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<br />I <br /> <br />Sample Disclosure Format for Target Housing Sales <br />Disclosure of Information on lead-Based Paint and lead-Based Paint Hazards <br /> <br />Þl..ead Warning Statement . <br />Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 <br />is notified that such property may present exposure to lead from lead-based 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 learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. <br />Lead poisoning also poses a particular risk to pregnant WOmen. The seller of any interest in residential real property <br />is required to provide the buyer with any information on lead-based paint hazards fiiJm risk assessments or <br />inspections in the seller's possession and notify the buyer of any known leacJ.based paint hazards, A risk <br />assessment or inspectjon for poSSIble lead-based paint hazards is recommended poor to purchase. <br /> <br />Seller's Disclosure (initial) <br />(a) Presence of lead-based paint andlor lead-based paint hazards (check one below): <br /> <br />0 Known lead-based paint and/or lead-based paint hazards are present in the housing (explain). <br /> <br />0 Seller has no knowledge of.lead-based paint and/or lead-based paint hazards in the housing, <br /> <br />- (b) Records and reports available to the seller (check one below): <br /> <br />0 Seller has provided the purtlaser with aU available records amteports pertaining to lead-based paint <br />and/or lead-based paint hazards in the hosing (list documents below). <br /> <br />It <br /> <br />0 Seller has no reports or I'ŒOrds pertaining to lea~based painfand/or lead-based paint hazards in the <br />housing. . <br /> <br />Purchaser's Acknowledgment (initial) . <br />- (c) Purchaser has received copies of all 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 /> <br />0 Received a 1O-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 /> <br />0 Waived the opportunity to conduct a ri$k assessment or inspectiomr the presence of lead-based paint <br />and/or lead-based paint hazards. <br /> <br />Agent's Acknowledgment (initial) <br />- (f) Agent has informed the seller oflhe seiler's obligations under 421S,C. 4852(d) and is aware of hislher <br />responsibility to ensure compliance. <br /> <br />Certification of Accuracy <br />The following parties have reviewed the information above and certify. to the best of their knowledge. thateh <br />information pro,¡ided by the signatory is true and accurate. <br /> <br />Seller <br /> <br />Date <br /> <br />Seller <br /> <br />Date <br /> <br />Date <br /> <br />Agent <br /> <br />Date <br /> <br />8'gent <br />Purchaser <br /> <br />Date <br /> <br />Purchaser <br /> <br />Date <br /> <br />. <br />