Disclose & Close — Seller Intake Form (Attorney Review Draft v0.9)

Property Seller Intake Form

Georgia — Seller's Disclosure Intake

54 questions · 11 sections · Maps to GAR F301 and Federal Lead-Based Paint Disclosure

IMPORTANT: This intake form collects factual information about the seller's property. Disclose & Close is a marketing and referral platform — not a law firm. This form does not constitute legal advice, and no attorney-client relationship is formed with Disclose & Close. Seller responses will be used to (1) generate a draft disclosure document and risk summary for seller review, and (2) connect the seller with a licensed Georgia real estate attorney for consultation. All draft outputs require attorney review before use.

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Section 1

Property & Seller Basics

Q1–Q6 ▼

Full property address (street, city, zip) *

F301 · LBP

Your full legal name(s) as title holder(s) *

List all owners exactly as they appear on the deed.

F301 · LBP

What is the current occupancy status? *

Occupied by seller Vacant Tenant-occupied Other

F301

What year was the home originally built? *

If unknown, provide your best estimate and note "approximate."

F301 · LBP

Is this a single-family home, condo, townhome, manufactured/mobile home, or other? *

Single-family Condo Townhome Manufactured/Mobile Other

F301

How long have you personally owned and occupied this property? *

Note: Ownership period may be relevant to your disclosure obligations. A licensed attorney can advise you on which forms apply to your situation.

F301

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Section 2 — Federal Requirement

Lead-Based Paint Disclosure

Q7–Q9 · Skip if built 1978 or later ▼

Federal law (42 U.S.C. § 4852d) requires this disclosure for all homes built before 1978. Skip this section if the home was built in 1978 or later.

Was the home built before 1978? *

Yes

LBP

Do you have any knowledge of lead-based paint or lead-based paint hazards in the property? *

This includes walls, trim, windows, doors, or any painted surfaces.

Yes

If Yes, explain: _______________________________________________

LBP

Do you have any records or reports pertaining to lead-based paint in the property? *

Examples: prior inspection reports, contractor disclosures, renovation records.

Yes

If Yes, list all records available: _______________________________________________

LBP

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Section 3

Structural Condition

Q10–Q15 ▼

Have you observed any cracks, settling, shifting, or movement in the foundation or exterior walls? *

Yes

If Yes, explain: _______________________________________________

F301

Have any additions, renovations, or alterations been made to the home? *

Include finished basements, room additions, garage conversions, deck additions, etc.

Yes

If Yes, explain: _______________________________________________

F301

Were all additions or alterations performed with required permits and to code? *

Answer based on your actual knowledge of permit and code compliance status.

Yes

If No, explain: _______________________________________________

F301

Is the dwelling a mobile, modular, or manufactured home? *

Yes

If Yes, explain: _______________________________________________

F301

Have there been any code violations or zoning violations issued against the property? *

Yes

If Yes, explain: _______________________________________________

F301

Are you aware of any pest infestation (termites, wood-boring insects, or rodents), past or present? *

Yes

If Yes, explain: _______________________________________________

F301

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Section 4

Roof, Gutters & Drainage

Q16–Q21▼

Approximately what year was the current roof installed or last replaced? *

F301

What is the roofing material? *

ShinglesMetalTileFlat/TPOOther

F301

Is there currently any roof leakage or water intrusion? *

Yes

If Yes, explain: _______________________________________________

F301

Have there been any roof leaks or repairs during your ownership? *

Describe what was repaired, by whom, and when.

Yes

If Yes, explain: _______________________________________________

F301

Are gutters and downspouts in functional condition? *

Yes

If No, explain: _______________________________________________

F301

Has the property experienced any drainage or water runoff problems? *

Yes

If Yes, explain: _______________________________________________

F301

⚙️

Section 5

Mechanical Systems & Components

Q22–Q31▼

Heating & Cooling

What type of heating system does the home have? *

Gas forced airHeat pumpElectricBoilerOther

F301

Approximately what year was the HVAC system installed? *

If there are separate heating and cooling units, note each.

F301

Is the HVAC system currently functional? *

Yes

If No, explain: _______________________________________________

F301

Are you aware of any defects or needed repairs to the HVAC system? *

Yes

If Yes, explain: _______________________________________________

F301

Electrical

Does the dwelling or garage have aluminum wiring other than the primary service line? *

Aluminum wiring (common in homes built 1965–1973) is a fire risk and must be disclosed.

Yes

If Yes, explain: _______________________________________________

F301

Are there any known electrical issues, deficiencies, or items in need of repair? *

Yes

If Yes, explain: _______________________________________________

F301

Is there a fireplace or wood-burning stove? If so, is it in functional condition? *

Yes

If Yes, explain condition: _______________________________________________

F301

Appliances & Other Systems

Are any appliances or fixtures included in the sale in need of repair or replacement? *

List specific items if yes.

Yes

If Yes, explain: _______________________________________________

F301

Is any appliance, system, or fixture currently leased (e.g., water softener, propane tank, solar)? *

If yes, list item, monthly cost, and transfer fee if applicable.

