Lead Warning Statement
Every purchaser 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 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’s Disclosure (initial)
- __________ 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).
___________________________________________________________________________________
___________________________________________________________________________________
- Seller has no knowledge of lead-based paint and/or lead-based paint
hazards in the housing.
- __________ 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)
- __________ Purchaser has received copies of all information listed
above.
- __________ Purchaser has received the pamphlet Protect Your Family
From Lead in Your Home.
- __________ Purchaser has (check one below):
- Received a 10-day opportunity (or mutually agreed upon period) to
conduct a risk assessment inspection for the presence of lead-based
paint and/or lead-based paint hazards; or
- Waived the opportunity to conduct a risk assessment or inspection
for the presence of lead-based paint and/or lead-based paint
hazards.
Agent’s Acknowledgment (initial)
- __________ Agent has informed the seller of the seller’s obligations
under 42 U.S.C. 4852(d) 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 provided by the
signatory is true and accurate.
|
_______________________________ |
________ |
_______________________________ |
________ |
|
Seller |
Date |
Seller |
Date |
|
_______________________________ |
________ |
_______________________________ |
________ |
|
Agent |
Date |
Agent |
Date |
|
_______________________________ |
________ |
_______________________________ |
________ |
|
Purchaser |
Date |
Purchaser |
Date |