Lead Warning Statement

Lead Warning Statement
Building Address
Apt
Every tenant of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The Landlord of any interest in residential real property is required to provide the buyer with information on lead-based paint hazard from risk assessment or inspections in the Landlord’s possession and notify the tenant of any known lead-based hazards. A risk assessment or inspection for possible lead-based paint hazard is recommended to be performed by the tenant prior to move in.
Landlord’s Disclosure
a) Presence of lead-based paint and/or lead hazards (Landlord to check (i) or (ii) below):
(i) _______Known lead-based paint and/or lead-based paint hazards are present in the Unit and/or common areas (explain).
(ii) _______Landlord has no records or reports pertaining to lead-based paint and/or lead-based paint hazards in the Unit and/or common areas.
b) Records and reports available to the Landlord (Landlord to initial (i) or (ii) below):
(i) _______Landlord has provided the Tenant with all available records and reports pertaining to lead-based paint hazards in the Unit and/or common areas (list document below).
(ii) _______Landlord has no records or reports pertaining to lead-based paint and/or lead-based paint hazards in the unit and/or common areas.
Tenants Acknowledgment
(c) _______Tenant has received copies of all information listed above.
(d) _______Tenant has downloaded the pamphlet Protect your Family from Lead in your Home.
(e) Tenant has (check (i) or (ii) below):
(i) _______Received a 10 day opportunity (or other mutually agreed upon period) to conduct a risk assessment or inspection for the presence.
ii) _______Waived the opportunity to conduct a risk assessment or inspection for the presence of lead-based paint/or lead-based paint hazards.
Agent’s (Broker) acknowledgement
(f) _______Agent (all Brokers) has informed the Landlord of the Landlord’s obligation under 42 U.S.C. 4852d and is aware of Agent’s (all Broker) independent 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.
Hidden
Landlord’s Signature:
Tenant’s Signature:*
Hidden
Agent’s Signature:

LINDALOUEY.COM

Lead Warning Statement

Lead Warning Statement

Landlord’s Disclosure

Tenants Acknowledgment

Agent’s (Broker) acknowledgement

Certification of Accuracy

ADDRESS

PHONE

EMAIL