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Sample Disclosure Format for Target Housing Sales Disclosure of Information on Lead -Based Paint and Lead -Based Paint Hazards Lead Warning Statement Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead -based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced infetlWnce quotient behavioral problerr;4 and impaired memory. Lead poisoning also poses a parbcularnsk to pregnant women. The sefler of any interest in residential real property is required to provide the buyer with any information on lead -based paint hazards fi0m risk assessments or inspections in the sellers possession and notify the buyer of any known lead -based paint hazards. A risk assessment o inspecton forpossbfe lead -based paint hazards is recommended prior to purchase. Seller's Disclosure (initial) (a) Presence of lead -based paint and/or lead -based paint hazards (check one below): Known lead -based paint and/or lead -based paint hazards are present in the housing (explain). Q Seller has no knowledge of lead -based paint and/or lead -based paint hazards in the housing. (b) Records and reports available to the seller (check one -below): Seller has provided the purchaser with all available records andreports pertaining to lead -based paint and/or lead -based paint hazards in the hosing (list documents below). Seller has no reports or reords pertaining to lead based paintand/or lead -based paint hazards in the housing. Purchaser's Acknowledgment (nitiaD (c) Purchaser has received copies of all information fisted above. (d) Purchaser has received the pamphletProtect Your Family from Lead in Your Home. (e) Purchaser has (check one below): El Received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessmentro inspection for the presence of lead -based paint and/or lead -based paint hazards; or Waived the opportunity to conduct a risk assessment or inspectiodor the presence of lead -based paint and/or lead -based paint hazards. Agent's Acknowledgment (initial) (f) Agent has informed the seller of the seller's obligations under 42 M.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, thatdh information presided by the signatory is true and accurate. Seller Date Seller gent Date Agent Date Date Purchaser Date Purchaser Date