Rental Transaction

Lead-Based Paint Disclosure (Rental)

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Street Address                 City                                      State                               Zip

WARNING! LEAD FROM PAINT, DUST, AND SOIL CAN BE DANGEROUS IF NOT MANAGED PROPERLY

 

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

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, lessors must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention.

 

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

(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. Penalties for failure to comply with Federal Lead-Based Paint Disclosure Laws include treble (3 times) damages, attorney fees, costs, and a penalty up to $10,000 for each violation.

______________________________    ___________________________ Lessor                                          Date                     Lessee                                     Date

______________________________    ___________________________ Lessor                                          Date                     Lessee                                     Date

______________________________    ___________________________ Lessor                                          Date                     Lessee                                     Date

State Specific Real Estate Forms

–For State Specific Real Estate Forms you can download in Word format, go to http://www.uslegalforms.com/realestate/


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