ILS Statement of Record - Wireframes - final

Interstate Land Sales (ILS)
Registration
Wireframes

Designed by
Naureen Ghani
Version 0.20
1

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PAPERWORK REDUCTION ACT

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OMB Control Number:
3170-0012 Expiration Date:
12/31/2018

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is
not required to respond to a collection of information unless it displays a valid OMB control number. The
OMB control number for this collection is 3170-0012. It expires on 06/30/2015. The time required to
complete this information collection is estimated to average approximately 20 minutes per response,
including the time for reviewing any instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. The obligation
to respond to this collection of information is mandatory (15 U.S.C. 1703-1704). Comments regarding this
collection of information, including the estimated response time, suggestions for improving the usefulness
of the information, or suggestions for reducing the burden to respond to this collection should be
submitted to Bureau at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street
NW, Washington, DC 20552, or by email to CFPB_Public_PRA@cfpb.gov.

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PRIVACY ACT STATEMENT

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Climate
• Additional Information
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OMB Control Number: 3170-0012
Expiration Date: 06/30/2015

The Bureau will not disclose any personally identifiable information collected except to the extent that it is
required to do so by law and as provided in the Privacy Act Statement listed below. Additionally, the
Bureau will treat the information collected consistent with its confidentiality regulations at 12 C.F.R. Part
1070, et seq.
The Privacy Act of 1974, as amended, 5 U.S.C. § 552a (the “Privacy Act”), governs the collection,
maintenance, use, and dissemination of certain information about “individuals” by agencies of the Federal
Government, including the CFPB. The Privacy Act applies only to information about individuals that exists
in an agency’s “system of records.” The Bureau publishes “System of Record Notices” or “SORNs” that
identify its system of records. You can view these SORNs, or read the full Privacy Act.
I hav e read, understand and accept the terms and conditions stated in the abov e statment.

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

SUBDIVISION PROFILE

The Developer Details will
be pre-populated.

Subdivision
Subdivision Number Subdivision Name
40001-01-2013

Test Subdivision

County/Parish/Borough

State

Middlesex

New Jersey

Developer
Company Name

Contact Person First Name

Test Developer

Joe

Doe

Address 2

Address 1
123 Test Lane

City

Suite 100

Zip

State

Sayreville

Phone

Contact Person Last Name

New Jersey

08872

Email Address

(732) 123-4567

Test@xyz.com

The information can be updated by accessing My Profile.

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
Property Report
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• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
• Additional Information
• Upload AID
 Amendment
 Annual Reporting
 Tasks/Notes

STATEMENT OF RECORD DISCLAIMERS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

(a) If the developer represents either orally or in writing that it will provide or complete roads or facilities for water, sewer,
gas, electricity or recreational amenities, it must be contractually obligated to do so (see § 1011.15(f)), and the obligation
shall be clearly stated in the Property Report. While the developer may disclose relevant facts about completion, the
obligation to complete cannot be conditioned, other than as provided for in § 1011.15(f), and an estimated completion
date (month and year) must be stated in the Property Report. However, a developer that has only tentative plans to
complete may so state in the Property Report, provided that the statement clearly identifies conditions to which the
completion of the facilities are subject and states that there are no guarantees the facilities will be completed.
(b) If a party other than the developer is responsible for providing or completing roads or facilities for water, sewer, gas,
electricity or recreational amenities, that entity shall be clearly identified in the Property Report under the categories
described in § 1010.110, § 1010.111 or § 1010.114, as applicable.

A statement shall be included in the proper section of the Property Report.
The ‘‘Date of This Report’’ is the date the Statement of Record becomes effective and is not populated until the
Property Report is approved and submission has become effective.
In this Property Report, the words ‘‘you’’ and ‘‘your’’ refer to the buyer. The words ‘‘we,’’ ‘‘us’’ and ‘‘our’’
refer to the developer.
Answers to questions and information about this subdivision may be obtained by telephoning the developer at the
number listed above.
All currency information in this property report is in US Dollars ($).

I have read, understand and accept the terms and conditions stated above in the Property Report.

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• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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Documentation (AID)
• Additional Information
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PURCHASER ENTITLEMENT

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario 1
Select Yes and no subsequent
questions will be displayed

Consumer Informational Message: The Federal revocation period is seven (7) days unless the purchaser is
entitled to a longer period by operation of state law.
Will the Deed be delivered within 180 days of signing the contract or agreement of sale?
Yes

No

Developer Informational Message: The deed must be a warranty deed, or where such a deed is not commonly used, a
similar deed legally acceptable in the jurisdiction where the lot is located. The deed must be free and clear of liens and
encumbrances.

Consumer Warning: Under Federal law you may cancel your contract or agreement of sale any
time within two years from the date of signing, if a deed is not delivered within 180 days of the
signing of the contract or if the necessary provisions are not included in the contract.

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Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
• Additional Information
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Scenario 2
Select No and then Yes, Yes,
Yes, and Yes for subsequent
PURCHASER ENTITLEMENT
questions
The Federal revocation period is seven (7) days unless the purchaser is entitled to a longer period by
operation of state law.
OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Will the Deed be delivered within 180 days of signing the contract or agreement of sale?
Yes

No

Are provisions included in the contractor agreement?
Yes

No

(A) A legally sufficient and recordable lot description?
Yes

No

(B) A provision that the seller will give the purchaser written notification of purchaser’s default or breach of contract and
the opportunity to have at least 20 days from the receipt of notice to correct the default or breach?
Yes

No

(C) A provision that, if the purchaser loses rights and interest in the lot because of the purchaser’s default or breach of
contract after 15% of the purchase price, exclusive of interest, has been paid, the seller shall refund to the purchaser any
amount which remains from the payments made after subtracting 15% of the purchase price, exclusive of interest, or the
amount of the seller’s actual damages, whichever is the greater.
Yes

No

Consumer Warning: Under Federal law you may cancel your contract or agreement of sale any
time within two years from the date of signing, if a deed is not delivered within 180 days of the
signing of the contract or if the necessary provisions are not included in the contract.

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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Documentation (AID)
• Additional Information
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RISKS OF BUYING LAND

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

(1) The future value of any land is uncertain and dependent upon many factors. DO NOT expect all land to
increase in value.
(2) Any value which your lot may have will be affected if the roads, utilities and all proposed improvements are
not completed. This paragraph may be omitted if all improvements have been completed or if no
improvements are proposed.
(3) Resale of your lot may be difficult or impossible, since you may face the competition of our own sales
program and local real estate brokers may not be interested in listing your lot.
(4) Any subdivision will have an impact on the surrounding environment. Whether or not the impact is adverse
and the degree of impact will depend on the location, size, planning and extent of development. Subdivisions
which adversely affect the environment may cause governmental agencies to impose restrictions on the use
of the land. Changes in plant and animal life, air and water quality and noise levels may affect your use and
enjoyment of your lot and your ability to sell it.
(5) In the purchase of real estate, many technical requirements must be met to assure that you receive proper
title. Since this purchase involves a major expenditure of money, it is recommended that you seek
professional advice before you obligate yourself.

Warnings

Throughout this Property Report there are specific warnings concerning the developer, the
subdivision or individual lots. Be sure to read all warnings carefully before signing any
contract or agreement.

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
• Additional Information
• Upload AID
 Amendment
 Annual Reporting
 Tasks/Notes

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

GENERAL INFORMATION

The Developer Details will be
pre-populated.

Subdivision Information
Subdivision Number Subdivision Name
40001-01-2013

Test Subdivision

Covered Lots
120

County/Parish/Borough

State

Middlesex

New Jersey

Proposed Lots
120

Developer Information
Developer Name
Test Developer

Address 2

Address 1
123 Test Lane

City

Suite 100

Zip

State

Sayreville

Phone
(732) 123-4567

New Jersey

08872

Email Address
Test@xyz.com

The information can be updated by accessing My Profile.

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SUBDIVISION INFORMATION

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Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

A person with legal title to property generally has the right to own, use and enjoy the property. A
contract to buy a lot may give you possession but doesn’t give you legal title. You won’t have legal
title until you receive a valid deed. A restriction or an encumbrance on your lot, or on the subdivision,
could adversely affect your title.
Here we will discuss the sales contract you will sign and the deed you will receive. We will also
provide you with information about any land use restrictions and encumbrances, mortgages, or liens
affecting your lot and some important facts about payments, recording, and title insurance.

