MISSISSIPPI OFFICIAL WOOD DESTROYING INSECT REPORT Adopted and approved by the Mississippi Pest Control Advisory Council and Approved By the Bureau of Plant Industry Inspection Co. ABC Pest Group Case Number (VA/FHA/Other): Address PO Box 2831 Inspector: Sam Eagleye City/State/Zip Jackson, MS 39236 ID Number: License Number 123456 Phone: 800 689-0233 Inspection Date: 10/3/2007 Party Requesting Inspection Roger Homebuyer Purchaser Seller Agent Owner/Seller Structure(s) Inspected House Address 12345 Maple Blvd Jackson, MS 39236 Report Forwarded to: Title Company and/or Mortgage Company Purchaser Seller Agent Were any areas of the structure(s) obstructed or inaccessible? No Specify obstructions or inaccessible areas not covered on reverse side. Conditions conducive to wood destroying insect infestation: No If yes, explain: Firewood against siding at nw corner of house. Inspection Reveals Visible Evidence of: Active Infestation Previous Infestation Previous Treatment Visible Insect Damages (Check Each Column or No) No No No No Subterranean Termites Drywood Termites Wood Borer Beetles Specify Other Specify Remarks/Additional Findings: GRAPH MUST BE COMPLETED FOR EVERY STRUCTURE INSPECTED. Structure previously treated by this company: No This company has contract in force: No Expiration Date: Contract Transferable No Date of Treatment: Common Name of Insect: Insect damage and/or conditions conducive as reported on this form: Insect Damage Conditions Conducive (Check Each Column or No, If Applicable) No No Will be or has been corrected by this company: N N Recommend evaluation by qualified expert to determine if repairs are needed. N Additional Comments:
KEY SYMBOLS: X - Subterranean termite damage B - Wood boring beetle damage D - Drywood termite damage C - Conditions conducive to wood destroying Insects X Active subterranean termites B Active wood boring beetles D Active drywood termites 1 square = 245667 foot/feet Graph Comments: READ AND UNDERSTAND BOTH SIDES OF THIS REPORT. Inspectors Signature Date 10/5/2007 Licensee or Permit Holder s Signature of Approval Date 10/4/2007 Notice of inspection was posted at or near: Access Opening Water Heater Beneath Kitchen Sin Date Posted: 10/15/2007 I HAVE RECEIVED THE ORIGINAL OR A LEGIBLE COPY OF THIS FORM, HAVE READ, AND UNDERSTAND SAME. Signature of Individual Purchasing Property Date Wed, Oct 3, 2007 (CONTINUED ON OTHER SIDE) 092401
STATEMENT OF PEST CONTROL OPERATOR A. THIS REPORT IS MADE ON THE BASIS OF WHAT WAS VISIBLE AND ACCESSIBLE AT THE TIME OF THE INSPECTION and is not an opinion covering areas such as, but not necessarily limited to, those that are enclosed or inaccessible, brick and stucco below the soil, expansion joints, areas concealed by wall coverings, floor coverings, furniture, equipment, stored articles, or any portion of the structure in which inspection would necessitate removing or defacing any part of the structure. B. Detached garages, sheds, lean-tos, fences, or other buildings on the property will not be included in this inspection report unless specifically noted. C. Any visible damage to a wood member in accessible areas has been reported. The above named firm s inspectors are not engineers or builders, and you may wish to call a qualified engineer or expert in the building trade to ascertain their opinion as to whether there is structural damage to this property. D. If visible evidence of active or previous infestation of listed wood destroying insects is reported, it should be assumed that some degree of damage is present. E. If visible damage is reported, it does not imply that damage should be repaired or replaced. Evaluation of damage and any corrective action should be performed by a qualified building expert. F. Inspection does not cover any condition or damage which was not visible at time of inspection but which may be revealed in the course of repair or replacement work. G. THIS IS NOT A STRUCTURAL DAMAGE REPORT. NEITHER IS THIS A WARRANTY AS TO ABSENCE OF WOOD DESTROYING INSECTS. H. Neither I nor the company for which I am acting have had, presently have, or contemplate having any interest in the property. I do further state that neither I nor the company for which I am acting is associated in any way with any party to this transaction. PRIVACY ACT INFORMATION - The information requested on this form will be evaluating the property for a VA or HUD insured loan. Although you are not required by law to provide this information, failure to provide it can result in rejection of the property as security for your loan. The information collected will not be disclosed outside VA or HUD except as permitted by law. VA and HUD are authorized to request this information by stature (38U.S.C., 1810(B)(4) and 12 U.S.C. 1701 et seq.) Additional Comments:
Wood Destroying Insect Inspection Report Addendum Inspector s Name: Sam Eagleye Property Address: 12345 Maple Blvd Jackson, MS 39236 Date 10/3/2007 FHA/VA Case No. Structure(s) Inspected: House Notes Here
INSPECTION PHOTOS # # 1 # 2 # 3 # 4 # 5 P1 12345 Maple Blvd ; Jackson, MS 39236