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|  |  | SB0310 | - 2 - | LRB095 10796 AJO 31044 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 that  | 
| 14 |  | would
have a substantial adverse effect on the value of the  | 
| 15 |  | residential
real property or that would significantly impair  | 
| 16 |  | the health or
safety of future occupants of the residential  | 
| 17 |  | real property
unless the seller reasonably believes that the  | 
| 18 |  | 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 deemed
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| 21 |  | to be warranties, prospective buyers may choose to rely on
this  | 
| 22 |  | information in deciding whether or not and on what terms
to  | 
| 23 |  | 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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|  |  | SB0310 | - 3 - | LRB095 10796 AJO 31044 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. | 
..... | 
..... | 
..... | 
Seller  has  occupied  the  property | 
 
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within the last 12 months. | 
 
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 | 8 |  |  |  |  |  |  (No explanation is needed.) |  
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 | 9 |  | 2. | 
..... | 
..... | 
..... | 
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. | 
..... | 
..... | 
..... | 
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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 | 15 |  |  | 
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insurance on the property.  | 
 
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 | 16 |  | 4. | 
..... | 
..... | 
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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 or floors. | 
 
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 | 24 |  | 7. | 
..... | 
..... | 
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I am aware of  material  defects  in | 
 
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the electrical system. | 
 
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 | 26 |  | 8. | 
..... | 
..... | 
..... | 
I am  aware  of  material defects in | 
 
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|  |  | SB0310 | - 6 - | LRB095 10796 AJO 31044 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 |  |     Note:  These disclosures are not intended to cover the  | 
| 5 |  | common
elements of a condominium, but only the actual  | 
| 6 |  | residential real
property including limited common elements  | 
| 7 |  | allocated to the
exclusive use thereof that form an integral  | 
| 8 |  | part of the
condominium unit. 
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| 9 |  |     Note:  These disclosures are intended to reflect the current  | 
| 10 |  | condition of
the premises and do not include previous problems,  | 
| 11 |  | if any, that the seller
reasonably believes have been  | 
| 12 |  | corrected.
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| 13 |  |     If any of the above are marked "not applicable" or "yes",  | 
| 14 |  | please explain here
or use additional pages, if necessary: 
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| 15 |  | ............................................................. 
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| 16 |  | ............................................................. 
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| 17 |  | ............................................................. 
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| 18 |  |     Check here if additional pages used: .....
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| 19 |  |     Seller certifies that seller has prepared this statement  | 
| 20 |  | and
certifies that the information provided is based on the  | 
| 21 |  | actual
notice or actual knowledge of the seller without any  | 
| 22 |  | specific
investigation or inquiry on the part of the seller.   | 
| 23 |  | The seller
hereby authorizes any person representing any  | 
| 24 |  | principal in this
transaction to provide a copy of this report,  | 
| 25 |  | and to disclose
any information in the report, to any person in  | 
| 26 |  | connection
with any actual or anticipated sale of the property. 
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|  |  | SB0310 | - 7 - | LRB095 10796 AJO 31044 b |  | 
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| 1 |  | Seller: ............................... Date: ...............
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| 2 |  | Seller: ............................... Date: ...............
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| 3 |  |     THE PROSPECTIVE BUYER IS AWARE THAT THE PARTIES MAY CHOOSE
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| 4 |  | TO NEGOTIATE AN AGREEMENT FOR THE SALE OF THE PROPERTY SUBJECT  | 
| 5 |  | TO
ANY OR ALL MATERIAL DEFECTS DISCLOSED IN THIS REPORT ("AS  | 
| 6 |  | IS").
THIS DISCLOSURE IS NOT A SUBSTITUTE FOR ANY INSPECTIONS  | 
| 7 |  | OR WARRANTIES
THAT THE PROSPECTIVE BUYER OR SELLER MAY WISH TO  | 
| 8 |  | OBTAIN
OR NEGOTIATE.  THE FACT THAT THE SELLER IS NOT AWARE OF A  | 
| 9 |  | PARTICULAR
CONDITION OR PROBLEM IS NO GUARANTEE THAT IT DOES  | 
| 10 |  | NOT EXIST.
THE PROSPECTIVE BUYER IS AWARE THAT HE MAY REQUEST  | 
| 11 |  | AN INSPECTION OF
THE PREMISES PERFORMED BY A QUALIFIED  | 
| 12 |  | PROFESSIONAL. 
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| 13 |  | Prospective Buyer: .................. Date: ...... Time: ....
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| 14 |  | Prospective Buyer: .................. Date: ...... Time: ....
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| 15 |  | (Source: P.A. 90-383, eff. 1-1-98; 91-357, eff. 7-29-99.)
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