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ACT 250 DISCLOSURE STATEMENT
GENERAL INSTRUCTIONS
Prior to the division or partition of land, the seller or other person dividing or partitioning the land shall prepare an “Act 250
Disclosure Statement.” A person who is dividing or partitioning land, but is not selling it, shall file a copy of the statement with the
town clerk, who shall record it in the land records. The seller who is dividing or partitioning land as part of the sale shall provide
the buyer with the statement within ten days of entering into a purchase and sale agreement for the sale or exchange of land, or at
the time of transfer of title, if no purchase and sale agreement was executed, and shall file a copy of the statement with the town
clerk, who shall record it in the land records. Failure to provide the statement as required shall, at the buyer’s option, render the
purchase and sales agreement unenforceable. Do not send Act 250 Disclosure Statement to the Natural Resources Board.
LINE-BY-LINE INSTRUCTIONS
1. - 7. Subdivider(s) Be sure to enter the full names and mailing addresses of all Subdivider(s) and Buyer(s). Be certain to
and Buyer(s) complete all items.
8. Benefit Indicate by checking “yes” or “no” whether any family member listed in #6 will derive any profit or
to Family consideration, or acquire any other beneficial interest from the partition or division of the land which
Members from is the subject of this Disclosure Statement. If the family member receives financial support from the
Subdivider’s subdivider(s), or if the subdivider(s) receive financial support from the family member, there is a
Transactions presumption of financial benefit and that person should be listed. If, however, a child is emancipated
and is not receiving financial support from the parent, there is no presumption of benefit and that family
member should not be listed.
9. Affiliated This includes all persons who are affiliated with the Subdivider in the partition or division of the land in
Persons question (i.e. derive a profit, consideration or other beneficial interest from the subdivision). However,
some individuals and entities are presumed not to be affiliated with the Subdivider in the subdivision,
unless there is substantial evidence of an intent to evade the purposes of Act 250. These include:
(i) A stockholder in a corporation subdividing land, where the stockholder and the stockholder’s
spouse, children, parents and siblings own less than 5% of the outstanding shares of the
corporation.
(ii) A court-appointed guardian, licensed attorney, real estate broker or salesperson, engineer
or land surveyor, unless the compensation or benefit which they receive for their duties
indicates more than an agency relationship with the Subdivider.
(iii) A chartered lending institution which financed the Subdivider’s purchase or ownership of
the land, provided the financing rate is not substantially higher than the prevailing lending
rates in the community.
10. Affiliated Land List all lots or parcels of land partitioned or divided for the purpose of resale by the persons identified
Transactions in item #9 above within the preceding five years and within the same jurisdictional area of the District
Environmental Commission or within five miles of the land being divided if the previously divided land
is in another district (see map on our website). Subdivided lots or parcels which were conveyed by these
persons prior to July 1, 1987, and which are more than five miles away from the land being partitioned
or divided, need not be listed. List the full name of the person, the town in which the land is located, a
brief description of the land (i.e. undeveloped land, residential subdivision, lot number, etc.), the number
of acres, and the date the lot or parcel was created. Dates for creation of lots or parcels can include
the date a plot plan is filed in the town land records, the date a subdivision permit or wastewater and
potable water supply permit by the state or delegated municipality is issued, the date a local subdivision
or zoning permit is issued, or in the absence of any of the above, the date of the legal conveyance of the
lot, whichever is first.
11. Notice That With this statement buyers are on notice that the partition or division of land which is the subject of this
An Act 250 Disclosure Statement may be subject to the permit requirements of Act 250. The buyer should request
Permit May be a jurisdictional opinion from the District Coordinator serving the district in which the land is located
Required regarding the applicability of Act 250 to this transaction by submitting the Disclosure Statement to the
coordinator at the appropriate Regional Office (see map on our website).
12. Act 250 Permit Enter the Act 250 Land Use Permit Number for this land, if one has been issued.
Number
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