REAL ESTATE RENTAL FORM
Maintenance/Management

(Download link is below the form)

MAINTENANCE/MANAGEMENT - ACKNOWLEDGE RENOVATION

ACKNOWLEDGEMENT OF RENOVATION TO BE DONE

(To be given to rental residents prior to renovation or repair activity but no more than 60 days be-fore beginning renovation activities in any residential dwelling unit built before 1978. Residents should also be given a notice that shall describe the general nature and locations of the planned renovation activities; the expected starting and ending dates. Renovation is defined as any activity that results in the disturbance of more than two square-feet of paint per building component including removal of large structures such as walls, ceiling, replastering, and window replacement and surface preparation activities such as sanding, scraping, or other activities that generate lead paint dust).

Protect Your Family From Lead In Your Home, informing me of the potential risk of lead hazard exposure from renovation activity to be performed in my dwelling unit. I re-ceived this pamphlet before the work began.

Property Address_______________________________________________

Printed Name of Resident ________________________________________

Signature of Resident ___________________________________________

Date____________________________

Please note: When an occupant is unavailable for signature or refuses to sign the acknowledgment of receipt of the pamphlet, the owner/manager can certify delivery.  If residents are unavailable for signature, the owner may fill in the following section.

__ The resident was unavailable. I certify that I have made a good faith effort to deliv-er the pamphlet, Protect Your Family From Lead In Your Home, to the unit listed below at the dates and times indicated, and that the occupant refused to sign the acknowledgment. I further certify that I have left a copy of the pamphlet at the unit with the occupant.

Property Address_______________________________________________

Attempted delivery Dates & Times_________________________________

Printed Name of Owner/Manager__________________________________

Signature of Owner/Manager_______________________________________

Date____________________________

If residents refuse to sign, the owner may fill in the following section.

__ I certify that I have made a good faith effort to deliver the pamphlet, Protect Your Family From Lead In Your Home, to the unit listed below, and that the occupant was unavailable to sign the acknowledgment. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door.

Property Address_______________________________________________

Attempted delivery Dates & Times _________________________________

Printed Name of Owner/Manager (Person Leaving Pamphlet)

__________________________________

Signature of Owner/Manager_______________________________________ 

Date____________________________

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