** 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
Yes
**Lot Dimensions **Lot Size (Square Feet) **Lot Size (Acres)
**Total Acreage
5 to less than 10
Zero Lot Line Up to 10,889 Sq. Ft. 1/2 acre to 1 acre One+ to Two acres
Two + to Five acres 20 to less than 50 50 to less than 100
200 to less than 500 Non-Applicable100 to less than 200
**Homestead Y/NYes No
**CDD Y/NAnnual CDD Fee
Yes NoOther Exemptions Y/N
Yes No
Future Land Use
Completed Pre-Construction
Construction StatusUnder Construction
Projected Completion Date
Yes No
**New Construction
Yes No
**Total Units Land Lease Fee
Yes No
**Township
**Legal Description
LAND AND TAX TAB - LEGAL **Tax ID
Rev. 0622215-2
Millage Rate
Development Planned Unit
Special Tax District Y/N (Tampa)
LAND AND TAX TAB - PARCEL
LAND AND TAX TAB - LOT INFORMATION Flood Zone Code
Census TractCensus Block
Cable
Flood Insurance
Maintenance/Repairs
Private Road
Tennis Courts
Electric
Ground Maintenance
Not Applicable
Recreational Facilities
Water/Sewer
Escrow Reserves Fund
Insurance Building
Other
Roof
1/4 Acre to 21,779 Sq. Ft.
10 to less than 20
500+ acres
**Full Baths **Half Baths **Square Feet Heated Total SqFtINTERIOR TAB - INTERIOR INFORMATION
Builder Measured Owner Provided Public Records**Sq Ft Source
Septic Sprinkler Meter
City Water Cable Connected
Fiber Optics Fire Hydrant
Private Sewer Private Utilities
Public Sewer Mini Sewer
Street Lights Underground
Well
**Bed
Appraisal
**Utilities (10)
Aerobic Septic
Electric
None
Generator Hookup
Public Utilities
Sprinkler Recycled
BB/HS Internet Avail
Canal/Lake For Irrigation
Other
Integrated Generator
Public Municipal Water
Public Water Avail
Cable Available
County Water
Gas
Private Municipal System
Private Municipal Water
Sprinkler Well
Page 4
Additional Rooms (9) Breezeway Family Room
Inside Utility
Loft
Foyer
Media Room
**Air Conditioning (2)
Humidistat No Air Wall Units/Window Zoned/MultipleCentral
**Heating and Fuel (6)
Fuel - Gas BottledCentral Fuel - Electic Fuel - Gas Natural Fuel - Oil
Heat Pump Heat Recovery Unit No Heat Other Partial
Radiant / Baseboards Radiant / Ceiling Solar Space Heater Wall Furnace
Wall Units / Window Units Zoned / Multiple
**Appliances Included (13)
Compactor Convection Oven
Dryer Freezer
Hot Water Electric Hot Water Gas
Microwave Hood None
Range Range Hood Solar Hot Water Ownded
Solar Hot Water Rented Washer Water Softener Rented
Water Filter Owned Wine/Bar Refrigeration
Rev. 0622215-2
Bonus Room
Florida Room
Den / Library / Office
Game Room
Double Master Bedroom
Inlaw / Rental Apt
Built In Oven
Disposal
Water Aerator Rented
**Interior Features (14)
Cook Top Only
Exhaust Fan
Indoor Grill
Other
Refrigerator
Water Softener Owned
Water Filter Rented
Dishwasher
Gas Appliances
Microwave
Oven Double
Tankless Water Heater
Water Aerator Owned
Kitchen Reverse OsmosisSys
Oven
Attic
Ceiling Fan(s)
Dumb Waiter
Handicapped Modified
Medical Alarm
Smoke Alarms
Tray Ceiling
Washer/Dryer Hookup
Other
Attic Ventilator
Central Vacuum
Elevator
Hot Tub/Spa
Radiant Barrier
