SINGLE RESIDENTIAL DATA INPUT FORM Name Phone # Street Number FSBO Company Address Asking Price Ad/Account Number City Zip Code Zone Year Built Year Built Description. Area Estimate Town Records Lease Option Historic Under Constr Map Model Completed To Be Built Lot Sub Div Est Acrerage Block E/Row Assmt $ Mill Rate Page Owner Taxes Vol. Listing Office Information Show LA/PubID ByBr (% or $) Dual/Var List Type. ER EA Listing Office: Alliance Realty NE, LLC Broker fax # 866-866-7978 Broker Phone # 866-866-7978 E-Mail - info@alliancerealtyne.com Internet Photo School Information Elementary Middle Jr. High Sr. High Refer to Table General Information Appx SqFt 0-9999 AGENT Choose One OWNER TOWN Rooms Choose One Foundation W x L OWNER AGENT TOWN Levels House Style Bungalow Log Cape Cod Mobile Home Colonial Raised Ranch Cottage Ranch Farm House Rooming House One Choice required Row House Split House Tudor Victorian Half Duplex Exterior Siding Aluminum Log Stucco Asbestos Redwood Vinyl Brick Shake Vertical Cedar Shingle Cinderblock Steel ClapBoard Stone One Choice required, Select up to Three Page 1 of 5
Seasonal Color Basement Crawl Space Part w/hatch Part w/walk Conc Floor Full w/hatch Full w/ Walk Dirt Floor Part Basement Full Basement One Choice required, Select up to Three Basement Finish Fully Finished Partially Finished Unfinished Flooring Carpeted Plywood Vinyl Laminate Tile Linoleum Slate One Choice required, Select up to Three Property Remarks Attic Apartment Crawlspace Expandable Finished Floored Hatch Opening Pull Down Storage Unfinished Walk Up Partially Finished One Choice required, Garage Attached Car Port 0-9 Barn Detached Tandem Under House Select Up to Two Number of Half Bath Number of Number of Bedrooms 1: 2: 3: Approximate Room Sizes and Descriptions Living Room W x L Master Bedroom W x L Formal Dining Room W / Formal Great Room Comb Living /Din x L Built In Hutch Comb Living /Din Suite Walk In Closet First Floor Whirlpool Ceiling Fan Dressing Room Half Bath 2nd Bedroom W x L Dressing Room Half Bath Walk In Closet Studio 3rd Bedroom W x L Dressing Room Half Bath Walk In Closet Studio Page 2 of 5
Kitchen W x L Breakfast Bar Eat In Galley Country Kitchen Island Breakfast ok Remodeled Pantry Family Room / Den W x L Book Shelves Ceiling Fan Entertainment CT First Floor Lower Level Upper Level Wet Bar 4th Bedroom W x L Dressing Room Half Bath Walk In Closet Studio Baths Full Half Lower 1st Floor 2nd Floor 3rd Floor Additional Rooms/Inforamtion Breakfast Room Den Greenhouse Library Laundry Rooms Maid's Room Mud Room Nursey Office Sewing Room Utility Sun Room Study Loft Select up to Three InLaw Access Detached Separate Entry First Floor Over Garage Lower Level Second Floor Possible Select up to Three Laundry Location First Lower Upper Appliances Included Compactor Dishwasher Disposal Grill Hood Hot Water Tap Dryer Microwave Freezer Refridgerator Subzero Washer Oven/Range Select up to Six Deck W x L Covered GRND Upper Patio Wrap Select One Additional Features Mechanical Features Electric Air Filter Humidifier Sprinkler System Intercom Auto Garage Door Multi-line Phone Dehumidifier Security System Generator Smoke Detector Central Vacuum Pool Above Ground Above Ground Heated InDoor In Ground Heated In Ground Select One Interior Features Atrium Coffered Ceiling Bar Crown Molding Foyer Ceiling Fan French Doors Chair Rail Slider Wet Bar Whirlpool Wainscoting Hot Tub Sauna Workshop Wine Cellar Handicap Facilites Granite/Corian Countertops Select up to Four Number of s Page 3 of 5
Waterfront Access Assoc Mandatory Assoc Optional Dock Frontage Harbor Ocean River Sound Beach Lake View Brook Pond Walk To If, One Choice Required, Select Up to 4 Miscellaneous Features Walk to Bus Lines Commuter Bus Private Rec Facilities Private School Professional Use Public Rec Facilities Select Up to 2 Lot Description Corner View Sub Division Culdasac Neighborhood Farmland Open Poss Sub Divide Lightly ed Level Topography Secluded Landscape ed If, One Choice Required, Select Up to 4 Exterior Features Barn Garden Area Kennel Gas Grill Out Building Breezeway Cabana Gazebo Greenhouse Stable Stone Wall Fence Guest House Tennis Court Fruit Trees Hot Tub Handicap Access Horses Permitted Underground Utilities Select up to Four Driveway Asphalt Cement Circular Gravel Heated Paved Crushed Stone Shared Dirt One Choice Required, Select Up To Two Utilities/Energy Features Fuel Above Ground Coal In-Ground Propane Solar Electric Geothermal Gas Oil, Select Up to Two Water Public Available Public Connected Spring Well Shared Well, Select Up to Two Hot Water Fuel Domestic Oil Electric Propane Gas, Select Up to Two Fuel Cost Heat Baseboard Radiator Stove Heat Pump Space Heater WAIR Radiant Steam, Select Up to Two Energy Features Partial Thermo Pane Windows /Coal Stove Partial Storm Windows Attic Fan Thermo Pane Windows Fireplace Insert Storm Windows Full Screens Full Storm WIndow Multi Zone Heat Day/Night Thermostat Screens Partial Screens NONE, Select Up to Four Amps Cable Available Both Sewer Lein Water Neither Shared Septic Public Available Public Connected Hot Water Owner Sewer Septic Cesspool Own, Select Up to Two Central Air Combo Cooling Individual Units Page 4 of 5 Rent
Insulation Information DISCLOSURE REQUIRED B Y LAW FOR NEW CONSTRUCTION Environmental Information UFFI Info Radon Lead Asbestos Information Financing Sellar Concession PUD Possession 30-60 60-90 OV-90 This Listing will expire 1 year from the date this document is signed by the seller. Unless otherwise stated. PUDC $ Immediate Annually Monthly Negotiable One Choice Required Directions **All Information Deemed Reliable But t Guaranteed** The undersigned REALTOR represents the he/she has a valid and legally enforceable exclusive agreement with the Owner. The undersigned Owner agrees that the above information on all pages is true and correct to the best of their knowledge and authorizes said REALTOR to submit this listing to the MLS. Owner Signature (Digital if filled in Online) REALTOR Signature (Digital if filled in Online) Alliance Realty NE, LLC Owner Name (print or type) Listing Office Name Owner Signature (Digital if filled in Online) Owner Name (print or type) Page 5 of 5