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

TITLE TO THE PROPERTY AND LAND USE
METHOD OF SALE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario 1
Select Yes

Sales Contract and Delivery of Deed

Will the buyer sign a purchase money or installment contract or similar instrument in connection with the
purchase of the lot?
Yes

No

When will a deed be delivered?
180 days after the sale

Details can be found within 1010.109(b)(1)(i) 15 U.S.C. §1703(d)

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE
METHOD OF SALE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Sales Contract and Delivery of Deed

Is an Installment Contract being used?
Yes

Scenario 1
Select Yes and subsequent
questions will be displayed.
Select Yes for the first two and
no for rest

No

If you fail to make your payments required by the contract, you may lose your lot and all monies paid.
Will there be seller financing at the time of the Sale?
Yes

No

If, at the time of a credit sale, the developer gives the buyer a deed to the lot, what type of security must the
buyer give the seller?
Test information

Can the developer of the subdivision encumber the lots under contract?
Yes

No

Can the owner of the subdivision encumber the lots under contract?
Yes

No

Can the subdivision creditor encumber the lots under contract?
Yes

No

Consumer Warning: The (indicate subdivision developer, owner, or their creditors) can place a
mortgage on or encumber the lots in this subdivision after they are under contract. This may
cause you to lose your lot and any monies paid on it.

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SUBDIVISION LIST
SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE
METHOD OF SALE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Sales Contract and Delivery of Deed

Is an Installment Contract being used?
Yes

Scenario 2
Select Yes and subsequent
questions will be displayed.
Select Yes for the first and no
for next.

No

If you fail to make your payments required by the contract, you may lose your lot and all monies paid.
Will there be seller financing at the time of the Sale?
Yes
No
If, at the time of a credit sale, the developer gives the buyer a deed to the lot, what type of security must the
buyer give the seller?
Test information

Can the developer or the owner of the subdivision or their creditors encumber the lots under contract?
Yes

No

The lots are to be sold on the basis of an installment contract. However, the developer or the
owner of the subdivision or their creditors cannot encumber the lots under contract.

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SUBDIVISION LIST
SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE
METHOD OF SALE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Sales Contract and Delivery of Deed

Is an Installment Contract being used?
Yes

No

Scenario
Select No and Quitclaim is
selected. Select Yes for the Oil,
Gas and Mineral.

Type of Deed

What type of deed will be used to convey title to lots in the subdivision?
Warranty Deed
Quitclaim Deed
Other

Explain Other

The Quitclaim deed used to transfer title to lots in this subdivision gives you no assurance of
ownership of your lot.
Oil, Gas and Mineral Rights
Are Oil and Gas rights
reserved?
Yes

For Lots:

Lot # 1, 2,3

No

Are Mineral rights reserved?
Yes

No

The oil, gas, or mineral rights to Lot # 1,2,3 in this subdivision will not belong to the purchaser of those lots. The
exercise of these rights could affect the use, enjoyment and value of your lot.

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE
ENCUMBRANCES, MORTGAGES AND LIENS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

In General

Scenario
Select Yes and then select
or fill in any applicable
information

Are any of the lots or common facilities which serve the subdivision, other than recreation facilities subject to a blanket
encumbrance, mortgage or lien?
Yes

No

Identify the type of encumbrance?
Easements
Encroachments
Liens
Lis Pendens
Protective or Restrictive Covenants
Other

Identify the type of lien?

Explain Other:

Explain Other:

Trust Deeds and Mortgages
Mechanic's Liens
Judgments and Attachments
Tax Liens
Special Assessments
Other

Who is the holder of the lien?
Bank

What lots are covered by the lien?
1,2,3

Are any blanket encumbrance, mortgage or lien not current in accordance with its terms?
Yes
No
Explain:

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ENCUMBRANCES, MORTGAGES AND LIENS
Release Provisions

Scenario

Select or fill in applicable information
check for provision B and yes for the
questions. This also shows no provisions
message and will only be displayed if
selected

Explain the effect of any release provisions of any blanket encumbrance, mortgage or lien and select the appropriate
statements that pertain.
Test

Included Lots? All or provide the lot numbers.
(A) The release provisions for the (indicate all or particular lots mentioned above) have not been recorded. Therefore, they
may not be honored by subsequent holders of the mortgage. If they are not honored, you may not be able to obtain clear title
to a lot covered by this mortgage until we have paid the mortgage in full, even if you have paid the full purchase price of the
lot. If we should default on the mortgage prior to obtaining a release of your lot, you may lose your lot and all monies paid.
(B) The release provisions are recorded and the lot purchaser may pay the release price of the mortgage, supported by
documentation supplied in § 1010.209
Does the purchaser have to pay release fee?
Yes

No

What is the release fee?
100.00

The amount may be in addition to the contract payments unless there is a bona fide trust or escrow arrangement in which
the purchaser’s payments are set aside to pay the release price before any payments are made to the developer.
(C)There are no provisions in the blanket encumbrance for release of an individual purchaser’s lot from a blanket encumbrance.
The (type of encumbrance) on (indicate all or particular lots mentioned above) in this subdivision does not contain any
provisions for the release of an individual lot when the full purchase price of the lot has been paid. Therefore, if your lot
is subject to this (type of encumbrance), you may not be able to obtain clear title to your lot until we have paid the (type
of encumbrance) in full, even though you may have received a deed and paid the full purchase price of the lot. If we
should default on the (type of encumbrance) prior to obtaining a release, you may lose your lot and all monies paid.
Can the provisions for release of individual lots from the blanket encumbrance only be exercised by the developer?
Yes
No
The release provisions in the (type of encumbrance) on (indicate all or particular lots) in this subdivision may be exercised only by us. Therefore, if we
default on the (type of encumbrance) before obtaining a release of your lot, you may lose your lot and any money you have paid for it.

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE

Scenario
Select or fill in applicable
RECORDING THE CONTRACT AND DEED
information. Select no and no and
Method or Purpose of Recording
then Yes and Yes and select none
Is there any protection for recording of deeds and contracts for the lot purchaser in your jurisdiction?of the options.
Yes

No

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Explain Yes

Can the sales contract and deed be recorded?
Yes

No

Explain Yes

Who will be responsible to record the contact or deed?
Will the developer or subdivision owner have the sales contract officially acknowledged?
Yes

No

Explain No?

Will the applicable jurisdiction record sales contract?
Yes

No

Explain No?

Select if any of the following apply at or immediately after, the signing of a contract:
the contract or a deed transfer to the buyer is not recorded by the developer or owner
title to the lot is not otherwise transferred of record to a trust
other sufficient notice of transfer or sale is not placed of record

Consumer Warning: Unless your contract or deed is recorded you may lose your lot through the
claims of subsequent purchasers or subsequent creditors of anyone having an interest in the
land.

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Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PAYMENTS

Escrow

Scenario 1
Select Yes and provide the
necessary information

Are any purchasers’ deposits, down payments, or installment payments placed in a third party controlled escrow or
similar account?
Deposit
Down Payment
What
type
of
payment?
No
Yes
Installment Payments
Explain
The deposits given in connection with the execution of the sales contract will be held in a separate escrow account.

Escrow Holder Company

Escrow Holder Name

Escrow Holder Company

Address 2

Address 1

Suite 120

Test Drive 1

City

Zip

State
New Jersey

Parlin

08859

Prepayment
Are there any prepayment penalties or privileges?
Yes

No

Explain

Default
What are the developer’s or subdivision owner’s remedies against a defaulted purchaser?

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Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PAYMENTS

Escrow

Scenario 2
Select No and the warning
message will be provided

Are any purchasers’ deposits, down payments, or installment payments placed in a third party controlled escrow or
similar account?
Deposit
Down Payment
What
type
of
payment?
Yes
No
Installment Payments
You may lose your (indicate deposit, down payment and/or installment payments) on your lot if we fail to deliver
legal title to you as called for in the contract, because (they are/it is) not held in an escrow account which fully
protects you.

Prepayment
Are there any prepayment penalties or privileges?
Yes

No

Explain

Default
What are the developer’s or subdivision owner’s remedies against a defaulted purchaser?

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

TITLE TO THE PROPERTY AND LAND USE
PAYMENTS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Title Insurance

Scenario
Select No and informational
message will be displayed.

Is the Developer delivering a title insurance policy to the buyer?
Yes

No

The purchaser should obtain an attorney’s opinion of title or a title insurance policy which will describe the rights of
ownership which are being acquired in the lot. It is recommended that an appropriate professional should interpret
the opinion or policy.

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RESTRICTIONS ON THE USE OF YOUR LOT
Restrictive Covenants

Scenario
Select No and informational
message will be displayed.

Are there any restrictive covenants ?
Yes

No

Since there are no restrictive covenants on the use of the lots, they may be used for purposes which could adversely
affect the use and enjoyment of surrounding lots.

