Disclosure Of Information On Radon Hazards Form
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1DISCLOSURE OF INFORMATION ON RADON HAZARDS
(For Residential Real Property Sales or Purchases)
Radon Warning Statement
Every buyer of any interest in residential real property is notified that the property may present
exposure to dangerous levels of indoor radon gas that may place the occupants at risk of developing radon-
induced lung cancer. Radon, a Class-A human carcinogen, is the leading cause of lung cancer in non-
smokers and the second leading cause overall. The seller of any interest in residential real property is
required to provide the buyer with any information on radon test results of the dwelling showing elevated
levels of radon in the seller's possession.
The State of ______________________________ strongly recommends ALL homebuyers have an
indoor radon test performed prior to purchase or taking occupancy, and mitigated if elevated levels are found.
Elevated radon concentrations can easily be reduced by a qualified, licensed radon mitigator.
Property Address:
Seller's Disclosure (initial each of the following which applies)
(a)
Elevated radon concentrations (above EPA or IEMA recommended Radon Action Level) are
known to be present within the dwelling. (Explain)
(b)
Seller has provided the purchaser with the most current records and reports pertaining to elevated
radon concentrations within the dwelling.
(c)
Seller either has no knowledge of elevated radon concentrations in the dwelling or prior elevated
radon concentrations have been mitigated or remediated.
(d)
Seller has no records or reports pertaining to elevated radon concentrations within the dwelling.
Purchaser's Acknowledgment (initial each of the following which applies)
(e)
Purchaser has received copies of all information listed above.
(f)
Purchaser has received the IEMA approved Radon Disclosure Pamphlet.
Agent's Acknowledgment (initial) (if applicable)
(g)
Agent has informed the seller of the seller's obligations under StateS law.
Certification of Accuracy
The following parties have reviewed the information above and each party certifies, to the best of his or her
knowledge, that the information he or she provided is true and accurate.
Seller
Seller
Printed Name
Printed Name
Seller
Date
Seller
Date
Signature
Signature
Purchaser
Purchaser
Printed Name
Printed Name
Purchaser
Date
Purchaser
Date
Signature
Signature
Agent
Agent
Printed Name
Printed Name
Agent
Date
Agent
Date
Signature
Signature
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