New York State Disclosure Form for Buyer and Seller

This form was provided to me by (Print Name of Licensee)

Landmark VP Realty @ Valley Palms Real Estate, Inc.

A licensed real estate broker acting in the interest of the :

Seller as a (check relationship below)

Seller’s Agent

Broker’s Agent

Buyer as a (check relationship below)

Buyer’s Agent

Broker’s Agent

Dual Agent

Dual Agent with Designated Sales Agent

For advance informed consent to either dual agency or dual agency with designated sales agents complete section below:

Advance Informed Consent Dual Agency

Advance Informed Consent to Dual Agency with Designated Sales Agents

If dual agent with designated sales agents is indicated above

is appointed to represent the buyer; and is appointed to represent the seller in this transaction.

(I) (We) acknowledge receipt of a copy of this disclosure form:

Signature of Buyer(s) or Seller(s): Upload Signature

Date :

These disclosures are being provided by Landmark VP Realty @ Valley Palms Real Estate, Inc a license RE Brokerage", The phone numbers 1-855-7OWN-NOW ;1-8.5.5-7.6.9-6.6.6.9