Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips,
and dust can pose health hazards if not managed properly. Lead exposure is especially
harmful to young children and pregnant women. Before renting pre-1978 housing, landlords
must disclose the presence of known lead-based paint and/or lead-based paint hazards
in the dwelling. Tenants must also receive a federally approved pamphlet on lead
poisoning prevention.
Lessor's Disclosure (initial)
__________(a) Presence of lead-based paint or lead-based paint hazards (check one
below):
Known lead-based paint and/or lead-based paint hazards
are present in the housing (explain).
________________________________________________________________________ ________________________________________________________________________
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 one below):
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).
________________________________________________________________________ ________________________________________________________________________
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. 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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