If a buyer refuses to sign the disclosure statement set forth in § 39-30.040, the transferor may comply with the requirements of this section by delivering that statement to the buyer as provided in § 36-30.030 and affixing and signing the following declaration to the statement:

I (Insert name) have delivered a copy of the foregoing disclosure statement as required by law to (insert Buyer's name) who has refused to sign.

I declare the foregoing to be true under penalty of perjury.