Real Estate Disclosure Statement

Property Information

Property Address City State ZIP Code

Seller Information

Seller Name(s) Email Phone

Disclosure Details

Are you aware of any material defects affecting the property? Are there any environmental hazards (lead paint, asbestos, radon, etc.)? Have there been any recent repairs, renovations, or additions? Are there any boundary disputes or encroachments? Any history of water damage, flooding, or mold? Other known issues or conditions:

Certification

Seller's Signature Date