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

REPORTS
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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

REPORTS
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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RESTRICTIONS ON THE USE OF YOUR LOT
Restrictive Covenants

Scenario
Select Yes to all text messages
and appropriate informational
messages are displayed

Have any restrictive covenants been recorded against the land in the subdivision?
Yes

No

Do they contain items which require the purchaser to secure permissions, approvals or take any other action prior to
using or disposing of his lot (e.g., architectural control, developer’s right of first refusal, building deadlines, etc.)?
Yes

No

Explain the meaning and effect upon the purchaser of any of the restrictive covenants

Are there any restrictive covenant used that have not been recorded?
Yes

No

Explain how will they be imposed?

The restrictive covenants have not been recorded; that there is no assurance they will be applied uniformly; that
they may be changed and that they may be difficult to enforce.

A complete copy of these restrictions is available upon request.

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

REPORTS
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TITLE TO THE PROPERTY AND LAND USE
RESTRICTIONS ON THE USE OF YOUR LOT

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Easements

Scenario
Select Yes and Yes add
appropriate information and
click Add More Easements

Are there easements which may have an effect on the purchaser’s building or lot use plans (e.g., large drainage
easements along lot lines, high voltage electric transmission lines, pipe lines or drainage easements which encroach
upon the building area of the lot or inhibit its use)?
Yes

No

Type of Easement

Warning Text for the Easement

Identify easement affected Lots?

State the affect on use of the lots?

Add More Easements
Is the subdivision subject to any type of flood control or flowage easements?
Yes

No

Identify easement affected Lots?

State the affect on use of the lots?

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

REPORTS
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TITLE TO THE PROPERTY AND LAND USE
RESTRICTIONS ON THE USE OF YOUR LOT

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Easements

Scenario
To Add additional easements

Are there easements which may have an effect on the purchaser’s building or lot use plans (e.g., large drainage
easements along lot lines, high voltage electric transmission lines, pipe lines or drainage easements which encroach
upon the building area of the lot or inhibit its use)?
Yes

No

Type of Easement

Warning Text for the Easement

Identify easement affected Lots?

State the affect on use of the lots?

Type of Easement

Warning Text for the Easement

Identify easement affected Lots?

State the affect on use of the lots?

Add More Easements
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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Plats

Scenario 1
Select No and a warning message is
displayed

Have the subdivision plans and plats of specific units been approved by the regulatory authorities?
Yes

No

Regulatory authorities have not approved the proposed plats; that they may require
significant alterations before they will approve them and they may not allow the land to be
used for the purpose for which it is being sold.

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION LIST
SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

REPORTS
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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Plats

Scenario 2
Select Yes and then No and No

Have the subdivision plans and plats of specific units been approved by the regulatory authorities?
Yes

No

Have plats covering the lots in this Report been recorded?
Yes

No

Is the description of the lots given in this Report legally adequate for the conveyance of land in the jurisdiction where the
subdivision is located?
Yes

No

The description of the lots is not legally adequate for the conveyance of the lots and that it will not be until the plat
is recorded.

Link to Add Plat Maps

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Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Plats
Have the subdivision plans and plats of specific units been approved by the regulatory authorities?
Yes

No

Have plats covering the lots in this Report been recorded?
Yes

No

Where are they recorded?

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
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Scenario 3
Select Yes

Link to Add Plat Maps

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Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Zoning

Scenario 2
Select Yes and Yes

For what purpose may the lots be used (e.g., single family homes, camping, commercial)?
Single Family

Does this use conform to local zoning requirements and the restrictive covenants?
Yes

No

Explain

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Surveying

Scenario
Select Yes

Has each lot been surveyed and is each lot marked for identification?
Yes

No

State estimated cost to the purchaser

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Permits

Scenario
Select Yes and Yes

Does the purchaser need to obtain a building permit before beginning construction on his lot?
Yes

No

Where is the permit obtained?
Test Information

Are any other permits necessary to use the lot for the purpose for which it is sold or for construction in connection with
its use?
Yes

No

Explain
Test Information

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Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Environments

Scenario
Select Yes

Has there been any environmental impact study prepared which considers the effect of the subdivision on the
environment?
Yes

No

Do not know

Summarize any adverse conclusions
Adverse Conclusion Test

Refer to the proper State Clearinghouse for complete information.

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Environments

Scenario 2
Select Do not know

Has there been any environmental impact study prepared which considers the effect of the subdivision on the
environment?
Yes

No

Do not know

All inquiries should be made to the State or Area Clearinghouse.

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•
•

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SUBDIVISION INFORMATION

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Disclaimer

Property Report
• Disclaimer
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• General Information
• Title to the Property and Land Use
o
o
o
o
o
o

TITLE TO THE PROPERTY AND LAND USE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PLATS, ZONING, SURVEYING, PERMITS AND ENVIRONMENT
Environments

Scenario 3
Select No

Has there been any environmental impact study prepared which considers the effect of the subdivision on the
environment?
Yes

No

Do not know

No determination has been made as to the possible adverse effects the subdivision may have upon the environment
and surrounding area.

Method of Sale
Encumbrances, Mortgages and Liens
Recording the Contract and Deed
Payments
Restrictions on the Use of the Lot
Plats, Zoning, Surveying, Permits and
Environment

Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
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 Tasks/Notes
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Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
o
o

Access to the Subdivision
Access within the Subdivision

Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•

ROADS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ACCESS TO THE SUBDIVISION
Is access to the subdivision provided by public or private roads?
Public

Private

What type of surface do they have?

Explain Other:

Asphalt
Concrete
Composite Surfaces
Bituminous Surface
Gravel Surface
Other

How many lanes?

What is the width of the wearing surface?
15

2

Who is responsible for their maintenance?
Middlesex County

Is there cost to the purchaser?
Yes

No

Indicate Amount

Are any improvements contemplated?
Yes

Who will pay for it?

No

When will they begin?

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Scenario
Select Yes and Yes and fill in any
necessary information

When will they be completed?
(MM/YYYY)

(MM/YYYY)

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• General Information
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• Roads
o
o

Access to the Subdivision
Access within the Subdivision

Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•
•

Scenario
Yes , No and No and fill in
any necessary information

ROADS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018 Select

ACCESS WITHIN THE SUBDIVISION

How have legal and physical access by conventional automobile been or will they be, provided to the lots (e.g., road on
recorded easement; right of way dedicated to the public; right of way dedicated to use of lot owners)?
Right of way dedicated to use of lot owners

Who is responsible for the road construction?
Purchaser and Developer

Is there any construction cost to the purchaser?
Yes

No

Indicate Amount

Is there any financial assurance of completion?
Yes

No

No funds have been set aside in an escrow or trust account and there are no other financial
arrangements to assure completion of the roads.
How many lanes do the interior roads have?

Are there separate units or sections in the subdivision which will have
different completion dates or different surfaces.
Yes

Estimated staring date of construction
01/2013

(MM/YYYY)

The percentage of construction now complete?

No

Estimated completion date of construction
(MM/YYYY)

12/2013

Final road surface

5
Asphalt

Present road surface

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gravel

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• Roads
o
o

Access to the Subdivision
Access within the Subdivision

Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
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 Tasks/Notes
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Scenario
Yes , Yes and Yes and fill in
any necessary information

ROADS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018Select

ACCESS WITHIN THE SUBDIVISION

How have legal and physical access by conventional automobile been or will they be, provided to the lots (e.g., road on
recorded easement; right of way dedicated to the public; right of way dedicated to use of lot owners)?
Right of way dedicated to use of lot owners

Who is responsible for the road construction?
Purchaser and Developer

Is there any construction cost to the purchaser?
No

Yes

Indicate Amount

Is there any financial assurance of completion?
Yes

No

How many lanes do the interior roads have?

Are there separate units or sections in the subdivision which will have
different completion dates or different surfaces.

2

Yes

No

ROAD CHART
Unit

Estimated
starting date
(MM/YYYY)

1

01/2013

2

06/2013

Percentage of
construction
now complete

Estimated
completion date
(MM/YYYY)

Present Surface

5

05/2013

gravel

asphalt

12/2013

gravel

asphalt

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o
o

Access to the Subdivision
Access within the Subdivision

Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
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ROADS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ACCESS WITHIN THE SUBDIVISION

Scenario
Select Yes , and No and fill
necessary information

Are there arrangements for maintenance?
Yes

No

Who is responsible for road maintenance?
Public Authority

If the roads are to be maintained by a public authority, a property owners’ association or some other entity at some
time in the future, who is responsible for their maintenance during the interim period?
What is the cost to the purchaser during the interim
period?

What is the cost to the purchaser after acceptance for
permanent maintenance?

Will the roads be maintained so as to provide access to the lots on a year round basis?
Yes
No

Access may not be available year round.
Identify the months when access may not be available to lots

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• Roads
o
o

Access to the Subdivision
Access within the Subdivision

Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
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ROADS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ACCESS WITHIN THE SUBDIVISION

Scenario
Select No and fill necessary
information

Are there arrangements for maintenance?
Yes

No

Purchasers are responsible for maintaining the roads and that, if maintenance is not
performed, the roads may soon deteriorate and access may become difficult or impossible.

