Environmental Engineering Reference
In-Depth Information
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 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 mem-
ory. 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
(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 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
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 (i) or (ii) below):
(i)___received a 10-day opportunity (or mutually agreed upon period) to conduct a risk
assessment 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
of 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
Seller
Date
Seller
Date
Seller
Date
Seller
Date
Figure 13.2
Model residential lead disclosure form.
