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Seller's Name: ..............................................
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This Report is a disclosure of certain conditions of the |
residential real
property listed above in compliance with the |
Residential Real Property
Disclosure Act. This information is |
provided as of ...(month) ...(day)
...(year), and does not |
reflect any changes made or occurring after that date
or |
information that becomes known to the seller after that date. |
The
disclosures herein shall not be deemed warranties of any |
kind by the seller or
any person representing any party in this |
transaction.
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In this form, "am aware" means to have actual notice or
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actual knowledge without any specific investigation or |
inquiry.
In this form, "material defect" means a condition that |
would
have a substantial adverse effect on the value of the |
residential
real property or that would significantly impair |
the health or
safety of future occupants of the residential |
real property
unless the seller reasonably believes that the |
condition has
been corrected.
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The seller discloses the following information with the
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knowledge that even though the statements herein are not deemed
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to be warranties, prospective buyers may choose to rely on
this |
information in deciding whether or not and on what terms
to |
purchase the residential real property.
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The seller represents that to the best of his or her actual
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knowledge, the following statements have been accurately noted
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as "yes" (correct), "no" (incorrect), or "not applicable" to |
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the
property being sold. If the seller indicates that the |
response
to any statement, except number 1, is yes or not |
applicable, the
seller shall provide an explanation, in the |
additional information
area of this form.
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YES |
NO |
N/A |
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1. |
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..... |
..... |
Seller has occupied the property |
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within the last 12 months. |
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| | | | (No explanation is needed.) |
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2. |
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..... |
I am aware of flooding or recurring |
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leakage problems in the crawl |
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space or basement. |
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3. |
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I am aware that the property is |
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located in a flood plain or that I |
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currently have flood hazard |
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insurance on the property. |
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4. |
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I am aware of material defects in |
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the basement or foundation |
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(including cracks and bulges). |
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5. |
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I am aware of leaks or material |
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defects in the roof, ceilings, or |
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chimney. |
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6. |
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I am aware of material defects in |
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the walls , windows, doors, or floors. |
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7. |
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I am aware of material defects in |
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the electrical system. |
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8. |
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I am aware of material defects in |
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| | | | defined in Section 10 of
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| | | | the Methamphetamine Control
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| | | | and Community Protection Act.
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Note: These disclosures are not intended to cover the |
common
elements of a condominium, but only the actual |
residential real
property including limited common elements |
allocated to the
exclusive use thereof that form an integral |
part of the
condominium unit.
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Note: These disclosures are intended to reflect the current |
condition of
the premises and do not include previous problems, |
if any, that the seller
reasonably believes have been |
corrected.
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If any of the above are marked "not applicable" or "yes", |
please explain here
or use additional pages, if necessary:
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.............................................................
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Check here if additional pages used: .....
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Seller certifies that seller has prepared this statement |
and
certifies that the information provided is based on the |
actual
notice or actual knowledge of the seller without any |
specific
investigation or inquiry on the part of the seller. |
The seller
hereby authorizes any person representing any |
principal in this
transaction to provide a copy of this report, |
and to disclose
any information in the report, to any person in |
connection
with any actual or anticipated sale of the property.
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Seller: ............................... Date: ...............
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Seller: ............................... Date: ...............
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THE PROSPECTIVE BUYER IS AWARE THAT THE PARTIES MAY CHOOSE
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TO NEGOTIATE AN AGREEMENT FOR THE SALE OF THE PROPERTY SUBJECT |
TO
ANY OR ALL MATERIAL DEFECTS DISCLOSED IN THIS REPORT ("AS |
IS").
THIS DISCLOSURE IS NOT A SUBSTITUTE FOR ANY INSPECTIONS |
OR WARRANTIES
THAT THE PROSPECTIVE BUYER OR SELLER MAY WISH TO |
OBTAIN
OR NEGOTIATE. THE FACT THAT THE SELLER IS NOT AWARE OF A |
PARTICULAR
CONDITION OR PROBLEM IS NO GUARANTEE THAT IT DOES |
NOT EXIST.
THE PROSPECTIVE BUYER IS AWARE THAT HE MAY REQUEST |
AN INSPECTION OF
THE PREMISES PERFORMED BY A QUALIFIED |
PROFESSIONAL.
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Prospective Buyer: .................. Date: ...... Time: ....
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Prospective Buyer: .................. Date: ...... Time: ....
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(Source: P.A. 96-232, eff. 8-11-09.)
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