Lead Paint Disclosure (Page 2 of 2) in pdf

Lead Paint Disclosure Page 2

[__] The Lessor has no knowledge of any lead-based paint and / or any lead-based paint hazards

in the housing unit.

Records and reports that were made available to the Lessor:

[__] The Lessor has provided the Lessee with all available records and reports that pertain to

lead based paint and / or lead-based paint hazards in the housing unit.

Documents provided: ____________________________________________________________

______________________________________________________________________________

[__] The Lessor has no knowledge of any lead-based paint and / or any lead-based paint hazards

in the housing unit.

Lessee’s Acknowledgment:

______ (Initial) Lessee has received copies of all information listed above.

______ (Initial) Lessee has received the pamphlet Protect Your Family from Lead in Your Home.

Agent’s Acknowledgement:

______ (Initial) 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.

The following parties signed below have reviewed the above information and hereby certify to

the best of their knowledge that the information that they have provided is accurate and true.

______________________________________________________________________________

Signature of the Lessee

Date

______________________________________________________________________________

Signature of the Lessor

Date

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Lead Paint Disclosure Page 2