What is the estimated cost of construction to the purchaser?
1000

What is the estimated cost of maintenance to the purchaser?
50

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ROADS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ACCESS WITHIN THE SUBDIVISION

Scenario
Add necessary details

NEARBY COMMUNITIES CHART
Complete the Nearby Communities Chart by listing the county seat (identify) and at least two nearby communities.
Include at least one community of significant size which offers general services.
Nearby Communities

Population

Distance Over Paved
Roads
(in miles)

Distance over
Unpaved Roads
(in miles)

Total

Access to the Subdivision
Access within the Subdivision

Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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 Amendment
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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•

UTILITIES
WATER
How is water to be supplied to the individual lots ?
Central System

Scenario
Select Individual System
No, No and Yes

Individual System

Individual System
Indicate Type of Individual System?
Individual Private Well
Individual Cistern
Other Individual System

The purity and chemical content of the water cannot be determined until each individual well or source of water is
completed and tested.
What are the total estimated costs of the system, including but not limited to, the costs of installation, storage, any
treatment facilities and other necessary equipment?
Does the sales contract contains provisions for refund or exchange in the event a productive well cannot be installed?
Yes

No

There is no assurance a productive well can be installed and, if it cannot, no refund of the purchase price of the lot
will be made.
Are any hydrological surveys in connection with the use of individual wells or sources of hauled water for cisterns
Yes

No

There is no assurance of a sufficient supply of water for the anticipated population.
Is a permit required to install the individual system to be used?
Yes

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

No

From whom and where is the permit secured?
Cost of Permit

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o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
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• Certification
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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER
How is water to be supplied to the individual lots ?
Central System

Scenario
Select Individual System
No and Yes

Individual System

Individual System

Indicate Type of Individual System?
Individual Private Well
Individual Cistern
Other Individual System

The purity and chemical content of the water cannot be determined until each individual well or source of water is
completed and tested.
What are the total estimated costs of the system, including but not limited to, the costs of installation, storage, any
treatment facilities and other necessary equipment?
Where will the water to fill the individual Cistern be secured?

Delivery costs for a supply sufficient to serve the monthly needs of a family of four
living in a house on a year-round basis

Cost of Water

Water stored for extended periods tends to become stale and may acquire an unpleasant taste or odor.
Are any hydrological surveys in connection with the use of individual wells or sources of hauled water for cisterns
Yes
No

There is no assurance of a sufficient supply of water for the anticipated population.
Is a permit required to install the individual system to be used?
Yes

No

From whom and where is the permit secured?
Cost of Permit

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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER
How is water to be supplied to the individual lots ?
Central System

Who is the supplier?
Developer
Affiliate
Subsidiary
Other

Scenario
Central System
Select Developer, No

Individual System

Central System
Explain Other
Is the operation of the entity supervised or regulated by a governmental agency?
Yes

No

Supplier Name
Address 1
City

Address 2
State

Zip

Phone

Neither the operation of the water system nor the rates are regulated by a public authority.

We do not own or operate the central water system so we cannot assure its continued
availability for your use.

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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER
How is water to be supplied to the individual lots ?
Central System

Who is the supplier?
Developer
Affiliate
Subsidiary
Other

Supplier Name

Scenario
Central System
Select Other, Yes and No

Individual System

Central System
Explain Other
Is the operation of the entity supervised by a governmental agency?
Yes
No
Is the supplier of water a governmental agency?

Yes

No

Test Supplier

Address 1

Address 2

Test Lane 1

City
Sayreville

State

Zip

New Jersey

Phone

08859

Where will the water mains be extended for each lot?
In front of
Adjacent to

Are there are separate units or sections of the subdivision included in the Statement of Record which have different
completion dates?
Yes
No
When will the construction begin?
MM/YYYY
What is the present percentage of completion of the water mains and central supply plant?
When will service be available to the individual lots?

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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER
How is water to be supplied to the individual lots ?
Central System

Individual System

Central System

Who is the supplier?
Developer
Affiliate
Subsidiary
Other

Supplier Name

Explain Other
Is the operation of the entity supervised by a governmental agency?
Yes

No

Address 2

Address 1
City

Scenario
Central System
Select Other, Yes and Yes

State

Phone

Zip

Where will the water mains be extended for each lot?
In front of
Adjacent to

Are there are separate units or sections of the subdivision included in the Statement of Record which have different
completion dates?
Yes
No
WATER CHART
Unit

Estimated starting date
(MM/YYYY)

Percentage of construction
now complete

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Estimated service availability
date (MM/YYYY)

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o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Scenario
Central System
Select No and Yes

Central System

What is the present capacity of the central plant (i.e., how many connections can be supplied)?
Is the capacity sufficient to serve all lots in the Statement of Record?
No
Yes
List of limitations

Number of lots

List of (limitations) . (indicate number of lots) in this subdivision which can currently be served.
Does it require expansion in phases?
Yes

No

Indicate the timetable for each phase to be in service and what will trigger beginning of the expansion for each phase?
WATER CHART
Phase

Trigger for Expansion

Estimated Start of Phase

Estimated End of Phase

Add More
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• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Central System

Scenario
Central System
Yes, No and No or just No for the
first question`

Have there been any hydrological surveys to determine that a sufficient source of water is available to serve the
anticipated population of the subdivision?
Yes

No

Has the water in the central system been tested for purity and chemical content?
Yes

No

Did the results show that the water meets all standards for a public water supply?
Yes

No

There is no assurance of a sufficient supply or that the water is drinkable.

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o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
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
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UTILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Central System

Scenario
Central System,
No and No

Is there any financial assurance of completion of the central system and any future expansion?
Yes

No

Explain

No funds have been set aside in an escrow or trust account nor have any other financial
arrangements been made to assure completion of the water system.
If the developer or an affiliate or subsidiary of the developer operates the central system, have all permits been
obtained from the proper agencies for the construction, use and operation of the central system?
Yes

No

Explain

No funds have been set aside in an escrow or trust account nor have any other financial
arrangements been made to assure completion of the water system.

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o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
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
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Central System

Scenario
Central System
Yes, & Yes

Is the purchaser to pay any construction costs, one-time connection fees, availability fees, special assessments or
deposits for the central system?
No
Yes
Type of Cost
Construction Costs
One-time Connection Fees
Availability Fees
Special Assessment Fees
Deposits

Fees

Add More Fees

Is the purchaser responsible for construction costs of the water mains,?
Yes

No

State the cost to install the mains to the most remote lot covered by this report.

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• Roads
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o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
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
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Central System

Scenario
Central System
No, Yes, Yes, No, and No

Is the purchaser to pay any construction costs, one-time connection fees, availability fees, special assessments or
deposits for the central system?
Yes

No

There are no charges other than use fees.
If a purchaser wishes to use a lot prior to the date central water is available to it, may the purchaser install an individual
system?
Yes

No

Include the information required for individual systems by clicking here.

Add Individual Systems
Information

Will the purchaser be required to discontinue use of any individual system and connect to the central system when
service is available to the lot?
Yes

No

Is the purchaser not required to connect to the central system?
Yes

No

Must any construction costs, connection fees, availability fees, special assessments or deposits in connection with
the central system still be paid?
Yes

No

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Central System

Scenario
Central System
No, No Yes, & Yes

Is the purchaser to pay any construction costs, one-time connection fees, availability fees, special assessments or
deposits for the central system?
Yes

No

There are no charges other than use fees.
If a purchaser wishes to use a lot prior to the date central water is available to it, may the purchaser install an individual
system?
Yes

No

Water will not be available until the central system is extended to the lot.
If connection to the system is voluntary and not all purchasers elect to use the system, will the cost to those who do
use the system be increased?
Yes

No

Connection to the central system is voluntary and those who use the system may have to pay
a disproportionate share of the cost of the system and its operation.
Is the developer constructing the system but will later turn it over to a property owners’ association for operation
and maintenance?
Yes

No

Will it be conveyed free and clear of any encumbrance?

State the estimated date of the conveyance

Yes

No

State conditions of the conveyance

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
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•
•
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

WATER

Central System

Scenario
Central System
Yes, No, Yes, Yes, Yes,

Is the purchaser to pay any construction costs, one-time connection fees, availability fees, special assessments or
deposits for the central system?
No
Yes

There are no charges other than use fees.
If a purchaser wishes to use a lot prior to the date central water is available to it, may the purchaser install an individual
system?
Yes

No

Water will not be available until the central system is extended to the lot.
If connection to the system is voluntary and not all purchasers elect to use the system, will the cost to those who do
use the system be increased?
Yes

No

Connection to the central system is voluntary and those who use the system may have to pay
a disproportionate share of the cost of the system and its operation.
Is the developer constructing the system but will later turn it over to a property owners’ association for operation and
maintenance?
Will it be conveyed free and clear of any encumbrance?
No
Yes
Yes
No
State the estimated date of the conveyance

State conditions of the conveyance

Is there a charge or if the association must assume an encumbrance?
Yes
No
State the estimated amount of either

State terms for retirement of either obligation.