Solid Surface Counters
TV Antenna
Wet Bar
Blinds/Shades
Corridor Access
Fire Sprinkler
In Wall Pest System
Rods
Solid Wood Cabinets
Unfurnished
Wheelchair Accessible
Built in Features
Crown Moulding
Furnished
Inside Utility
Sauna
Storage Room
Video Monitoring
Whole House R.O. System
Cathedral/Vaulted Ceiling
Dry Bar
Furnishing - Optional
Intercom System
Skylights
Thermal Windows
Walk In Closet
Window Treatment
Interior Layout (8)
Eating Space In Kitchen Formal Dining Room Separate
Formal Living Room Separate
Living/Dining Room Combo
Living Room/Great Room Master Bedroom Downstairs Open Floor Plan
Breakfast Room Separate
Great Room Kitchen/Family Room Combo 'L' Dining
Split Bedroom
Volume Ceilings
Master Bath Features (4)
Bath w Spa/Hydro Massage Tub
Bidet Garden Bath
Handicapped Accessible Shower - No Tub
Dual Sinks
Tub w Separate Shower Stall
Tub w Shower
Closet Pantry
Island
Pantry Walk In Pantry
Bamboo [G]
Concrete [G]
Other
Brick/Stone
Cork [G]
Marmoleum [G]
Quarry Tile
Slate
Carpet
Marble
Forestry Stewardship Certified [G]
Parquet
Recycled/Composite Flooring [G]
Terrazzo
Ceramic Tile
Laminate
Porcelain Tile Other
Vinyl
**Fireplace Y/N
Security System
Yes No
Leased Owned
Fireplace Description (2)
Family Room
Decorative
Gas Fireplace
Master Bedroom
Wood Burning FP
Free Standing
Electric Fireplace
Living Room
Non Wood BurningFire Place
Other Room
Other – Specify in Remarks
**Floor Covering (6)
Wood
Salvaging Flooring [G]
Reclaimed Wood [G]
Kitchen Features (5)
Breakfast Bar
Desk Built In
Page 5
ROOMS TAB - ROOM DIMENSIONS
Choices for Room Types are: 2nd Bedroom, 3rd Bedroom, 4th Bedroom, 5th Bedroom, Balcony/Porch/Lanai, Bonus Room, Breezeway, Den/Library/Office, Dinette, Dining Room, Double Master Bedroom, Family Room, Florida Room, Foyer, Game Room, Great Room, Inlaw/Rental Apartment, Inside Utility, Kitchen, Living Room, Loft, Master Bedroom, Media Room, Study/Den, Studio
Choices for Rooms Level are: Basement, Fifth Level, First Level, Fourth Level, Second Level, Third Level
Choices for Primary Floor Covering are: Bamboo, Brick/Stone, Carpet, Ceramic Tile, Concrete, Cork, Forestry Stewardship Certified, Laminate, Marble, Marmoleum,Other, Parquet, Porcelain Tile, Quarry Tile, Reclaimed Wood, Recycled/Composite Flooring, Salvaging Flooring, Slate, Terrazzo, Vinyl, Wood
Room Type Room Level Room Dimensions ( WxL) Room Primary Floor Covering1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Rev. 0622215-2
REQUIRED ROOMS: LIVING ROOM or GREAT ROOM, KITCHEN, MASTER BEDROOM
19
20
21
22
23
24
25
Water Access (10)
Beach – PublicBeach – Private
Canal – Saltwater
Intracoastal Waterway
Limited Access
Creek
Lagoon
Marina
Beach – Access Deeded
Gulf/Ocean
Lake
Pond
Bay/Harbor
Canal – Freshwater
Gulf/Ocean to Bay
Lake – Chain of Lakes
River
Yes No
WATER/GREEN TAB - WATER ACCESS
**Water Access Y/N
**Water View Y/N
Yes No
Water View (10)
Bay/Harbor – Full Bay/Harbor – Partial
Gulf/Ocean – Full
Lagoon
Pond
Beach
Gulf/Ocean – Partial
Lake
River
Water Frontage (10)
Beach – Private
Creek
Lagoon
