DISCLOSURE OF INFORMATION AND ACKNOWLEDGEMENT LEAD BASE PAINT AND/OR LEAD-BASE PAINT HAZARDS
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Include street, city, state, and zip code
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)
Checkmark the correct box in a. + b. and all seller's initial in a. + b..
Presence of lead-based paint and / or lead-based paint hazards (check one below): a:
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Known lead-based paint and / or lead-based paint hazards are present in the housing
Seller has no knowledge of lead-based paint and / or lead-based paint hazards in the housing.
Seller (s) Initials a:
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Records and Reports available to seller (check one below): b.
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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.
Seller (s) Initials b.
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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 Signature
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Co-Seller Signature
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Type a question
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