Lead Warning Statement
Every purchaser 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 seller of any interest in residential real property is required to provide
the buyer with any information on lead-based paint hazards from risk assessments
or inspections in the seller's possession and notify the buyer of any known lead-based
paint hazards. A risk assessment or inspection for possible lead-based paint hazards
is recommended prior to purchase.
Seller's Disclosure (initial)
__________(a) Presence of lead-based paint and/or lead-based paint hazards (check
one below):
Known lead-based paint and/or lead-based paint hazards
are present in the housing (explain).
______________________________________________________ ______________________________________________________
Seller has no knowledge of lead-based paint and/or
lead-based paint hazards in the housing.
__________(b) Records and reports available to the seller (check one below):
Seller has provided the purchaser with all available
records and reports pertaining to lead-based paint and/or lead-based paint hazards
in the housing (list documents below).
_______________________________________________________ _______________________________________________________
Seller has no reports or records pertaining to lead-based
paint and/or lead-based paint hazards in the housing.
Purchaser's Acknowledgment (initial)
__________(c) Purchaser has received copies of all information listed above.
__________(d) Purchaser has received the pamphlet Protect Your Family From Lead
in Your Home.
__________(e) Purchaser has (check one below):
Received a 10-day opportunity (or mutually agreed
upon period) to conduct a risk assessment or inspection for the presence of lead-based
paint and/or lead-based paint hazards; or
Waived the opportunity to conduct a risk assessment
or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Agent's Acknowledgment (initial)
__________(f) Agent has informed the seller of the seller's obligations under 42
U.S.C. 4852d 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 provided by the signatory is true and accurate.
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