Massachusetts Tenant Lead Law Notification

Property Address:

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Under Massachusetts and federal law, landlords are required to notify tenants about the presence of lead-based paint hazards before leasing housing built before 1978. Please carefully read and complete the following sections.

1. Landlord's Disclosure

• Known lead-based paint and/or lead-based paint hazards are present in the housing:
• Landlord has provided the tenant with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards:

Landlord/Agent Name:

Landlord/Agent Signature:     Date:

2. Tenant's Acknowledgment

• Tenant has received copies of all information listed above:
• Tenant has received the "Protect Your Family from Lead in Your Home" pamphlet:

Tenant Name(s):

Tenant Signature:     Date:

Tenant Signature:     Date:

3. Agent's Acknowledgment (if applicable)

Agent has informed the landlord of the landlord's obligations under 42 U.S.C. 4852(d) and is aware of his/her responsibility to ensure compliance.

Agent Signature:     Date: