Real Estate Hazard Disclosure Form

REAL ESTATE HAZARD DISCLOSURE FORM

Property Identification

Parties

Hazard Disclosures — Seller Responses

The Seller must disclose known environmental or health hazards affecting the Property to the best of Seller's knowledge. For each item below, check the applicable box and provide explanation where indicated. If Seller is uncertain, check Unknown.

Asbestos (friable or non-friable asbestos-containing materials): Yes No Unknown
If yes or remediation performed, describe date and actions taken:

Lead-based Paint (if home built before 1978 or unknown age): Yes No Unknown
If yes, provide locations, dates of testing, and remediation history:

Radon (elevated radon levels or mitigation systems): Yes No Unknown
If yes, indicate test results and mitigation details:

Mold, Moisture Intrusion, or Water Damage: Yes No Unknown
If yes, describe locations, dates and remediation performed:

Underground Storage Tanks (UST) or fuel tanks on property: Yes No Unknown
If yes, provide status, removal or closure documentation:

Hazardous Materials, Soil or Groundwater Contamination, or Environmental Cleanup: Yes No Unknown
If yes, identify the contaminant, location, and remediation status:

Floodplain, Flood Zone, or Repeated Flooding: Yes No Unknown
If yes, indicate flood zone designation, history and any mitigation:

Seismic / Earthquake Fault Zone or Geologic Hazard: Yes No Unknown
If yes, describe known exposures or improvements:

Wildfire / High Fire Severity Zone / Fire Hazard: Yes No Unknown
If yes, indicate history and mitigation measures:

Evidence of Illegal Drug Manufacturing (e.g., methamphetamine contamination): Yes No Unknown
If yes, provide details of testing and remediation:

Pest Infestation or Structural Damage (termites, rodents, etc.): Yes No Unknown
If yes, describe inspections, repairs and dates:

Prior Hazard Remediation or Abatement Work (asbestos removal, soil cleanup, etc.): Yes No Unknown
If yes, provide dates, contractor information, and documentation location:

Insurance Claims Related to Hazard Events (flood, fire, mold, etc.): Yes No Unknown
If yes, number of claims:

Other Known Hazards: Yes No Unknown
If yes, describe:

Seller's Certification

The undersigned Seller certifies, under penalty of perjury, that the information provided in this Hazard Disclosure Form is true and complete to Seller's actual knowledge as of the date signed below. Seller affirms that all known hazard conditions affecting the Property have been disclosed. Seller further certifies that Seller has disclosed any available reports, test results, permits, approvals, or closure documents related to the hazards identified above, if any.

Buyer's Acknowledgement

The undersigned Buyer acknowledges receipt of this Hazard Disclosure Form prior to entering into a purchase contract or prior to closing, and acknowledges the opportunity to obtain inspections, testing, and independent advice concerning the hazards disclosed herein. Buyer understands that this disclosure is based on Seller's actual knowledge and is not a substitute for Buyer-ordered inspections, testing or investigations.

Additional Disclosures / Comments

Default; Remedies; Governing Law

Any material misrepresentation or intentional omission in this Hazard Disclosure Form shall constitute a breach of Seller's obligations under any contract between the parties and entitle Buyer to pursue all available remedies at law or in equity, including rescission, damages, or specific performance as applicable. This Disclosure and any dispute arising hereunder shall be governed by the substantive law governing the sale contract for the Property. The parties agree that this Disclosure constitutes part of the sale transaction documents and that its terms are binding upon the parties and their successors and assigns.

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