Sample
attachment to agreement required by law:
Property
Address:________________________________ Date:__________
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. Lessee 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 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
Acknowledgement
(c)
____ Lessee has received copies of all information listed above.
(d)
____ Lessee has received the pamphlet Protect Your Family from Lead In
Your Home
Lessee
________________ Date ______ Lessor ________________ Date _____
Lessee
________________ Date ______ Lessor ________________ Date _____