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Sample Disclosure Format for Target Housing Sales <br />Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards <br />ead Warning Statement <br />Every purchaser of any intenst in n;sidenSa/ real property on which a 2sidential dwelling was built prior to 1978 <br />is noted that such property may present exposure to lead from learnbased paint that may place young children <br />at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological <br />damage, including/earning disabilities, reduced intelligence quotient, behaviors! problems, and impaired memory. <br />Lead poisoning also poses a particu/arrisk to pregnant women. The seller of any interest in residential n;a! properly <br />is required to provide the buyer with any infom~ation on lead-based paint hazanis fiam risk assessments or <br />inspections in the sellers possession and notify the buyer of any known lead-based paint hazards. A risk <br />assessment or inspection for possible lead-based paint hazanis is recommended prior to purchase. <br />Seller's Disclosure (initial) <br />(a) Presence of lead-based paint and/or lead-based paint hazards (check one below): <br />Known lead-based paint and/or lead-based paint hazards are present in the housing (explain). <br />Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. <br />(b) Records and reports available to the seller (check one below): <br />Seller has provided the purchaser with all available records andeports pertaining to lead-based paint <br />and/or lead-based paint hazards in the hoeing (list documents below). <br />Seller has no reports or repors pertaining to lead-based paintand/or lead-based paint hazards in the <br />housing. <br />Purchaser's Acknowledgment (nitiaq <br />(c) Purchaser has received copies of ail information listed above. <br />(d) Purchaser has received the pamphlelProtect Your Family from Lead in Your Home. <br />(e) Purchaser has (check one below): <br />Received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessmentro <br />inspection for the presence of lead-based paint and/or lead-based paint hazards; or <br />Waived the opportunity to conduct a risk assessment or inspectiofnr the presence of lead-based pairrt <br />and/or lead-based paint hazards. <br />Agents Acknowledgment (initial) <br />(f) Agent has informed the seller of the seller's obligations under 42 L$.C. 4852(d) and is aware of his/her <br />responsibility to ensure compliance. <br />Certification of Accuracy <br />The following parties have reviewed the infonnation above and certify, to the best of their knowledge, thatAh <br />information presided by the signatory is true and accurate. <br />Seller Date Seiler Date <br />ent Date Agent Date <br />Purchaser Date Purchaser Date <br />