Lead Paint Disclosure - Housing Rentals and Leases

LEAD WARNING STATEMENT

        Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips and dust can pose health hazards if not managed properly.  Lead exposure is especially harmful to young children and pregnant women.  Before renting housing built prior to 1978 the landlord must disclose the presence of known lead based paint and/or lead-based paint hazards in the dwelling.  Leesee must also receive a Federally approved pamphlet on lead poisoning prevention.

    LANDLORD'S DISCLOSURE (initial)

        ___    (A)   Presence of lead-based paint or lead-based paint hazard (check one below).

        ___    Known lead-based paint and/or lead-based paint hazards are present in the housing (explain below).
                    ____________________________________________________________________________
                    ____________________________________________________________________________

        _X_   Landlord has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

        ___    (B)   Records and reports available to the landlord (check one below).

        ___    Landlord has provided the tenant with all available records and reports pertaining  to  lead-based paint
                  and/or lead-based paint hazard in the housing (list documents below).
                    ____________________________________________________________________________
                    ____________________________________________________________________________

        _X_    Landlord has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in
                   the housing.

    TENANT'S ACKNOWLEDGEMENT (initial)

        _X_    (C)   Tenant has received copies of all information listed above.

        _X_    (D)   Tenant has received the pamphlet PROTECT YOUR FAMILY from LEAD in YOUR HOME

AGENT'S ACKNOWLEDGMENT (initial)

        ___    (E)   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.

    CERTIFICATION OF ACCURACY

        The following parties have reviewed the Information above and certify, to the best of their knowledge, that the information provided by the signatory is true
and accurate.

    LANDLORD SIGNATURE AND DATE

Signature

Print Name

Date

    TENANT SIGNATURE AND DATE

Signature

Print Name

Date