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Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Sales

Property Address:

Lead Warning Statement

Every lessee of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The lessor of any interest in residential real property is required to provide the lessee with any information on lead-based paint hazards from risk assessments or inspections in the lessor’s possession and notify the lessee of any known leadbased paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to lease.

Lessor’s Disclosure

(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below):
(i)
Known lead-based paint and/or lead-based paint hazards are present in the housing (explain).
(ii)
Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b) Records and reports available to the lessor (check (i) or (ii) below):
(i)
Lessor has provided the lessee with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing (list documents below).
(ii)
Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

Lessee’s Acknowledgment

(initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphlet Protect Your Family from Lead in Your Home.

Agent’s Acknowledgment

(initial)
(e) Agent has informed the lessor of the lessor’s obligations under 42 U.S.C. 4852(d) and is aware of his/her responsibility to ensure compliance.

Certification of Accuracy

The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate.