Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Lease of target housing (built before 1978) | 40 CFR 745.113(b) | 24 CFR 35.92(b)
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. Lessees 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 (initial (i) or (ii) below):
________ [X] (i) Known lead-based paint and/or lead-based paint hazards are present in the housing. Describe what is known: A 2019 inspection found lead-based paint on the exterior window trim and the front porch railing. The paint was intact at the last check. No lead-based paint was found on interior walls.
________ [ ] (ii) 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 (initial (i) or (ii) below):
________ [X] (i) 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: Lead-based paint inspection report, ABC Environmental, March 12, 2019 (12 pages)
________ [ ] (ii) Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.
Lessee's Acknowledgment
(c) Lessee has (initial (i) or (ii) below):
________ [X] (i) received copies of all records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing listed above.
________ [ ] (ii) not received any records and reports regarding lead-based paint and/or lead-based paint hazards in the housing.
________ [X] (d) Lessee has received the pamphlet "Protect Your Family From Lead in Your Home" (initial).
Agent's Acknowledgment
Initial, or enter N/A if not applicable.
N/A (e) Lessor's agent has informed the lessor of the lessor's obligations under 42 U.S.C. 4852d and is aware of his/her responsibility to ensure compliance.
N/A (f) Lessee's agent has informed the lessor of the lessor's obligations under 42 U.S.C. 4852d and is aware of his/her responsibility to ensure compliance. (Only required if the lessee's agent receives compensation from the lessor.)
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.
Required attachments
- [checked] EPA pamphlet "Protect Your Family From Lead in Your Home" (or an EPA-approved equivalent), given to the lessee
- [checked] Copy of: Lead-based paint inspection report, ABC Environmental, March 12, 2019 (12 pages)