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• Roads
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o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ELECTRICITY

Will electric service be provided to the subdivision?

Yes

Scenario
Yes, No, and Yes

No

Who will provide electrical services to the subdivision?

Supplier Name

Address 2

Address 1
City

State

Phone

Zip

Have primary electrical service lines been extended in front of, or adjacent to, all of the lots?
Yes

No

When will the construction begin?

When will service be available?
MM/YYYY

MM/YYYY
Under what conditions will construction begin?

Who is responsible for their construction?
Are there separate units or sections having different service availability dates?
Yes

No

ELECTRICITY CHART
Unit
Estimated starting date
(MM/YYYY)

Percentage of construction
now complete

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date (MM/YYYY)

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• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
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Expiration Date: 12/31/2018

ELECTRICITY

Scenario
No, and No

Is construction of the lines or service to the ultimate consumer provided by an entity other than a publicly regulated
utility?
No
Yes
Supplier Name
Who provides, or will provide, the service?

Address 1

Address 2
State

City

Zip

Phone

Who will be responsible for maintenance?

What is the assurance of completion?

What charges or assessments will the purchaser pay?

If the primary service lines have not been extended in front of, or adjacent to each lot, will the purchaser be
responsible for any construction costs?
Yes

No

What is the utility company’s policy and charges for extension of primary lines?

Based on that policy, what would be the cost to the purchaser for extending primary service to the most remote lot in
this Report?

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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ELECTRICITY

Will electric service be provided to the subdivision?

Yes

Scenario
No, No and No

No

What is an alternate source (e.g., generators, etc.)

What are the estimated costs?

Are the lines to be installed by some entity other than a publicly regulated utility?
Yes

No

Is there any financial assurance?
Yes

No

No funds have been set aside in an escrow or trust account nor have any other financial
arrangements been made to assure construction of the electric lines.

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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

TELEPHONE

Is telephone service now, or will it be, available?

Yes

Scenario
Yes, No and No

No

Who will furnish the service?

Supplier Name

Address 2

Address 1
City

State

Phone

Zip

Have the service lines been extended in front of, or adjacent to, each of the lots?
Yes

No

Will the purchaser be responsible for any construction costs?
Yes

No

When will the construction begin?

When will service be available?

MM/YYYY

MM/YYYY

Under what conditions will construction begin?

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• General Information
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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes
•
•
•
•

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

TELEPHONE

Is telephone service now, or will it be, available?
Who will furnish the service?

Yes

Scenario
Yes, No and Yes

No

Supplier Name

Address 2

Address 1
City

State

Phone

Zip

Have the service lines been extended in front of, or adjacent to, each of the lots?
Yes

No

Will the purchaser be responsible for any construction costs?
Yes

No

What is the utility company’s policy and charges for
extension of service lines?

Based on that policy, what would be the cost to the purchaser of extending service lines to the most remote lot
in this Report?

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• Roads
• Utilities
o
o
o
o
o

Water
Sewer
Electricity
Telephone
Fuel or Other Energy Sources

Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
 Annual Reporting
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

FUEL OR OTHER ENERGY SOURCES

Scenario
Add appropriate data

What fuel, or other energy source, will be available for heating, cooking, etc. in the subdivision?
Electricity
Natural Gas
Propane Gas
Oil
Other

Explain Other

Describe the availability of the fuel or other energy source?

Supplier Name
Address 1
City

Address 2
State

Phone

Zip

If the fuel is natural gas, when will the mains be installed to the lots?

What is the cost to the purchaser for installation fees and connection fees?
Installation Fees

Connection Fees

If oil or propane gas will be used, include the cost of a storage tank.

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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes

FINANICAL INFORMATION

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Yes and no option selected

Has the developer had a deficit in retained earnings or experienced an operating loss during the last fiscal year or, if
less than a year old, since its formation?
Yes

No

Select one of the following.
(1) All facilities, utilities and amenities proposed to be completed by the developer in the Property Report and
sales contract have been completed so that the lots included in the Statement of Record are immediately usable
for the purpose for which they are sold
(2) The developer is contractually obligated to the purchaser to complete all facilities, utilities and amenities
promised by it in the Statement of Record.
Select all that apply.
(i)The developer has made financial arrangements, such as the posting of surety bonds (corporate or individual notes
or bonds are not acceptable), irrevocable letters of credit, escrow or trust accounts, to assure that the facilities,
utilities and amenities will be completed by the dates set out in the Property Report or contract.
(ii)The sales contract provides for delivery of a deed within 180 days of the signing of the contract which conveys title
free of any mortgage or lien, or the developer has filed an assurance of title agreement with ILSRP as outlined in §
1010.212(e)
(iii) Any down payments or deposits are held in an escrow or trust account.

This may affect the developer’s ability to complete promised facilities and to discharge
financial obligations.
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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
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
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 Amendment
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Are the developer’s financial statements audited?
Yes

Scenario
Yes and Decline to give an
opinion

No

Did the accountant qualify the opinion or decline to give an opinion?
Qualify the opinion

Decline to give an opinion

Explain

A copy of our current financial available at the CFPB ILS website by clicking on the link below.
Link to Financials

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

FIRE PROTECTION

Scenario
Add necessary information

Describe the availability of fire protection.

Fire Department
Address 1

City

Address 2

State

Zip

Phone

Availability (indicate if year round)

Distance in Miles

Any Other Details

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• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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 Amendment
 Annual Reporting
 Tasks/Notes

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

POLICE PROTECTION

Scenario
Add necessary information

Describe the availability of police protection.

Police Department
Address 1

City

Address 2

State

Zip

Phone

Availability

Distance in Miles

Any Other Details

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• Local Services
o
o
o
o
o
o
o
o

LOCAL SERVICES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

SCHOOLS

Scenario
Add necessary information,
Yes

Select if elementary, junior high and senior high schools are available to residents of the subdivision.
Elementary High School

Junior HIgh School

Senior High School

Is school bus transportation available at the subdivision?
Yes

No

Any Other Details

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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 Amendment
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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

LOCAL SERVICES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

HOSPITAL

Scenario
Add necessary information,
Yes

Provide name and location of the nearest hospital.

Hospital Name
Location

Is ambulance service available?
Yes

No

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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 Amendment
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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

LOCAL SERVICES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PHYICIANS AND DENTISTS

Scenario
Add necessary information

Provide name and location of the nearest Physician and Dentist

Physician
Location

Dentist

Location

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

LOCAL SERVICES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

SHOPPING FACILITIES

Scenario
Add necessary information

Provide location of the nearest shopping facilities

Shopping Center Location

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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• Roads
• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

LOCAL SERVICES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

MAIL SERVICE

Scenario
Add necessary information, Yes

Is Mail Service available to the subdivision?
Yes

No

Describe the arrangements the purchasers must make to receive mail service.

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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• Roads
• Utilities
• Financial Information
• Local Services
o
o
o
o
o
o
o
o

LOCAL SERVICES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PUBLIC TRANSPORTATION

Scenario
Add necessary information, Yes

Is there public transportation available in the subdivision or to nearby towns?
Yes

No

Give the location of the nearest public transportation and the distance from the subdivision.

Distance in Miles

Fire Protection
Police Protection
Schools
Hospital
Physicians and Dentists
Shopping Facilities
Mail Service
Public Transportation

• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
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
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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
o
o

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
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 Amendment
 Annual Reporting
 Tasks/Notes

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RECREATIONAL FACILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITIES TO BE COVERED

Scenario
Check all that apply

Recreational facilities information shall be provided if any of the following is applicable. Select all that apply.
(1) The developer is contractually responsible to provide or complete recreational facilities which are:
(i) Within, adjacent or contiguous to the subdivision
(ii) Maintained substantially for the use of lot owners
(2) Third party is responsible to provide or complete recreational facilities which are:
(i) Within, adjacent or contiguous to the subdivision
(ii) Maintained substantially for the use of lot owners

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o
o

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
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RECREATIONAL FACILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITY CHART DETAILS

Scenario
Enter the Information in the
table

Recreational facilities information should be provided in the below chart based on the details mentioned.
(1) Facility - Identify each recreational facility. Identify closely related facilities (e.g., swimming pool and bathhouse) separately only if
their availability dates differ.
(2) Percent of construction now complete - State the present percentage of completion of construction for each recreational facility.
(3) Estimated date of start of construction - Insert the estimated date of the start of construction for the facility (month and year).
(4) Estimated date available for use - If the construction of the facility is not complete or if it is not available to lot owners for its intended
use, indicate the estimated date (month and year) that the facility will be available for use. If the ‘‘estimated date available for use’’
for any facility has been amended to delay it to a later date, indicate such delay in a statement immediately below the chart.
Underline the response. This statement shall include the name of the facility and the prior estimated availability date, and it shall be
referenced to the appropriate facility listed on the chart by use of an asterisk or other appropriate symbol. If a facility is 100 percent
completed and in use, no date is needed.
(5) Financial assurance of completion - If the construction of the facility is not complete, state whether there is any financial assurance of
completion. If none, state ‘‘none.’’ If such exists, state the type of assurance (i.e., bond, escrow, or trust). If no documentation for such
assurance has been provided in § 1010.214 of the Statement of Record, then do not indicate such assurance on the chart, but in place
of such assurance on the chart state ‘‘none.’’
(6) Buyer’s annual cost or assessments -State the lot buyer’s annual cost or assessments for using the facility. These costs should include
any applicable property owners’ association assessment, and the developer’s maintenance assessment. If the cost information is
lengthy, you may use an asterisk or other appropriate symbol and include the cost information in a paragraph below the chart.

