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| | HB5131 | - 2 - | LRB102 25310 LNS 34584 b |
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1 | | Seller's Name: ..............................................
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2 | | This Report is a disclosure of certain conditions of the |
3 | | residential real
property listed above in compliance with the |
4 | | Residential Real Property
Disclosure Act. This information is |
5 | | provided as of ...(month) ...(day)
...(year), and does not |
6 | | reflect any changes made or occurring after that date
or |
7 | | information that becomes known to the seller after that date. |
8 | | The
disclosures herein shall not be deemed warranties of any |
9 | | kind by the seller or
any person representing any party in this |
10 | | transaction.
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11 | | In this form, "am aware" means to have actual notice or
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12 | | actual knowledge without any specific investigation or |
13 | | inquiry.
In this form, "material defect" means a condition |
14 | | that would
have a substantial adverse effect on the value of |
15 | | the residential
real property or that would significantly |
16 | | impair the health or
safety of future occupants of the |
17 | | residential real property
unless the seller reasonably |
18 | | believes that the condition has
been corrected.
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19 | | The seller discloses the following information with the
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20 | | knowledge that even though the statements herein are not |
21 | | deemed
to be warranties, prospective buyers may choose to rely |
22 | | on
this information in deciding whether or not and on what |
23 | | terms
to purchase the residential real property.
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24 | | The seller represents that to the best of his or her actual
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25 | | knowledge, the following statements have been accurately noted
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26 | | as "yes" (correct), "no" (incorrect), or "not applicable" to |
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| | HB5131 | - 3 - | LRB102 25310 LNS 34584 b |
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1 | | the
property being sold. If the seller indicates that the |
2 | | response
to any statement, except number 1, is yes or not |
3 | | applicable, the
seller shall provide an explanation, in the |
4 | | additional information
area of this form.
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5 | | |
YES |
NO |
N/A |
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6 | | 1. |
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..... |
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Seller has occupied the property |
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7 | | |
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within the last 12 months. |
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8 | | | | | | (No explanation is needed.) |
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9 | | 2. |
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I am aware of flooding or recurring |
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10 | | |
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leakage problems in the crawl |
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11 | | |
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space or basement. |
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12 | | 3. |
..... |
..... |
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I am aware that the property is |
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13 | | |
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located in a flood plain or that I |
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14 | | |
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currently have flood hazard |
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15 | | |
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insurance on the property. |
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16 | | 4. |
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..... |
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I am aware of material defects in |
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17 | | |
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the basement or foundation |
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18 | | |
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(including cracks and bulges). |
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19 | | 5. |
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I am aware of leaks or material |
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20 | | |
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defects in the roof, ceilings, or |
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21 | | |
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chimney. |
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22 | | 6. |
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I am aware of material defects in |
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23 | | |
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the walls, windows, doors, or floors. |
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24 | | 7. |
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I am aware of material defects in |
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25 | | |
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the electrical system. |
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26 | | 8. |
..... |
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I am aware of material defects in |
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| | HB5131 | - 6 - | LRB102 25310 LNS 34584 b |
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1 | | | | | | defined in Section 10 of
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2 | | | | | | the Methamphetamine Control
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3 | | | | | | and Community Protection Act.
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4 | | 24. | ..... | ..... | ..... | I am aware of unsafe concentrations | |
5 | | | | | | of or unsafe conditions relating | |
6 | | | | | | to mold on the premises. |
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7 | | Note: These disclosures are not intended to cover the |
8 | | common
elements of a condominium, but only the actual |
9 | | residential real
property including limited common elements |
10 | | allocated to the
exclusive use thereof that form an integral |
11 | | part of the
condominium unit.
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12 | | Note: These disclosures are intended to reflect the |
13 | | current condition of
the premises and do not include previous |
14 | | problems, if any, that the seller
reasonably believes have |
15 | | been corrected.
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16 | | If any of the above are marked "not applicable" or "yes", |
17 | | please explain here
or use additional pages, if necessary:
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18 | | .............................................................
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19 | | .............................................................
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20 | | .............................................................
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21 | | Check here if additional pages used: .....
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22 | | Seller certifies that seller has prepared this statement |
23 | | and
certifies that the information provided is based on the |
24 | | actual
notice or actual knowledge of the seller without any |
25 | | specific
investigation or inquiry on the part of the seller. |
26 | | The seller
hereby authorizes any person representing any |
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| | HB5131 | - 7 - | LRB102 25310 LNS 34584 b |
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1 | | principal in this
transaction to provide a copy of this |
2 | | report, and to disclose
any information in the report, to any |
3 | | person in connection
with any actual or anticipated sale of |
4 | | the property.
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5 | | Seller: ............................... Date: ...............
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6 | | Seller: ............................... Date: ...............
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7 | | THE PROSPECTIVE BUYER IS AWARE THAT THE PARTIES MAY CHOOSE
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8 | | TO NEGOTIATE AN AGREEMENT FOR THE SALE OF THE PROPERTY SUBJECT |
9 | | TO
ANY OR ALL MATERIAL DEFECTS DISCLOSED IN THIS REPORT ("AS |
10 | | IS").
THIS DISCLOSURE IS NOT A SUBSTITUTE FOR ANY INSPECTIONS |
11 | | OR WARRANTIES
THAT THE PROSPECTIVE BUYER OR SELLER MAY WISH TO |
12 | | OBTAIN
OR NEGOTIATE. THE FACT THAT THE SELLER IS NOT AWARE OF A |
13 | | PARTICULAR
CONDITION OR PROBLEM IS NO GUARANTEE THAT IT DOES |
14 | | NOT EXIST.
THE PROSPECTIVE BUYER IS AWARE THAT HE MAY REQUEST |
15 | | AN INSPECTION OF
THE PREMISES PERFORMED BY A QUALIFIED |
16 | | PROFESSIONAL.
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17 | | Prospective Buyer: .................. Date: ...... Time: ....
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18 | | Prospective Buyer: .................. Date: ...... Time: ....
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19 | | (Source: P.A. 98-754, eff. 1-1-15 .)
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