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<br />Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards <br /> <br />Lead Warning Statement <br />Housing built before 7978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose <br />health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant <br />women. Before renting pre-7978 housing, lessors must disclose the presence of known lead-based paint and/or <br />lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead <br />poisoning prevention. <br /> <br />Lessor's Disclosure <br />(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below): <br />(i) Known lead-based paint and/or lead-based paint hazards are present in the housing <br />(explain). <br /> <br />(ii) _ Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the <br />housing. <br /> <br />(b) Records and reports available to the lessor (check (i) or (ii) below): <br /> <br />(i) Lessor has provided the lessee with all available records and reports pertaining to <br />lead-based paint and/or lead-based paint hazards in the housing (list documents <br />below). <br /> <br />(ii) _ Lessor has no reports or records pertaining to lead-based paint and/or lead-based <br />paint hazards in the housing. <br /> <br />Lessee's Acknowledgment (initial) <br />(c) Lessee has received copies of all information listed above. <br />(d) Lessee has received the pamphlet Proted Your Family from Lead in Your Home. <br /> <br />Agenfs Acknowledgment (initial) <br />(e) Agent has informed the lessor of the lessor's obligations under 42 USe. 4852(d) and <br />is aware of his/her responsibility to ensure compliance. <br /> <br />Certification of Accuracy <br /> <br />The following parties have reviewed the information above and certify, to the best of their knowledge, that <br />the information they have provided is true and accurate. <br /> <br />Lessor <br /> <br />Date <br /> <br />Lessor <br /> <br />Date <br /> <br />Lessee <br /> <br />Date <br /> <br />Lessee <br /> <br />Date <br /> <br />Date <br /> <br />Agent <br /> <br />Date <br /> <br />Agent <br />