Pond
Beach – Public
Gulf/Ocean
Lake
River
Yes No
**Water Extras Y/N
Yes No
Water Extras (10)
Davits
Fishing Pier
Boats-None Allowed
Seawall – Concrete
Water Name Waterfront Feet
WATER/GREEN TAB - GREEN INFORMATION
Green Certifications (G) (4) EarthCraft House
FGBC Remodel
Geothermal HVAC
Other – Specify in Remarks
LEED for Homes
EPA Watersense
Green Water Features (G) (15)Cistern Dual Flush Toilets
High Eff. (Low Flow) Toilet Irrigation - None
Page 6
Non Toxic Fertilizer/Pesticides Veg. (Productive) GardenFl. Friendly/Native Landscape Rain Water Harvesting
Rev. 0622215-2
**Water Frontage Y/N
Creek
Intracoastal Waterway
Marina
Canal
Gulf/Ocean to Bay
Lake – Chain of Lakes
Bay/Harbor
Canal – Saltwater
Intracoastal Waterway
Marina
Canal – Freshwater
Gulf/Ocean to Bay
Lake – Chain of Lakes
Boathouse
Dock – Slip Deeded Off-Site
Private Lake Dues Required
Riprap
Skiing Allowed
Boat Ramp – Private
Dock – Slip Deeded On-Site
Lock
Sailboat Water
Dock – Slip 1st Come
Lift
Bridges – No Fixed Bridges
Seawall – Other
Drip Irrigation
Whole House Water Purification
Energy Star Home
Florida Certified Yard
LEED Certified Building
EPA Indoor Air Quality Plus
Florida Friendly Yard Recognition
Florida Water Star
LEED Neighborhood Development
FGBC Green Certified Home
FORTIFIED for Safer Living
NAHB Certification
Irrigation – Low Volume
High Eff. Faucet/Fixtures
Rain Barrels-Spigot/Overflow
Grey Water Use-Whole House
Irrigation – Reclaimed Water
Green Landscaping (G) (4)
Green Energy Features (G) (9) Energy Star Dishwasher
Gas Tankless Appliances
HVAC SEER 15+
Outdoor Lighting – Solar
Solar Power
Energy Star Refrigerator
Geothermal Heat Pump
HVAC SEER 20+
Programmable Thermostat
Solar Water Heater
Hydro Power
Radiant Barrier
Sprayfoam Insulation – Attic
Indoor Air Quality (G) (15) Bath Fans Vented to Outside
No/Low VOC Paint/Finish
Fresh Air Ventilation System
Non Toxic Pest Control
Sealed Combustion
HVAC Filter MERV 8+
HVAC Cartridge/Media Filter
Whole House Vacuum System
Disaster Mitigation (G) (7)Above Flood Plain Hurricane Insurance Fire Resistant Exterior
Lightning Protection System
Fire/Smoke Detection Integration
Safe Room
Co-Op Fee Simple
Condominium Condo - Hotel
Land-Lease Fractional Ownership
HERS Index Fireplace - Direct Vent
No/Low VOC Flooring
Range Hood Vented to Outside
Energy Star Qualified Roof ProductHeat Pump Water Heater
Energy Star Windows
Humidistat
Outdoor Lighting – None
Solar Hydronic Radiant Heat
Wind
Energy Start Washer
Heat Recovery Unit
Hydronic Radiant Heating
Reflective Roofing Material
Sprayfoam Insulation – Walls
Hurricane Shutters/Windows
HVAC UV/Elec. Filtration
Owner Phone
Tenant Name Tenant Phone
Fannie Mae Secured
Yes No
**HOA/COMM ASSN
None Optional
Required
HOA Fee
Monthly
Semi Annual
Management Contact Information
Annual
Condo Maintenance FeeCondo Maintenance Fee ScheduleAnnual Monthly
Quarterly Semi Annual
Mo. Maintenance $
Owner Name
Quarterly
OWNER TAB - OWNER
HOA Payment Schedule
COMMUNITY TAB -ASSOCIATION INFORMATION
** OWNERSHIP
Deduction Qual.