RECREATIONAL FACILITY CHART
Facility

Percentage
of
construction
now
complete

Estimated date
of start of
construction
(MM/YYYY)

Estimated
date available
for use
(MM/YYYY)

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Financial
assurance of
completion

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Buyer’s annual
cost or
assessments

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• Roads
• Utilities
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• Local Services
• Recreational Facilities
o
o

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITY DETAILS

Scenario
No, Yes, No

Constructing the facilities
Are the facilities complete?
Yes

No

Who is responsible for the construction of the facilities?

Is the purchaser required to pay any of the cost of construction of these facilities?
Yes

No

Estimate and disclose such cost

Maintaining the facilities
Who is responsible for the operation and maintenance of these facilities?

Facilities which will be leased to lot purchasers
Are any of the facilities covered here will be leased to a Property Owners’ Association or other lot owners in the
subject subdivision?
Yes

No

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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
o
o

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITY DETAILS

Scenario
Yes, Yes, Yes, Yes, Yes, Yes

Facilities which will be leased to lot purchasers
Are any of the facilities covered here will be leased to a Property Owners’ Association or other lot owners in the subject
subdivision?
Yes

No

Indicate term of lease

State which facilities are or will be leased

Will the lot owners have an opportunity to terminate or ratify the lease after control of the Property Owners’ Association is
turned over to them?
Yes

No

Does the owner of a recreational facility leased to the Property Owners’ Association or other lot owners encumber it?
No
Yes
Does the holders of such encumbrances acquire the leased facilities and not honor the lease?
Yes
No
Are the lease payments increased on an escalating or other basis?
No
Yes

What costs or expenses, if any, will be borne by the owner?
Can the lease can be assigned or sublet.
Yes

No

Explain

State how the lease can be terminated

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• Roads
• Utilities
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• Local Services
• Recreational Facilities
o
o

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes

RECREATIONAL FACILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITY DETAILS

Scenario
Yes, Yes, No

Transfer of the facilities
Are there presently any liens or mortgages on any of these recreational facilities?
Yes
No
Describe such liens or mortgages

Do the developer, or owner of the subdivision, their principals, or subsidiaries, intend to transfer the title of a listed
recreational facility in the future?
Yes

No

Explain when the title transfer of a listed recreational facility will happen

To whom will the transfer be made

Type of conveyance

Disclose any adverse effects on, or cost to, lot purchasers which may be caused by such transfer.
If any facility is to be transferred to lot owners as a Property Owners’ Association or otherwise, will the facility be
transferred free and clear of all liens and encumbrances?
Yes

No

State the amount of the encumbrance to be assumed
Disclose any contractual conditions on such transfer which relate to lot purchasers

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
o
o

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

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Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes

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RECREATIONAL FACILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITY DETAILS

Scenario
No

Permits
Are the necessary permits been obtained for the construction and/or use of the facilities?
Yes

No

Identify the permit or license

Identify the facilities for which such permits have not been obtained

The (identify the permit or license) has not been obtained and therefore there is no assurance
that the lot owners will be able to use the (identify the facility).

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• Local Services
• Recreational Facilities
o
o

RECREATIONAL FACILITIES

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RECREATIONAL FACILITY DETAILS

Scenario
General Public Scenario

Who may use the facilities
Indicate who will be permitted to use the recreational facilities (e.g., lot owners, their guests, employees of developer,
general public)
Lot owners
Lot owner guests
Employees of developer
General public
Other

Explain Other

Identify the facilities open to use by the general public

Recreational Facilities to be Covered
Recreational Facility Chart/Details

• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
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
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The (identify the facility) is open to use by the general public and their use of the facility may
limit use of it by lot owners.

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
•
•
•
•

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SUBDIVISION CHARACTERISTICS
AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Yes, and Yes

GENERAL TOPOGRAPHY
What is the general topography and the major physical characteristics of the land in the subdivision?

State the percentage of the subdivision which is to remain as natural open space and as developed parkland.

Are there any steep slopes, rock outcroppings, unstable or expansive soil conditions, etc., which will necessitate the use
of special construction techniques to build on, or use, any lot in the subdivision?
Yes
No
Identify the lots affected

Describe the techniques recommended

Do any lots in the subdivision have a slope of 20%, or more?
Yes

No

Some lots in this subdivision have a slope of 20%, or more. This may affect the type and cost of
construction.

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

SUBDIVISION CHARACTERISTICS AND
CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Yes and complete necessary
details

WATER COVERAGE
Are any lots, or portions of any lots, covered by water at any time?

What lots are affected?
When are they covered by water?

How does this affect their use for the purpose for which they are sold?
Can the condition be corrected?
Yes

No

At what cost to the purchaser?

Additional Information
Cost Sheet
E-Sign
Certification

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Documentation (AID)
 Amendment
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•
•
•
•

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

SUBDIVISION CHARACTERISTICS
AND CLIMATE

Scenario
Yes and complete any necessary
information

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

DRAINAGE AND FILL

Identify the lots which require draining or fill prior to being used for the purpose for which they are being sold

Who will be responsible for any corrective action?

Is the purchaser responsible?
Yes

No

What is the estimated costs?

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
•
•
•
•

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• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

FLOOD PLAIN

Scenario
Yes, Yes and Yes and fill any
necessary information

Is the subdivision located within a flood plain or an area designated by any Federal, state or local agency as being flood prone?
Yes

No

What lots are affected?
Is flood insurance available?
Yes

No

Is it required in connection with the financing of any improvements to the lot?
Yes

No

Explain

What is the estimated cost of the flood insurance?

Additional Information
Cost Sheet
E-Sign
Certification

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Documentation (AID)
 Amendment
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•
•
•

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• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
•
•
•
•

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SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

FLOODING AND SOIL EROSION

Scenario
Yes , Yes , Yes and Yes

Does the developer have a program which provides, or will provide, at least minimum controls for soil erosion, sedimentation
or periodic flooding throughout the subdivision?
Yes

No

Describe the program
Are the program approved by the appropriate government officials?
Yes

No

Program Start Date

Program Completion Date
MM/YYYY

MM/YYYY

Is the developer obligated to comply with the program?
Yes

No

Is there any financial assurance of completion?
Yes

No

Explain

A minimum program will usually provide for: (i) Temporary measures such as mulching and
seeding of exposed areas and silt basins to trap sediments in runoff water, and (ii) Permanent
measures such as sodding and seeding in areas of heavy grading or cut and fill along with the
construction of diversion channels, ditches, outlet channels, waterway stabilizers and sediment
control basins.
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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
Documentation (AID)
 Amendment
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•
•
•
•

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SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

FLOODING AND SOIL EROSION

Scenario
Yes , No and No or just No for
the first

Does the developer have a program which provides, or will provide, at least minimum controls for soil erosion, sedimentation
or periodic flooding throughout the subdivision?
Yes

No

Describe the program
Are the program approved by the appropriate government officials?
Yes

No

Program Start Date

Program Completion Date
MM/YYYY

MM/YYYY

Is the developer obligated to comply with the program?
Yes

No

Is there any financial assurance of completion?
Yes

No

The measures being taken may not be sufficient to prevent property damage or health and
safety hazards.

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

NUISANCES

Scenario
Yes

Are there any land uses which may adversely affect the subdivision?
Yes

No

Type of Nuisances
Unusual or unpleasant noises
Unusual or unpleasant odors
Pollutants
Existing or proposed industrial
Activity
Military installations
Airports
Railroads
Truck terminals
Race tracks
Animal pens
Noxious smoke
Chemical fumes
Stagnant ponds
Marshes
Slaughterhouses
Sewage treatment facilities
Other

Explain Other
Describe Nuisance

Add More

Additional Information
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E-Sign
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•
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•

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• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

NUISANCES

Scenario
No

Are there any land uses which may adversely affect the subdivision?
Yes

No

There are no nuisances which affect the subdivision.

