Real Estate Lead-Based Paint Disclosure Form
Real Estate Lead-Based Paint Disclosure Form
This Lead-Based Paint Disclosure Form is a legal requirement for residential properties built before 1978. It ensures buyers and renters are informed of potential lead hazards. Complete the form accurately, indicating any known lead-based paint presence or testing, and sign to certify its accuracy.
Property Information
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Property Address: |
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State: |
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Zip Code: |
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Year Built: |
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Type of Property: |
Seller/Lessor Information
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Name: |
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Address: |
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Phone Number: |
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Email Address: |
Buyer/Renter Information
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Name: |
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Address: |
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Phone Number: |
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Email Address: |
Lead-Based Paint Disclosure
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Question |
Response |
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Is the property built before 1978? |
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Is the seller/lessor aware of any lead-based paint on the property? |
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Has the property been tested for lead-based paint? |
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If tested, are there any known lead-based paint hazards? |
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Are there any reports or documentation regarding lead-based paint hazards on the property? |
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If yes, please provide details: |
Responsibilities
The individual functioning as the seller, who is identified by the name [Seller's Name], willingly acknowledges and affirms his appointed responsibility to ensure that he provides precise and reliable information pertaining to the presence and potential dangers of lead-based paint that may be found or exist on the property being sold.
The person designated as the buyer, whom we will refer to by their appropriate title and name as [Buyer's Name], has officially confirmed and recognized the receipt of an important and informative pamphlet. This publication, titled "Protect Your Family from Lead in Your Home," has been produced and distributed by the Environmental Protection Agency, commonly known as the EPA, in order to raise awareness and provide safety guidelines related to potential lead problems commonly found in residential environments.
Certification
I hereby affirm and certify that, to the maximum extent of my personal knowledge and awareness, all the information that I have supplied and provided in this Lead-Based Paint Disclosure Form is fundamentally accurate, genuine, and beyond dispute true.
Signature
Seller:
[Date]
Buyer:
[Date]
