REAL ESTATE PROPERTY INQUIRY FORM
Gift Fund Name: Owner Name(s): Address of Owner: City: Phone: State/Zip: Gift Fund Number: Date:
Section 1 - PROPERTY INFORMATION
Property Location:
Land Area (acres or sq. ft.): Zoning: Replacement cost of building: Current property insurance coverage: Date of acquisition/form of acquisition: Current cost basis (includes improvements): Principal balance of mortgage: Assessed value for real estate taxes: Land value: Appraised value: Appraiser & Address:
Building area (sq. ft. each floor):
Most recent appraisal date:
Occupancy status after transfer of title to charity: (Please check one) Unimproved (no buildings) Unoccupied (building, but occupant) Occupied (building with occupants)
Section 2 - PROPERTY ALLOWANCES/RESTRICTIONS
Check if there are any of the following. If so, explain in the notes section.
Zoning Variances, violations or special permits Restrictions/ Covenants/ Easements
Zoning violations Survey
Section 3 - CONDITION OF BUILDING
Check if there are conditions or problems with any of the following. If so, explain in notes section. Foundations/slab Basement water/dampness/sump pump Roof General structural UFFI (formaldehyde insulation) Termites/ants/pests Swimming pool Radon
BUILDING SYSTEMS Plumbing Air conditioning Water supply Sewage: type_____________________ Electrical Heating Hot water Other fixtures
Section 4 - RENTAL/CONDOMINIUM/COOPERATIVE
Check if any of the following exist. If so, explain in the notes section.
BUILDING SYSTEMS Lease Security deposit Building or sanitary code violations Rental arrears Common area fees arrears Financial statements
Section 5 - ENVIRONMENTAL
Check if any of the following exist. If so, explain in the notes section.
A. HISTORY OF PROPERTY Property has prior or current use for industrial, commercial, agricultural, manufacturing, waste disposal or any other non-residential purposes. Has an environmental analysis been conducted on the property? When?________________
B. CONDITION OF PROPERTY Stressed or denuded vegetation or unusual barren areas Discoloration, oil sheen's, or foul/unusual odors in water Storage drums Above or underground storage tanks; vent or filler pipes Evidence of oil or other chemicals in soil Evidence of PCBs Evidence of toxic air emissions
C. ADJACENT PROPERTIES Properties adjacent or close to subject have conditions requiring " yes" to any questions in (A) or (B) Set out those conditions in the Notes section below** Flood/ plain/wetlands/drainage Endangered plants or wildlife
** Are you aware of any other information concerning any part of the land or building which might affect the decision of the buyer, affect the value of the property or affect the use by the buyer? If so, indicate below. NOTES:
Section 6 - PROPERTY EXPENSE BUDGET
To hold this property as a Foundation asset, the following income and expenses are anticipated: A. Income 1. Rent 2. Other B. Expenses 1. Real estate taxes: Date taxes are due: _________________ 2. Utilities: Gas Oil Electric/Water/Sewer/Other C. Services 1. Caretaker/ Property manager/landscaping 2. Heating/cooling service contract/snow removal 3. Pool service 4. Common area charge (condominium) 5. Security 6. Other D. Maintenance/Repairs E. Insurance TOTAL EXPENSES: Annual or N/A
NET INCOME (Loss):
OTHER INFORMATION
Copy of Deed Appraisal (within 60 days of expected gift date) Copy of environmental analysis Survey Copy of plat/map Copy of last tax bill Photo of Property Copy of Restricted Covenants/special uses/easements/permits (if any) Homeowners’ Association bylaws, covenants or restrictions Copy of any special conditions (i.e. historic appearance commission regulations, etc.)
Additional Notes:
Signature(s) I (we) understand as set forth in the Charitable Giving Guide that all Gift Funds and Trusts are subject to the policies of Foundation For The Carolinas and that the information set forth in this document is true and accurate to the best of my (our) knowledge.
Signature
Date
Signature
Date
Mail or fax signed, completed form to: Foundation For The Carolinas, 217 South Tryon Street, Charlotte, NC 28202 December 2001 Phone: 704-973-4500 Toll Free: 888-335-9541 Fax: 704-973-4599