REAL ESTATE RENTAL FORM
Leasing Forms and Addendums

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LEASING FORMS & ADDENDUMS - LEAD DISCLOSURE

DISCLOSURE OF INFORMATION OF LEAD-BASED PAINT

OR LEAD-BASED PAINT HAZARDS

 As appropriate, this disclosure is provided to:

o A current tenant.

o An applicant prior to signing a rental agreement.

LEAD WARNING STATEMENT

Housing built prior to 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.

1. LESSOR'S DISCLOSURE INITIAL(A); (1) or (2) AND INITIAL (B); (1) or (2)
________ (a) Presence of lead-based paint and/or lead based paint hazards. (Initial one):

_______ (1) Known lead-based paint and/or lead-based paint hazards are present in the housing.
Explain:___________________________________________________

_______ (2) Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

________ (b) Records and reports available to the tenant: (Initial one)

________ (1) Lessor has provided the tenant with all available records and reports pertaining to lead-based paint and/or lead based paint hazard in the housing. (List below): _______________________________________________________

_______ (2) Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing

2. LESSEE'S ACKNOWLEDGEMENT (Initial)
______ (c) Lessee has received copies of all information
above; AND
______ (d) Lessee has received the pamphlet Protect Your Family
from Lead in the Home

3. AGENT'S ACKNOWLEDGEMENT (Initial)
______ (e) Agent has informed the lessor of the lessor's obligation under 42 U.S.C. 4582(d) and is aware of his/her responsibility to ensure compliance.

4. CERTIFICATION OF ACCURACY

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

_______________________________________ _______________________________________
Lessee                                        Date                               Lessee                                Date

_______________________________________ _______________________________________
Lessor                                        Date                                Lessor                                Date

_______________________________________ _______________________________________
Agent                                         Date                                 Agent                                Date

 

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