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Sample Disclosure Format for Target Housing Sales <br /> Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards <br />~..eadl Warning Statement <br /> Every pumhaser of any interest in residential real property on which a residential dwelling was built priorto 1978 <br /> is notified that such proper~y may present exposure to lead from lead-based paint that may place young children <br /> at ~fsk of developing lead poisoning. Lead poisoning in young ch~Tdren may produce permanent neurological <br /> damage, including learning disabilities, reduced intelligence quoEent, behavioral problems, and impaired memory. <br /> Lead poisoning also poses a pa~fcular risk to pregnant wbmen. The seller of any interest in residential real property <br /> is required to provide the buyer with any information on lead.based paint hazards f~m ~isk assessments or <br /> inspections in the selleds possession and notify the buyer of any known lead-based 'paint hazards. A ~sk <br /> assessment or inspec~on for possible lead-based paint hazards is mcommanded pri~r to pumhase. <br /> <br />Seller's Disclosure (initial) <br />~ (a) Presence of lead-based paint and/or lead-based paint hazards (check one below): <br /> O Known lead-based paint andlot ]earl-based paint hazards are present in the housing (explain). <br /> <br /> [~ Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. <br /> <br />~ (b) Records and reports available to the seller (check one below): <br /> [~ Seller has provided the purbaser with all available records andreports pertaining to lead-based paint <br /> and/or lead-based paint hazards in the hoaing (list documents below). <br /> <br />Seller has no reports or r~ords pertaining to lead:based paintand/or lead-based paint hazards in the <br />housing. <br /> <br />Purchaser's Acknowledgment (initial) <br /> (c) Purchaser has received copies'of all information listed above. <br /> <br />~ (d) Purchaser has received the pamphlet°rotect Your Family from Lead in Your Home. <br /> <br />~ (e) Purchaser has (check one below): <br /> ~ .Received a 10-day opportunity (or mutually agreed'upon period) to conduct a risk assessmen~'o <br /> ~nspection for the presence of lead-based paint and/or lead-based paint hazards; or <br /> <br /> [~ Waived the opportunity to conduct a risk assessment or inspecfio~r the presence of lead-based paint <br /> and/or lead-based paint hazards. <br /> <br />Agent's Acknowledgment (initial) <br />~ (f) Agent has informed the seller ofthe seller's obl'~3a§ons under 42 t$.C. 4852(d) and is aware of his/her <br /> responsibility to ensure compliance. <br /> <br />Cerliflcation of Accuracy <br />The following parties have reviewed the information above and certify, to the best of their knowledge, thatah <br />information provided by the signatory is true and accurate. <br /> <br />Seller <br /> <br />Purchaser <br /> <br />Date Seller Date <br /> Agent Date <br />Date Purchaser Date <br /> <br /> <br />