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Disclosure of Information on Lead-Based Paint …

Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards Lead Warning Statement Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is

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Text of Disclosure of Information on Lead-Based Paint …

Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint HazardsLead Warning StatementEvery purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 isnotified that such property may present exposure to lead from lead-based paint that may place young children at riskof 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 seller of any interest in residential real property isrequired to provide the buyer with any information on lead-based paint hazards from risk assessments or inspectionsin the seller s possession and notify the buyer of any known lead-based paint hazards. A risk assessment or inspectionfor possible lead-based paint hazards is recommended prior to 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) _____ Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.(b) Records and reports available to the seller (check (i) or (ii) below):(i) ______ Seller has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing (list documents below). ________________________________________ ________________________________________ _______(ii) _____ Seller has no reports or records pertaining to lead-based paint and/or lead-based painthazards in the s Acknowledgment(initial)(c) ________ Purchaser has received copies of all information listed above.(d) ________ Purchaser has received the pamphlet Protect Your Family from Lead in Your Home.(e) Purchaser has (check (i) or (ii) below):(i) _____ received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assess-ment or inspection for the presence of lead-based paint and/or lead-based paint hazards; or(ii) _____ waived the opportunity to conduct a risk assessment or inspection for the presence oflead-based paint and/or lead-based paint s Acknowledgment(initial)(f) ________ Agent has informed the seller of the seller s obligations under 42 4852(d) and isaware of his/her responsibility to ensure of AccuracyThe following parties have reviewed the information above and certify, to the best of their knowledge, that theinformation they have provided is true and ________________________________________ __________SellerDateSellerDate__________ ________________________________________ ________________________________________ __________PurchaserDatePurchaserDate____ ________________________________________ ______ ________________________________________ __________AgentDateAgentDate

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