Lead Paint Disclosure
Effective Date:
____/____/______
Tenant
[Legal Name] (AKA, “The Lessee”)
Located at
[Address]
[City], [State] [Zip Code]
&
Landlord
[Legal Name](AKA, “The Lessor”)
Located at
[Address]
[City], [State] [Zip Code]
The above mentioned parties do hereby agree as follows:
Statement of Warning for Lead:
Housing that was built before 1978 may contain paint that is lead-based. If not managed
properly lead from paint, paint chips, and dust can pose health hazards. Lead exposure is
especially harmful to young children and pregnant women. Lessors must disclose the presence
of paint that is lead-based and / or lead-based paint hazards that are present in the dwelling
before renting. A federally approved pamphlet on lead poisoning prevention must also be given
to all Lessees.
Lessor’s Disclosure:
Presence of lead-based paint and / or lead-based paint hazards:
[__] There are known lead-based paint and / or lead –based paint hazards in the housing unit.
Details: _______________________________________________________________________
______________________________________________________________________________
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