** Indicates a Required Field o Indicates a Single Choice Field □ Indicates a Multiple Choice Field [G] = Green Fields Office LISTING TAB-STATUS AND LISTING INFORMATION **Expiration Date **List Price Range Price Y/N Yes No Representation **Listing Type Exclusive Right to Lease L.S. / Exclusive Right To Sell Central Pasco DeSoto East Pasco Englewood Interealty Usage Lake and Sumter Lake Wales Lakeland Manatee Orlando Osceola Other Pinellas Suncoast Port Charlotte Sarasota Tampa Venice West Pasco West Volusia **Special Sale Provision **Special Listing Type ADDRESS **Street Number Street Dir Pre **Street Name Street Type Street Dir Post Unit Number **City **State **Zip Zip + 4 **County Floor Number Building # Floors Building Name/Number Floors in Unit Page 1 Seller Not Represented L.S. / Exclusive Agency Association SCHOOLS Elementary School Middle or Junior School High School AUCTION **Auction Auction Firm / Auction Website Auction Type Yes No EXTERIOR/POOL TAB - **POOL Private Pool Dimensions Pool Type (8) **List Date Entered Where Rev. 0622215-2 **Office Primary Board ID Auction Auction / REO Auction / Short Sale Absolute Reserve Auction Property Access Y/N Yes No Buyer's Premium Sold Data / Entry Only Seller Represented Exclusive Right to Sell Limited Service (L.S.) Bank Owned / REO Short Sale None of the Above Exclusive Agency Exclusion Exclusion / Variable Commission Not Applicable Other Variable Commission Bartow East Polk Community None Above Ground Auto Cleaner Child Safety Fence Diving Board Fiberglass Gunite/Concrete Heated Pool Heated Spa In Ground Infinity Edge Inside Other Water Feature Outside Bath Access Pool Sweep Salt Water [G] Screen Enclosure Solar Cover for Pool [G] Solar Powered Pool Pump [G] Spa Tile Vinyl Solar Heated Pool [G] Other Existing Lease Existing Lease or Tenant Y/N Yes No End Date of Lease (format: xx/xx/xxxx) Monthly Rental Amount Month to Month or Weekly Y/N Yes No Days Notice to Tenant if Not Renewing EXTERIOR/POOL TAB - EXTERIOR INFORMATION ½ Duplex Co-op Condo Manufactured / Mobile Home Farm Townhouse Villa Dock/Rackominium Single Family Home **Property Syle Condo - Hotel Modular Mobile Home Style Pre-Fabrication Mobile Home 15 days 30 days 60 days 90 days Vrange List Low Price Regional
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** Indicates a Required Field o Indicates a Single Choice Field □ Indicates a Multiple Choice Field [G] = Green Fields
Office
LISTING TAB-STATUS AND LISTING INFORMATION
**Expiration Date **List Price Range Price Y/NYes
No
Representation
**Listing Type Exclusive Right to Lease
L.S. / Exclusive Right To Sell
Central Pasco DeSoto East Pasco Englewood Interealty Usage
Lake and Sumter Lake Wales Lakeland ManateeOrlando
Osceola Other
Pinellas Suncoast Port Charlotte Sarasota Tampa Venice West Pasco West Volusia
**Special Sale Provision
**Special Listing Type
ADDRESS
**Street Number Street Dir Pre **Street Name Street Type Street Dir Post
Unit Number **City **State **Zip Zip + 4
**County Floor Number Building # Floors Building Name/Number Floors in Unit
Page 1
Seller Not Represented
L.S. / Exclusive Agency
Association
SCHOOLS
Elementary School Middle or Junior School High School
AUCTION
**Auction
Auction Firm / Auction WebsiteAuction Type
Yes
No
EXTERIOR/POOL TAB - **POOL
Private
Pool Dimensions
Pool Type (8)
**List DateEntered Where
Rev. 0622215-2
**Office Primary Board ID
Auction
Auction / REO
Auction / Short Sale
Absolute
Reserve
Auction Property Access Y/N
Yes
No Buyer's Premium
Sold Data / Entry Only
Seller Represented
Exclusive Right to Sell
Limited Service (L.S.)
