Every purchase 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 damages, 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 is required to provide the
buyer with any information on lead-based paint hazards from risk assessments
or inspections in the seller’s possession and notify the buyer of any known
lead-based paint hazards. A risk assessment or inspection for possible
lead-based paint hazards is recommended prior to purchase.
SELLER DISCLOSURE (Initial)
___(a) Presence of lead-based paint and/or lead-based paint hazard (check
one below):
Known lead-based paint and/or
lead-based paint hazards are present in the housing (explain):
____________________________________________________________________
____________________________________________________________________
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 one below):
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):
____________________________________________________________________
____________________________________________________________________
Seller has no reports or
records pertaining to lead-based paint and/or lead-based paint hazards in
the housing
PURCHASER'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 one below):
Received a 10-day opportunity
(or mutually agreed upon period) to conduct a risk assessment or inspection
of the presence of lead-based paint or lead-based paint hazards; or
Waived the opportunity to conduct a
risk assessment or inspection for the presence or lead-based paint and/or
lead-based paint hazards.
AGENT'S ACKNOWLEDGMENT (Initial):
___(f) Agent has informed the seller of the seller's obligations under 42
U.S.C. 4852d and is aware of his/her 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
Seller__________________________ Date _________
Seller__________________________ Date _________
Agent _________________________ Date _________
Purchaser______________________ Date _________
Purchaser______________________ Date _________
Agent_________________________ Date _________
Property Address:_______________________
___________________
