Lead-Based Paint Seller Disclosure Form
Property Information
Property Address
Seller's Disclosure
Known lead-based paint and/or hazards are present in the housing.
Explain (if known):
Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
Seller has provided all available records and reports.
List Documents:
Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.
Agent's Acknowledgment
Agent has informed the seller of the seller's obligations under 42 U.S.C. 4852d and is aware of his/her responsibility to ensure compliance.
Buyer's Acknowledgment
Buyer has received copies of all information listed above.
Buyer has received the pamphlet "Protect Your Family from Lead in Your Home."
Buyer has had 10-day opportunity (or mutually agreed period) to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Buyer has waived the opportunity to conduct a risk assessment or inspection.
Signatures
Seller Date
Buyer Date
Agent Date