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Sample Disclosure Format for Target Housing Safes Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards ®~ead Warning Statement Every purchaser of any interest in residenfial real property on which a residen&al 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 of risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The sel/er of any inferest in residen&a! real property is required to provide the buyer with any informaSon on lead-based paint hazards firim risk assessments or inspections in the seller's possession and notrfy the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible 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). 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): Q Seller has provided the purchaser with aA available records and'eports pertaining to lead-based paint and/or lead-based paint hazards in the hoeing (list documents below). r Seller has no reports or repors pertaining to lead-based pain~nd/or lead-based paint hazards in the housing. Purchaser's Acknowledgment Initial) (c) Purchaser has received copies of all information listed above. (d) Purchaser has received the pamphlelPratect Your Family from Lead in Your Home_ (e) Purchaser has (check one below): Q Received a 1(lday 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 Q Waived the opportunity to conduct a risk assessment or inspectioior the presence of lead-based paint and/or lead-based paint hazards. Agents Acknowledgment Initial) (f) Agent has informed the seller of the seller's obligatiorts under 42 t$.C_ 4852(d) and is aware of his/her responsibility to ensure compliance. Certification of Accuracy The follow~g parties have reviewed the information above and certify, to the best of their knowledge, thatdh information provided by the signatory is true and accurate. Seller Date Seller Date gent Date Agent Date Purchaser Date Purchaser Date 2 G ~' 1