Lead Paint Disclosure Form
Property Information
Property Address:
City, State, ZIP:
Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the property.
Seller has knowledge of lead-based paint and/or lead-based paint hazards in the property.
Explain (if any):
Seller has provided all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the property.
Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the property.
Purchaser's Acknowledgment
Purchaser has received copies of all information and reports listed above.
Purchaser has received the pamphlet "Protect Your Family From Lead in Your Home".
Purchaser has a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Purchaser waives the opportunity to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Agent's Acknowledgment (if any)
Agent has informed the seller of the seller's obligations under 42 U.S.C. 4852d.
Signatures
Seller's Signature
Date
Purchaser's Signature
Date
Agent's Signature
Date