Date:
Seller(s):
PropertyAddress:
Seller(s)certifiesthattothebestofSeller’s(s’)knowledgeandbelief(checkallthatapply):
Seller(s)hasnoknowledgeofthepresenceofconditionsthatcouldleadtothegrowthofmold(suchas,but notlimitedto,excessivehumidity,waterleakage,drainageproblems,flooding,etc).
Seller(s)hastreatedthePropertyAddressaboveformoldgrowingonstructuralcomponentssuchasbeams, studs,posts,wallcavitiesorpenetrating(growingbelowthesurface)ofwalls,ceilingsorfloors(“penetrating” doesnotmeanasmallamountofmoldormildewgrowingonshowercurtains,showersorbathtubs).
Pleaseprovidedetails-attachadditionalsheetsifnecessary
Seller(s)knowsofthepresenceofconditionsthatcouldleadtothegrowthofmold(excessivehumidity, waterleakage,drainageproblems,flooding,etc).(Pleaseprovidedetails)
Pleaseprovidedetails-attachadditionalsheetsifnecessary
TheSeller(s)makesthisdisclosureknowingthatthelistingagent,thebuyeragent,andanypotentialbuyer(s) willrelyontheinformationcontainedonthisdisclosure.
Seller'sSignature
PrintName
Seller'sSignature
PrintName
Date Date
I/Wehavereceivedandreadthisform.CompletionofthisformdoesnotmeanthattheSeller(s)hasperformed anyinvestigationofthePropertyorthatSeller(s)warrantsthatthePropertyiswithoutmold.
Note:Moldispresentinallhomes,andtherearecurrentlynostandardsforthepresenceofmoldormold remediation.ForfurtherinformationseetheConnecticutDepartmentofPublicHealth's" ".Thefactsheetisavailableathttp://www.state.ct.us/dph
©2002-2018ConnecticutAssociationofREALTORS®,Inc. 08/02,07/03;04/07;02/11