Bank Owned / REO
Short Sale
None of the Above
Exclusive Agency
Exclusion Exclusion / Variable Commission Not Applicable Other Variable Commission
Bartow East Polk
Community None
Above Ground Auto Cleaner Child Safety Fence Diving Board Fiberglass Gunite/Concrete Heated Pool
Heated Spa In Ground Infinity Edge Inside Other Water Feature Outside Bath Access
Pool Sweep Salt Water [G] Screen Enclosure Solar Cover for Pool [G]
Solar Powered Pool Pump [G]
Spa
Tile Vinyl
Solar Heated Pool [G]
Other
Existing Lease Existing Lease or Tenant Y/N
Yes NoEnd Date of Lease (format: xx/xx/xxxx) Monthly Rental Amount Month to Month or Weekly Y/N
Yes No
Days Notice to Tenant if Not Renewing
EXTERIOR/POOL TAB - EXTERIOR INFORMATION
½ Duplex Co-op Condo
Manufactured / Mobile Home
Farm
Townhouse Villa
Dock/Rackominium
Single Family Home
**Property Syle Condo - Hotel
Modular
Mobile Home Style
Pre-Fabrication
Mobile Home
15 days 30 days
60 days 90 days
Vrange List Low Price
Regional
**Property Description (4)
1st Floor Multi-Story
Detached
Ground Floor Unitl
3rd Floor+above Multi-Story
Elevated
In M / H Community
Penthouse
Tri-Level
Architectural Styles (6)
Bungalow
Courtyard
Florida
Patio
Traditional
Other
Page 2
Balcony
Corner Lot
End Unit
Golf Course View
Hilly
Level
Lot – Oversized
Pool View
Street One Way
Tennis Court View
Close to Bus Line
Corner Unit
Flood Zone
Greenbelt
Historic District
Lot – Flag
Lot - Tip
Sidewalk
Street Paved
Unincorporated
**Location (10)
E
W
NE
NW
SE
SW
N
S
Front Exposure
**Exterior Construction
(5) Asbestos Brick
Log On Piling
Siding Stem Wall
Stucco Wood Frame
Block
Metal Frame
ICF Insulated Concrete Forms [G]
Stone
Wood Frame (Forestry Stewardship Certified) [G]
**Roof (3)
Built up
Membrane
Metal
Other
Roof Over
Shake
Shingle
Slate
Tile
**Foundation (3)
Stilt / Wood
Rev. 0622215-2
Cape Cod
Custom
French Provincial
Ranch
Tudor
Colonial
Dutch Provincial
Historical
Spanish / Mediterranean
Victorian
Contemporary
Elevated
Key West
Townhouse
Villa
Coastal Constr Ctrl Lnn
Cul de Sac
Garden View
Greenbelt View
In City Limits
Lot - Irregular
Pasture/Agriculture
Street Brick
Street Private
Wooded View
Conservation Area
Drainage Canal
Golf Course Frontage
Highway Frontage
In County
Lot - Key
Park View
Street Dead-End
Street Unpaved
Zoning Permits Horses
SIP Structurally InsulatedPanel [G]
Tilt Up Walls [G]
Other
Basement
Crawlspace
Slab
Stem Wall
2nd Floor / Multi Story
Efficiency
High-Rise
Out of M / H Community
Townhouse 2-3 FloorsThree Story
Attached
End Unit
Mid-Rise
Split-Level
Two Story
One Story
Barn
**Exterior Features
French Doors
Handicap Modified
Oak Trees
Patio/Porch/Deck Covered
Outdoor Lights
Sprinkler Metered
Utility Shed
Balcony/Sun Deck
Fenced
Gutters/Downspouts
Mature Landscaping
Outdoor Shower
Rental Apartment
Sliding Doors
Trees/Landscaped
Detached In-Law Apt
Fruit Trees
Hot Tub/Spa
Other
Parking - RV/Boat
Satellite Dish
Stables
Wheelchair Accessible
Detached Workshop
Gazebo
Hurricane Shutters
Outdoor Grill
Patio/Porch/Deck Open
Sauna
Storage
Xeriscape
Dog Run
Greenhouse
Irrigation System
Outdoor Kitchen
Patio/Porch/Deck Screened
Screen/Covered Enclosure
Tennis Court - Private
2 Car Carport 3 Car Carport
4 Car Carport 4 Car Garage
1 Car Garage
**Garage / Carport (3)
5+ Car Garage
1 Car Carport
3 Car Garage
2 Car Garage
5+ Car Carport
Under Building parkingGolf Cart Garage NoneRV Carport RV Garage
Assigned Parking
Door Opener Golf Cart Parking
Oversized
Tandem Parking Workshop
Attached Covered Parking
Detached
Guest Parking No Street Parking Other
Parking Pad Side Rear Entry
Street Parking
Bath In Garage
Drive Space
None
Circular Drive
Garage Conversion
Garage Features (10)
Open Parking
Secured Parking
Washer/Dryer Hookup
Portico
Under Building Parking
Page 3
Fidelity Bond
Public Insurance
Building Exterior Community Pool
Gas
Internet Manager
Pest Control
Security Trash Removal
Garage Dimensions
Maintenance Includes (19)
Model / MakeMH Width
Single Double Triple
Alt Key/Folio **Taxes **Tax Year **Year Built
**Zoning Zoning Compatible Y/N
No
**Section
Yes *
**Legal Subdivision Name
**Plat Book/Page
**Subdivision Number Subdivision Section Number**Block/Parcel **Lot #
No
**Additional Parcel Y/N**Range
SW Subdiv Sub Condo Number SW Subdv Community Name Complex/Community Name/NCCB
No Call BoxElectronic Showing ButtonLock Box -Combination
IDX/VOW**Internet Y/N
Yes No
**Show Prop on Address on Internet
Yes No
**ID Y/N
Yes No
**Realtor.com Y/N **VOW AVM Y/N **IDX/VOW Display Comments Y/N Third Party Y/N
Yes No No
MARKETING LINKS and INFORMATION **Create Automatic Virtual Tour Link Virtual Tour
Yes No
Virtual Tour Lin 2
**Public Remarks
Realtor Only Remarks
**Driving Directions
The Owner has reviewed the foregoing information contained in this Data Entry Form and acknowledges the information to be true and correct to the best knowledge of the owner.
The Owner agrees to indemnify and hold harmless the My Florida Regional Multiple Listing Service (MFRMLS), the Originating Board, and their employees, the Listing Broker and licensees, the Selling Broker and licensees, and all other cooperating Brokers and licensees against any and all claims or liability (including attorney fees) arising from any breach of warranty by Owner or from any incorrect information supplied by Owner or from any facts concerning the Property which was known or reasonably should have been known to Owner but not disclosed by Owner.
At the request of the Listing Broker, unless otherwise properly indicated on this Data Entry form, MFRMLS will electronically transmit information about the Owner's property to Internet web sites to aid in the marketing of the Property for sale.
MFRMLS shall retain and make available all such data and photographs to all its participants for an indefinite period. MFRMLS assumes no responsibility or liability to Owner for errors or omissions on this Data Entry Form or in the MFRMLS computer system.
The Owner hereby authorizes Listing Broker to file this Data Entry form with the MFRMLS and the Owner will provide timely notice of all status changes. DATE OWNER SIGNATURE OWNER SIGNATURE