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 taken care
of properly. Lead exposure is especially harmful to young children and
pregnant women. Before renting pre-1978 housing, landlords must
disclose the presence of known lead-based paint and lead-based paint
hazards in the dwelling. Tenants will receive a federally approved
pamphlet on lead poisoning prevention.
Disclosure (
initial)
Presence of lead-based paint or lead-based paint hazards
(check one below):
____Known lead-based paint and/or lead-based paint hazards are present in___.
____No knowledge of lead-based
paint and/or lead-based
paint hazards in:___.
Owner/Manager Acknowledgment (initial)
____ Owner/Manager has informed the lessor of the lessor obligations under
42 U.S.C. 4582(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 is accurate.
Tenant:________________________________________
Date ____________________________________________________
Owner/Manager:
Date