuel Oil in Tank
 Wine Cooler  Shower Head/Sprayer  Gas Grill  Sewage Pump
 Storage Unit/System  Hot Tub  Solar Panel
Home Media  Window Blinds (and  Outdoor Furniture  Sump Pump
 Amplifier Hardware)  Outdoor Playhouse  Thermostat
 Cable Jacks  Window Shutters (and  Pool Equipment  Water Purification
 Cable Receiver Hardware)  Pool Chemicals System
 Cable Remotes  Window Draperies (and  Sauna  Water Softener
 Intercom System Hardware) System
 Internet HUB  Unused Paint Safety  Well Pump
 Internet Wiring  Alarm System (Burglar)
 Satellite Dish Landscaping / Yard  Alarm System (Smoke/Fire) Other
 Satellite Receiver  Arbor  Security Camera ____________________
 Under sink RO System
 Speakers  Awning  Carbon Monoxide Detector  ____________________
 Speaker Wiring  Basketball Post  Doorbell  ____________________
 Switch Plate Covers and Goal  Door & Window Hardware  ____________________
Clarification Regarding Multiple Items. Items identified above as remaining with Property where Seller is actually taking one or
more of such items shall be identified below. For example, if “Refrigerator” is marked as staying with the Property, but Seller is
taking the extra refrigerator in the basement, the extra refrigerator and its location shall be described below. This section shall
control over any conflicting or inconsistent provisions contained elsewhere herein.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Items Needing Repair. The following items remaining with Property are in need of repair or replacement:
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________

Copyright© 2023 by Georgia Association of REALTORS® F301, Seller’s Property Disclosure Statement Exhibit, Page 6 of 7, 01/01/23
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___________________________________________________________
RECEIPT AND ACKNOWLEDGEMENT BY BUYER SELLER’S REPRESENTATION REGARDING THIS
STATEMENT

Buyer acknowledges receipt of this Seller’s Property Seller represents that the questions in this Statement have
Disclosure Statement. been answered to the actual knowledge and belief of all Sellers
of the Property

________________________________________________ __________________________________________________
1 Buyer’s Signature 1 Seller’s Signature

________________________________________________
VishnuDutta Potluri __________________________________________________
Ramachandran Ganesan
Print or Type Name Print or Type Name

________________________________________________ __________________________________________________
Date Date

Poorna Panchapakesan
dotloop verified

________________________________________________ __________________________________________________
09/06/23 6:49 PM EDT
AU2L-LTGF-QM4Q-IDCQ

2 Buyer’s Signature 2 Seller’s Signature

________________________________________________ __________________________________________________
Poorna Panchapakesan
Print or Type Name Print or Type Name

________________________________________________ __________________________________________________
Date Date

 Additional Signature Page (F267) is attached.  Additional Signature Page (F267) is attached.

Copyright© 2023 by Georgia Association of REALTORS® F301, Seller’s Property Disclosure Statement Exhibit, Page 7 of 7, 01/01/23