Yes

If Yes, explain: _______________________________________________

F301

Are there any remotely accessed smart home devices (smart thermostats, video doorbells, smart locks, security cameras, lighting systems)? *

These must be disclosed per 2024 GAR form updates.

Yes

If Yes, explain: _______________________________________________

F301

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Section 6

Plumbing, Water & Sewer

Q32–Q37▼

What is the water source? *

Public/municipalPrivate wellShared well

F301

What is the sewer/wastewater system? *

Public sewerSeptic tankOther

F301

If septic: When was it last pumped/inspected? Are you aware of any issues? *

(Skip if Public Sewer selected in Q33)

F301

Have there been any plumbing leaks, backups, or frozen pipes during your ownership? *

Yes

If Yes, explain: _______________________________________________

F301

Is there any current issue with water pressure, water quality, or drainage? *

Yes

If Yes, explain: _______________________________________________

F301

What type of water heater does the home have, and approximately how old is it? *

F301

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Section 7

Water Intrusion, Moisture & Environmental

Q38–Q43▼

Has the property experienced any basement, crawl space, or interior flooding? *

Yes

If Yes, explain: _______________________________________________

F301

Is there any current moisture, water staining, or mold visible anywhere in the property? *

Yes

If Yes, explain: _______________________________________________

F301

Have there ever been adverse test results for radon, lead, mold, or other potentially toxic substances? *

Yes

If Yes, explain: _______________________________________________

F301

Is the property located in a FEMA Special Flood Hazard Area (flood zone)? *

You can verify at msc.fema.gov.

Yes

If Yes, explain: _______________________________________________

F301

Is any part of the property adjacent to wetlands, streams, or regulated water bodies? *

Yes

If Yes, explain: _______________________________________________

F301

Is the property within or adjacent to land zoned as agricultural or forestry use? *

Georgia's Right to Farm disclosure is required if applicable.

Yes

If Yes, explain: _______________________________________________

F301

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Section 8

Legal, Title & Encumbrances

Q44–Q50▼

Is the property subject to any HOA, community association, or deed restrictions? *

If yes, provide HOA name, monthly/annual dues, and any known violations.

Yes

If Yes, explain: _______________________________________________

F301

Are there any encroachments, unrecorded easements, or boundary line disputes with neighbors? *

Yes

If Yes, explain: _______________________________________________

F301

Are there any shared improvements with neighboring properties (shared driveway, well, septic, dock, etc.)? *

Yes

If Yes, explain: _______________________________________________

F301

Is there currently any active litigation related to the property? *

This includes construction defect claims, neighbor disputes, or title challenges.

Yes

If Yes, explain: _______________________________________________

F301

Have you signed any release related to defective products, construction, or insurance claims? *

Yes

If Yes, explain: _______________________________________________

F301

During your ownership, have there been insurance claims totaling more than 10% of the property's value? *

Yes

If Yes, explain: _______________________________________________

F301

Are there any liens, judgments, or outstanding mortgages against the property beyond your primary mortgage? *

Yes

If Yes, explain: _______________________________________________

F301

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Section 9

Land Use, History & Other Disclosures

Q51–Q54▼

Has the property or dwelling been designated as historic or located in a historic district? *

Yes

If Yes, explain: _______________________________________________

F301

Are there any known landfills, graves, burial pits, caves, mine shafts, or trash dumps on or near the property? *

Yes

If Yes, explain: _______________________________________________

F301

Is any part of the property or improvements located in a designated flood plain? *

Note: Q41 asks about FEMA Special Flood Hazard Areas (flood zones). This question addresses the broader flood plain designation, which may differ. Your attorney can clarify the distinction.

Yes

If Yes, explain: _______________________________________________

F301

Are you aware of any other fact or condition that could materially affect the value or desirability of the property that has not been disclosed above? *

Georgia law requires disclosure of all known material defects. When in doubt, disclose.

F301

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Section 10

Items Remaining With the Property

Checklist▼

Check all items that will remain with the property at closing.

Appliances & Kitchen

Refrigerator

Dishwasher

Range/Oven/Cooktop

Microwave

Garbage Disposal

Vent Hood

Laundry & Utility

Washer

Dryer

Water Heater

Water Softener

Attic Fan

Whole-House Generator

Interior

Window Treatments

Ceiling Fans

Light Fixtures

Fireplace Equipment

Smart Home Devices

Security System

Exterior & Other

Garage Door Openers

Storage Shed

Mailbox

Pool/Spa Equipment

TV Mounts

Items NOT included in sale

Section 11 — Seller Certification

By signing below, you certify that your responses are complete and accurate to the best of your actual knowledge and belief. You acknowledge that Disclose & Close is a marketing and referral platform, that this form does not constitute legal advice, and that all outputs generated from your responses must be reviewed by a licensed attorney before use in any real estate transaction.

Seller Signature

Print name & sign above

Date

Co-Seller Signature (if applicable)

Print name & sign above

Date