Informational Statement For Louisiana Residential Property Disclosure Form Page 5
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5Property Description (Address, City, State, Zip)
_________________________________________________________________
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Y
N
NK
(37) Were any additions or alterations made to the property?
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Y
N
NK
(a) If yes, were the necessary permits and inspections obtained for all additions or alterations?
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(38) Is there a homestead exemption in effect?
Y
N
NK
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□
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Y
N
NK
(39) Is there high speed Internet access available to the property?
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(40) Is there any pending litigation regarding the property?
Y
N
NK
(41) Does the property or any of its structures contain any of the following? (Check all that apply and provide the nature
and frequency at the end of this section.)
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Asbestos
Y
N
NK
Formaldehyde
Y
N
NK
□
□
□
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Y
N
NK
Y
N
NK
Radon gas
Chemical storage tanks
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□
□
□
□
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Contaminated soil
Y
N
NK
Contaminated water
Y
N
NK
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□
□
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Y
N
NK
Y
N
NK
Hazardous waste
Toxic Mold
□
□
□
□
□
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Y
N
NK
Y
N
NK
Mold/Mildew
Pets
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□
□
□
□
□
Electromagnetic fields
Y
N
NK
Crystal meth exposure
Y
N
NK
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Y
N
NK
Y
N
NK
Other adverse materials or conditions
Contaminated drywall/sheetrock
(42) Is there a cavity created within a salt stock by dissolution with water underneath the property?
□
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Y
N
NK
(43) Is there a solution mining injection well within two thousand six hundred forty feet (2640) feet of the property?
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Y
N
NK
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Question Number
Explanation of “Yes” answers
Additional sheet is attached
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
ACKNOWLEDGEMENTS
I/We attest that the above statements and explanations have been provided by me/us and are true and correct to the
best of my/our knowledge. (If either party is represented by a real estate licensee, your signature below acknowledges
that you have been informed of your duties and rights under LSA-R.S. 9:3195-3199 and have read and understand the
informational statement.)
Seller(s) acknowledge(s) that the information contained herein is current as of this date.
Seller (sign) _____________________________ (print) _________________________ Date ________ Time ________
Seller (sign) _____________________________ (print) _________________________ Date ________ Time ________
Purchaser(s) signing below acknowledge(s) receipt of this property disclosure.
Purchaser (sign) _________________________
(print) _________________________ Date ________ Time ________
Purchaser (sign) _________________________
(print) _________________________ Date ________ Time ________
Seller’s Initials: _____ _____
Purchaser’s Initials: _____ _____
LREC Rev. 08/01/13
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