Building Has Elevator Y/NYes No
Buyer Approval RequiredAssociation
Handicap Modified
Boat Slip
Community Hot
Association Recreation
Fitness
Card Entry
Fees Required
Gated Horse Stables
No Truck/RV/ Motorcycle Parking
Dock
Golf Community
Public Boat Ramp
Tennis Courts
Racquet Ball
Laundry Facility
Optional Additional Fees Playground
Recreation Building Security
Maintenance
Storage
PUD
Water Access
None
Private Boat
Park
Tub/SpaCommunity Boat Ramp
Waterfront Special Comm Tenants No Pets ComplexRestrictions
Other Fees Y/N Yes No
Other Fees Amount
Other Fees Term
Annual Monthly
Quarterly Semi Annual
Monthly HOA Amount
Monthly Condo Fee Amount
55+ 62+ N/A
COMMUNITY TAB - HOUSING FOR OLDER PERSONS
**HOUSING FOR OLDER PERSONS (2) FCHR Website
Yes No
Affidavit
Yes No
**Deed Restrictions Y/N
Yes No
Expire Renewal Date
PETSPets Allowed Y/N
Yes NoPet Restrictions Y/N
Yes No
Number of Pets Pet Size
Max Pet Weight Pet Restrictions
REALTOR INFORMATION TAB – REALTOR INFORMATIONFinancing Available (10)
Energy Efficient Mortgage [G]
Assumable - Must Qualify
FHA Flood Insurance Other
Seller Financing Special Funding
Conventional Exchange/TradeCash
Green Financing Available [G] Lease PurchaseRequiredVA
Realtor Info (Confidential) (7)
Bonus to Selling Bonus to Lease In Foreclosure Lease Available
Pet on Premises Tenant Occupied Vacant
Go To Site
Tenant Approval
Office Office
Page 7 Rev. 0622215-2
Owner Occupied
Variable Rate Commission
Recreation - Lease
CommunityIrrigation ByReclaimed Water [G]
Free
Airport/Runway
Community Features (25)
Ramp
Fishing PierOwned
Maximum Times Per Year
Number of Ownership YearsPrior to Leasing
Years of Ownership Prior to Leasing Y/N
Yes No
Additional Lease Restrictions
Association Approval Required Y/N Approval Process (Text)
Yes No
Lease Restrictions Y/N
Yes No
Realtor Information (25) Agent Related to Agent / Owner Brochure Available
Condominium Corporate Owned Fence Restrictions
Floor PlanAvailable
Foreign Seller In-Law Quarters
Lease Leasing Not
Right Of First Scrub Jay-check
CDD Addendum Required
Fixer-Upper
Lead Paint Disclosure Owner
Will Consider Financing
Special Assessments
Subject ToApproval
Assumable - Non Qualify
Lease Option
USDA
Contract for Deed
Pre-Foreclosure
Assoc Approval Required
Docs Available
HOA Disclosure Available
No Sign
Seller Property Disclosure
Termite Bond / Warranty
Owner
Disclosure Avail Relo
Restrictions Allowed
Refusal with county
Assumable Mortgage
Environmental Report Available
Other Disclosures-Contact Agent
Septic Sewer Addendum Req.
Vehicle Restrictions
Owner Will Assist w/ Closing CostsSold As-Is
AGENT/OFFICE**Agent ID Agent Name Agent Email Office Name and Information
List Agent 2 ID Agent 2 name Agent 2 Email Office 2 Name and Information
Team Name Interoffice Info
COMPENSATION **Non Rep Comp **Trans Broker Comp Bonus Amount**Single Agent Comp
Leasing Restrictions
Can Property Be Leased Y/N Minimum Lease Period
1-7 Days 1 Week 1 Month 1 Year 2 Months
2 Weeks 3 Months 4 Months 5 Months 6 Months
No Minimum7 Months
Yes No
Survey Available
Home Warranty
Page 8
Bonus Expiration DateBonus Yes
SHOWING INFORMATION
Call Center Phone Number Showing Time Showing Time Secure Remarks
**Showing Instructions (16) 24 Hour Notice Appointment Only Call Before Showing Call Listing Agent
Call Listing Office Call Owner Call Tenant Gate Code Required
Lock Box - Use RequestLock Box Coded
See Remarks Under Construction (Go to site)
Call Agent 2
Key-Listing Broker Office
Pet on Premises
Contact Call Center
Listing Agent Must Accompany
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
DATE BROKER
No
Yes No Yes No Yes
Web Link 1 Web Link 2
Rev. 0622215-2