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Real Property Address: ___________________________________________________________________________

The undersigned Seller hereby discloses to the undersigned Buyer the presence of a woodstove(s) or fireplace insert(s) located on the above-described real property. The woodstove(s) or fireplace insert(s) is generally described as (make, model #):


The woodstove(s) or fireplace insert(s) is:

☒ Certified or

☒ Noncertified

Seller and the Buyer understand that the City of Ashland’s Municipal Code Section 9.24.055 requires noncertified woodstoves or fireplace inserts be removed from buildings or structures located on the above-described real property upon Conveyance of Real Property, as defined by local ordinance; While generally in a real estate contract, the Seller will have responsibility for the removal of the noncertified woodstoves or fireplace inserts, the Seller and Buyer may agree in writing that the Buyer will assume responsibility for removal and proper disposal of the noncertified devices pursuant to local ordinance. Notwithstanding any contractual allocation of responsibility, in the event a Seller fails to remove such noncertified devices for any reason whatsoever, the undersigned Buyer shall have the ultimate responsibility to remove the noncertified devices within the time limits specified by local ordinance. The responsibility for removing any noncertified woodstoves or fireplace inserts shall be:

☒ Responsibility of the Seller

☒ Responsibility of the Buyer

The Seller and the Buyer also understand that this Disclosure Certificate must be executed by the Seller and acknowledged by the Buyer prior to closing or transfer and delivered to the City of Ashland with the executed Removal Certificate and receipt evidencing proper disposal. Failure to comply with the Disclosure, Removal, Disposal and Certificate requirements of AMC 9.24.055 is punishable by a fine of $500.00 as well as the cost of Court or Administrative proceedings to enforce the removal requirement.

Under penalty of Perjury and False Swearing, the undersigned Seller represents that he/she has read the forgoing document and that the statements and certifications hereon are true and correct.



State of Oregon



County of Jackson


The forgoing instrument was acknowledged before me on_________________________, by

______________________________________________, who represents that he or she is the owner of the above referenced property, or if the property is owned by an entity, represents that he or she is duly authorized by the entity to represent the entity is the owner of the property.

Notary Public for
My Commission Expires:

The undersigned Buyer acknowledges receipt of the Disclosure Certificate and acknowledges Buyer’s ultimate responsibilities for removal of noncertified devices under AMC 9.24.055.



(Ord. 2954, amended, 05/06/2008; Ord. 2936, added, 03/23/2007)