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
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 Amendment
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•
•
•

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

HAZARDS

Scenario
Yes , and Yes

Are there any unusual safety factors which affect the subdivision ?
Yes

No

Type of unusual safety factors
Explain Other

Dilapidated buildings
Abandoned mines
Abandoned wells,
Air or vehicular traffic hazards
Danger from fire or explosion
Radiation hazards
Other

Is the developer aware of any proposed plans for construction which may create a nuisance or safety hazard or adversely
affect the subdivision?
Yes

No

Describe the hazard or nuisance

•
•
•
•

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The measures being taken may not be sufficient to prevent property damage or health and
safety hazards.

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• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

HAZARDS

Scenario
No and No

Are there any unusual safety factors which affect the subdivision ?
Yes

No

Is the developer aware of any proposed plans for construction which may create a nuisance or safety hazard or adversely
affect the subdivision?
Yes

No

There are no unusual safety factors.

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
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
Additional Information &
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•
•
•

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
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• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

HAZARDS

Scenario
Yes

Is the area subject to natural hazards or has it been formally identified by any Federal, state or local agency as an area subject
to the frequent occurrence of natural hazards ?
Yes

No

Type of unusual safety factors
Tornadoes
Hurricanes
Earthquakes
Mudslides,
Forest fires
Brush fires
Avalanches
Flash flooding
Other

Explain Other

Please describe the natural hazards that frequently occur in the area.

If the jurisdiction in which the subdivision is located has a rating system for fire hazard, state the rating assigned to
the land in the subdivision and explain its meaning.

Additional Information
Cost Sheet
E-Sign
Certification

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 Amendment
 Annual Reporting
•
•
•
•

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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

SUBDIVISION CHARACTERISTICS AND CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

CLIMATE

Scenario
Enter Information

What are the average temperature ranges, summer and winter, for the area in which the subdivision is located ?
Season

Month

High
(Degrees Fahrenheit)

Low
(Degrees Fahrenheit)

Mean
(Degrees Fahrenheit)

Summer
Winter

What is the average annual rainfall ?
inches
What is the average annual snowfall?
inches

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
•
•
•
•

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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
o
o
o
o
o
o
o
o
o

SUBDIVISION CHARACTERISTICS AND
CLIMATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Enter required data

OCCUPANCY
How many homes are occupied on a full- or part-time basis as of (date of submission)?
Number of Homes
As of Date (MM/DD/YYYYY)

General Typography
Water Coverage
Drainage and Fill
Flood Plain
Flooding and Soil Erosion
Nuisances
Hazards
Climate
Occupancy

Additional Information
Cost Sheet
E-Sign
Certification

Additional Information &
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 Amendment
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•
•
•
•

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• General Information
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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

ADDITIONAL INFORMATION

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PROPERTY OWNERS’ ASSOCIATION

Scenario
Yes , No

Will there be a property owners’ association for the subdivision?
Yes

No

Has it been formed?
Yes

When will it be formed?

No

Who is responsible for its formation?

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
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• Roads
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• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
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
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PROPERTY OWNERS’ ASSOCIATION

Scenario
Yes , Yes , Yes, Yes. , No, Yes,
and Yes

Will there be a property owners’ association for the subdivision?
Yes

No

Has it been formed?
Yes

What is its name?

No

Is it operating?
Yes

No

Does the developer exercise, or have the right to exercise, any control over the Association because of voting rights
or placement of officers or directors?
Yes

No

For how long will this control last?

Is membership in the association voluntary?
Yes

No

What are the association dues?
Can they be increased?
Yes

No

Are members subject to special assessments?
Yes

For what purpose?

No

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• Roads
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• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PROPERTY OWNERS’ ASSOCIATION

Scenario
Yes , Yes , Yes, Yes. , Yes, Yes,
Yes and Yes

Will there be a property owners’ association for the subdivision?
Yes

No

Has it been formed?
Yes

What is its name?

No

Is it operating?
Yes

No

Does the developer exercise, or have the right to exercise, any control over the Association because of voting rights
or placement of officers or directors?
Yes

No

For how long will this control last?

Is membership in the association voluntary?
Yes

No

Since membership in the association is voluntary, you may be required to pay a disproportionate
share of the association costs or it may not be able to carry out its responsibilities.
Will non-member lot owners be subject to the payment of dues or assessments?
Yes
No
What are the association dues?

Can they be increased?
Yes

No

Are members subject to special assessments?
Yes

For what purpose?

No

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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
• Certification

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

PROPERTY OWNERS’ ASSOCIATION

Scenario
Yes , Yes , Yes, and No

What are the functions and responsibilities of the association?

Will the association hold architectural control over the subdivision?
Yes

No

Are there any functions or services that the developer now provides at no charge for which the association may be
required to assume responsibility in the future?
Yes

No

Will an increase in assessments or fees be necessary to continue these functions or services?
Yes

No

Does the current level of assessments, fees, charges or other income provide the capability for the association to
meet its present, or planned, financial obligations including operating costs, maintenance and repair costs and
reserves for replacement?
Yes

No

How will any deficit be made up?

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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
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
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

TAXES

Scenario
Yes

When will the purchaser’s obligation to pay taxes begin?

To whom are the taxes paid?
Developer
Other

Explain Other

Should we not forward the tax funds to the proper authorities, a tax lien may be placed against
your lot.
What are the annual taxes on an unimproved lot after the sale to a purchaser?

Is the subdivision encompassed within a special improvement district or is a special district proposed?
Yes
No
Describe the purpose of the district

State the amount of assessments

Describe the purchaser’s obligation to retire the debt.

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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
• Certification

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ADDITIONAL INFORMATION

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

VIOLATIONS AND LITIGATIONS

Scenario
Yes, No, No, No, and Yes

With respect to activities relating to or in violation of a Federal, state or local law concerned with the environment, land sales,
securities sales, construction or sale of homes or home improvements, consumer fraud or similar activity, has the developer,
the owner of the land or any of their principals, officers, directors, parent corporation, subsidiaries or an entity in which any of
them hold a 10% or more financial interest, been
(i) Disciplined, debarred or suspended by any governmental agency, or is there now pending against them an action which
could result in their being disciplined, debarred or suspended
Provide a brief description of the action and its present status or disposition shall be given.
Yes
No
(ii) Convicted by any court, or is there now pending against them any criminal proceedings in any court?
Yes

No

Has the developer, the owner of the land, any principal, any person holding a 10% or more financial or ownership interest
in either, or any officer or director of either, filed a petition in bankruptcy?
Yes

No

Has an involuntary petition in bankruptcy been filed against it or them or have they been an officer or director of a
company which became insolvent or was involved, as a debtor, in any proceedings under the Bankruptcy Act during the
last 13 years?
Yes

No

Is the developer or any of its principals, any parent corporation or subsidiary, any officer or director a party to any litigation
which may have a material adverse impact upon its financial condition or its ability to transfer title to a purchaser or to
complete promised facilities?
Yes

No

Describes the possible effects which the action may have upon the subdivision

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• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
• Certification

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

RESALE AND EXCHANGE PROGRAM

Scenario
Yes, No, Yes and Yes

Are there restrictions which might hinder lot owners in the resale of their lots ?
Yes

No

Restriction Types
A prohibition against posting signs
Limitations on access to the subdivision by outside
brokers or prospective buyers
The developer’s right of first refusal
Membership requirements
Other

Explain Other

Briefly explain the restrictions

Does the developer have an active resale program?
Yes

No

We have no program to assist you in the sale of your lot.
Does the developer have a lot exchange program?
Yes

No

Describe the program

State any conditions

Does the program reserves a sufficient number of lots to accommodate all those wishing to participate.?
Yes

No

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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
• Certification

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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

UNUSUAL SITUATIONS

Scenario
Yes, Yes, Yes, Yes, Yes, and Yes

Leases

Are leases applicable to this subdivision?
Yes

No

What is the term of the lease?

Is it renewable?
Yes

No

Is it recordable?
Yes

No

Can creditors of the developer, or owner, acquire title to the property without any obligation to honor the terms of the
lease?
Yes

No

Are the lease payments a flat sum or are they graduated?

Can the lessee mortgage or otherwise encumber the leasehold?
Yes

No

Will the lessee be permitted to remove any improvements which have been installed when the lease expires or is
terminated?
Yes

No

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• Roads
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• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
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
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UNUSUAL SITUATIONS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Yes, Yes, Yes and Yes

Foreign Subdivision

Is the owner or developer of the subdivision a foreign country corporation?
Yes

No

If legal action is necessary to enforce the contract, must it be taken in the courts of the country where the
subdivision is located?
Yes
No
Does the country in which the subdivision is located have any laws which restrict, in any way, the ownership of land by
aliens?
Yes

No

What are the restrictions?

