Residential Real Property Disclosure Report

The following information is provided pursuant to the
Illinois Residential Real Property Disclosure Act of 1993

Residential Real Property Disclosure Report

NOTICE: THE PURPOSE OF THIS REPORT IS TO PROVIDE PROSPECTIVE BUYERS WITH INFORMATION ABOUT MATERIAL DEFECTS IN THE RESIDENTIAL REAL PROPERTY. THIS REPORT DOES NOT LIMIT THE PARTIES RIGHT TO CONTRACT FOR THE SALE OF RESIDENTIAL REAL PROPERTY IN "AS IS" CONDITION. UNDER COMMON LAW SELLERS WHO DISCLOSE ADVERSE MATERIAL DEFECTS MAY BE UNDER A CONTINUING OBLIGATION TO ADVISE THE PROSPECTIVE BUYERS ABOUT THE CONDITION OF THE RESIDENTIAL REAL PROPERTY EVEN AFTER THE REPORT IS DELIVERED TO THE PROSPECTIVE BUYER. COMPLETION OF THIS REPORT BY SELLER CREATES LEGAL OBLIGATIONS ON SELLER. THEREFORE SELLER MAY WISH TO CONSULT AN ATTORNEY PRIOR TO COMPLETION OF THIS REPORT.

Property Address:

______________________________________________________

City, State and ZIP Code:

______________________________________________________

Seller's Name:

______________________________________________________

This report is a disclosure of certain conditions of the residential real property listed above in compliance with the Residential Real Property Act. This information is provide as of:

Date of Report: _______________________

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.

In this form, "am aware" means to have actual notice or actual knowledge without any specific investigation or inquiry. In this form, a "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.

The seller discloses the following information with the knowledge that even though the statement herein are not deemed 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.

The seller represents that to the best of his or her actual knowledge, the following statements have been accurately noted is "yes" (correct), "no" (incorrect), or "not applicable" to 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.

Yes | No | N/A |

[ ] | [ ] | [ ] | Seller has occupied the property within the last twelve months.


[ ] | [ ] | [ ] | I am aware of flooding or recurring leakage problems in the crawl space or basement.


[ ] | [ ] | [ ] | I am aware that the property is located in a flood plain or that I currently have flood hazard insurance on the property.


[ ] | [ ] | [ ] | I am aware of material defects in the basement or foundation (including cracks and bulges)


[ ] | [ ] | [ ] | I am aware of material defects in the roof, ceilings, or chimney.


[ ] | [ ] | [ ] | I am aware of material defects in the walls or floors.


[ ] | [ ] | [ ] | I am aware of material defects in the electrical system


[ ] | [ ] | [ ] | I am aware of material defects in plumbing system (includes such things as water heater, sump pump, water treatment system, sprinkler system, and swimming pool).


[ ] | [ ] | [ ] | I am aware of material defects in the well or well equipment.


[ ] | [ ] | [ ] | I am aware of material defects in the drinking water.


[ ] | [ ] | [ ] | I am aware of material defects in heating, air conditioning, or ventilating system.


[ ] | [ ] | [ ] | I am aware of material defects in fireplace or woodburning stove.


[ ] | [ ] | [ ] | I am aware of material defects in septic, sanitary sewer, or other disposal system.


[ ] | [ ] | [ ] | I am aware of unsafe concentrations of radon on the premises.


[ ] | [ ] | [ ] | I am aware of unsafe concentrations of or unsafe conditions relating to asbestos in the premises.


[ ] | [ ] | [ ] | I am aware of unsafe concentrations of or unsafe conditions relating to lead paint, lead water pipes, lead plumbing pipes, or lead in the soil on the premises.


[ ] | [ ] | [ ] | I am aware of mine subsidence, underground pits, settlement, sliding, upheaval, or other earth stability defects on the premises.


[ ] | [ ] | [ ] | I am aware of current infestations of termites or other wood boring insects.


[ ] | [ ] | [ ] | I am aware of a structural defect caused by past infestations of termites or other wood boring insects.


[ ] | [ ] | [ ] | I am aware of underground fuel storage tanks on the property.


[ ] | [ ] | [ ] | I am aware of boundary or lot line disputes.


[ ] | [ ] | [ ] | I have received notice of violation of local, state, or federal laws or regulations relating to this property, which violation has not been corrected.


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.

If any of the above are marked "not applicable" or "yes", please explain here or use additional pages, if necessary:

@@ {None}

Seller certifies that seller has prepared this statement and certifies that the information provided is based upon 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 this report to any person in connection with any actual or anticipated sale of the property.

Seller: ___________________________________________ Date: __________________

Seller: ___________________________________________ Date: __________________

PROSPECTIVE BUYER IS AWARE THAT THE PARTIES MAY CHOOSE 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. PROSPECTIVE BUYER IS AWARE THAT HE MAY REQUEST AN INSPECTION OF THE PREMISES PERFORMED BY A QUALIFIED PROFESSIONAL.

Prospective Buyer: _________________________________ Date: __________________

Prospective Buyer: _________________________________ Date: __________________

765 ILCS 77/35