MAKE YOUR FREE Lead Disclosure Statement
What is a Lead Disclosure Statement?
In addition to the Lead Disclosure Statement, landlords must also provide a tenant with the Environmental Protection Agency's (EPA) pamphlet entitled "Protect Your Family From Lead In Your Home." The regulation does not require the landlord to have the property inspected, but only to disclose information they may already have about lead in the property. The landlord and tenant (and agent, if involved) signing a lease are required to sign the Lead Disclosure Statement, and the landlord must retain the signed form for at least three years as proof that they have followed the rules.
When to use a Lead Disclosure Statement:
- You're a landlord leasing property built before 1978.
- You've fallen in love with a rental property built before 1978 and want to rent it.
Sample Lead Disclosure Statement
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LEAD WARNING AND DISCLOSURE STATEMENT
For the property located at: , , .
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 pre-1978 housing, landlords must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Tenants must also receive a federally approved pamphlet on poisoning prevention.
Landlord's Disclosure
(a) Presence of lead-based paint and/or lead-based paint hazards (Check (i) or (ii) below):
(i) __X__ Known lead-based paint and/or lead-based paint hazards are present in the housing (explain):
(ii) _____ 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 (i) or (ii) below):
Tenant's Acknowledgment (initial)
(c) _____ Tenant has received copies of all information listed above.
(d) _____ Tenant has received the pamphlet Protect Your Family From Lead In Your Home.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate.
| ____________________________________ | Date:____________________ |
Acknowledged by Tenant:
| ____________________________________ | Date:____________________ |