Must an alien obtain a permit or license to own land, build a home, live, work or do business in the country where the
subdivision is located?
Yes

No

Where is such permit or license secured?

How long is the permit valid for?

What is the cost of the permit?

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• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
• E-Sign
• Certification

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UNUSUAL SITUATIONS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Yes, Yes, Yes, Yes and Yes

Time Sharing

Is Time Sharing offered for this subdivision?
Yes

No

How is title to be conveyed?

How many shares will be sold in each lot?
How is use time allocated?

How are taxes, maintenance and utility expenses divided and billed?

How are voting rights in any Association apportioned?

Are there management fees?
Yes

No

What are their amounts and how are they apportioned?

Is conveyance of any portion of the lot contingent upon the sale of the remaining portions?
Yes

No

Is the initial buyer responsible for any greater portion of the expense than his normal share until the remaining interests are sold?
Yes
No
If the purchase of any of the portions is financed, will the default of one owner have any effect upon the remaining owners?
Yes

No

Explain

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• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

ADDITIONAL INFORMATION
UNUSUAL SITUATIONS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
No

Memberships

Does the purchaser receive any interest in title to the land?
Yes

No

You receive no interest in the title to the land but only the right to use it for a certain period of time.

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
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
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• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
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UNUSUAL SITUATIONS

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Yes, Yes, Yes, Yes

Memberships

Does the purchaser receive any interest in title to the land?
Yes

No

What is the term of the membership?

Is it renewable?
Yes

No

What disposition is made of the membership in the event of the death of the member?

Are the lots individually surveyed and the corners marked?
Yes

No

How does the member identify the area which the member is entitled to use?

What is the approximate square footage the member is entitled to use?

Are there different classes of membership?
Yes

No

How are the different classes identified and what are the differences between them?

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• Utilities
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• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
o
o

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
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OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

EQUAL OPPORTUNITY IN LOT SALES

Scenario
Yes and No checks

Is the developer in compliance with title VIII of the Civil Rights Act of 1968 by not directly or indirectly discriminating on the
basis of race, color, religion, sex, national origin, familial status, and handicap in any of the following general areas: Lot
marketing and advertising, rendering of lot services, and in requiring terms and conditions on lot sales and leases.
Yes

No

Is the developer, directly or indirectly, because of race, color, religion, sex, national origin, familial status, or handicap :
(1) Refusing to sell or lease lots after the making of a bona fide offer or to negotiate for the sale or lease of lots
or is otherwise making unavailable or denying a lot to any person
(2) Discriminating against any person in the terms, conditions or privileges in the sale or leasing of lots or in
providing services or facilities in connection therewith
(3) Making, printing, publishing or causing to be made, printed or published any notice, statement or
advertisement with respect to the sale or leasing of lots that indicates any preference, limitation or
discrimination against any person
(4) Representing to any person that any lot is not available for inspection, sale or lease when such lot is in fact
available
(5) For profit, inducing or attempting to induce any person to sell or lease any lot by representations regarding
the entry or non-entry into the neighborhood of a person or persons of a particular race, color, religion, sex,
national origin, familial status, or handicap

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• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
o
o
o
o
o
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ADDITIONAL INFORMATION

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

LISTING OF LOTS

Scenario
Add Lot information

Provide a listing of lots which shall consist of a description of the lots included in the Statement of Record by the names or
number of the section or unit, if any; the block number, if any; and the lot numbers. The lots shall be listed in the most
efficient and concise manner. If the filing is a consolidation, the listing shall include all lots registered to date in the
subdivision, except any which have been deleted by amendment

Property Owners’ Association
Taxes
Violations and Litigations
Resale or Exchange Program
Unusual Situations
Equal Opportunity in Lot Sales
Listing of Lots

• Cost Sheet
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SUBDIVISION INFORMATION

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Disclaimer
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Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes

COST SHEET

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Scenario
Cost Sheet

In addition to the purchase price of your lot, there are other expenditures which must be made. Listed below are the
major costs.
There may be other fees for use of the recreational facilities.
All Costs are subject to change.

Sales Price
Cash Price of Lot
Finance Charge
Total

Estimated One-Time Charges
1.

Water connection fee/installation or private well

2.

Sewer connection fee/installation of private on-site sewer system

3.

Construction costs to extend electric and/or telephone services.

4.

Other (Identify)

Total of Estimated Sales Price and One-Time Charges

Estimated Monthly/Annual Charges, Exclusive of Utilities
1. Taxes—Average unimproved lot after sale to purchaser
2. Dues and Assessments

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The inform ation contained in this Property Report is an accurate description of our subdivision and developm ent plans.

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SUBDIVISION LIST

OMB Control
OM
Number:
ounm
tr obleN
3170-0012
be-rXXXX
: 3170-0012
on
trBolCN
r:um
3170
ExpiratiEon
xpiDraat ieo:nXX/
DatXX/
e: 12/31/2018

SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
• Additional Information
• Upload AID
 Amendment
 Annual Reporting
 Tasks/Notes

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SAMPLE PROPERTY REPORT - TEMPLATE

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

SUBDIVISION INFORMATION
Subdivision Profile
Disclaimer

Property Report
Disclaimer
Purchase Entitlement
Risks of Buying Land
General Information
Title to the Property and Land Use
Roads
Utilities
Financial Information
Local Services
Recreational Facilities
Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Reporting
 Tasks/Notes


•
•
•
•
•
•
•
•
•
•
•

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SUBDIVISION INFORMATION
Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
 Amendment
 Annual Financial Statement
Reporting
 Tasks/Notes


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ANNUAL FINANCIAL STATEMENT

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

The aggregate sales price of all lots offered pursuant to a common promotional plan
equals $500,000.00 or less.
OR
Down Payments and deposits are held in an escrow or trust account (MANDATORY)
AND
The contract provides for delivery of a deed which conveys title free of any mortgage or
lien within 180 days of the signing of the contract. (In Lieu of delivery of a deed, the
developer may submit an Assurance of Title Agreement (MANDATORY)
The aggregate sales prices of all lots pursuant to a common promotional plan is at least
$500,000 but less than 1,500,000 OR
All facilities, utilities, and amenities proposed by the developer in the Property Report or
sales contract have been completed so that the lots in the Statement of Record are
immediately usable for the purpose for which they are sold. OR
The developer is contractually obligated to the purchaser to complete all facilities, utilities,
and amenities proposed by the developer in the Property Report and sales contract so
that all lots included in the Statement of Record will be useable for the purpose for which
they are sold by the dates set out in the Property Report.
AND
The developer has made financial arrangements, such as the positing of surety
bond(corporate bonds or individual notes or bonds are not acceptable) , irrevocable letters
of credit or the establishment of escrow or trust accounts, which assure completion of all
facilities, utilities and amenities proposed by the developer in the property report or
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contract.
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Disclaimer
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Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
• Additional Information
• Upload AID
 Amendment
 Annual Report
 Tasks/Notes

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

ANNUAL REPORT INFORMATION
Subdivision Information
Subdivision Name

Subdivision Number
40001-01-2013

Test Subdivision

Effective Date of Initial Statement of Record
06/01/2012

No of Unsold Remaining Registered Lots
120

Developer Information
Developer Name
Test Developer

Address 2

Address 1
123 Test Lane

City

Suite 100

Zip

State

Sayreville

Phone
(732) 123-4567

New Jersey

08872

Email Address
Test@xyz.com

The information can be updated by accessing My Profile.

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SUBDIVISION INFORMATION

Subdivision Profile
Disclaimer

Property Report
• Disclaimer
• Purchase Entitlement
• Risks of Buying Land
• General Information
• Title to the Property and Land Use
• Roads
• Utilities
• Financial Information
• Local Services
• Recreational Facilities
• Subdivision Characteristics and
Climate
• Additional Information
• Cost Sheet
• E-Sign
• Certification

Additional Information &
Documentation (AID)
• Additional Information
• Upload AID
 Amendment
 Annual Report
 Tasks/Notes

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ANNUAL REPORT INFORMATION

OMB Control Number: 3170-0012
Expiration Date: 12/31/2018

Developer is still engaged in land sales activity for mentioned subdivision and that no
material changes have occurred since the last effective date.
OR
Developer is still engaged in land sales activity for mentioned subdivision and that material
changes have occurred since the last effective date and that corrective pages to both
property report and AID accompany the report.
OR
Developer is no longer engaged in land sales activity for the mentioned subdivision.
Provide Reason:

Test@xyz.com

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