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<br />Disclosure of Infonnatlon on Lead-Based Paint and/or Lead-Based Paint Hazards <br /> <br />Lead Warning Statement <br /> <br />Every purchaser of any Interest In residential real property on which a residential dwelJ/ng was built prior to 1978 Is <br />notified that such property may present exposure to lead from lead-based paint that may place young children at risk <br />of developing lead poisoning. Lead poisoning In young children may produce permanent neurological damage, <br />Including learning disabilities, reduced IntelJ/gence quotient, behavioral problems, and Impaired memory. Lead <br />poisoning also poses a particular risk to pregnant women. The seller of any interest In residential real property Is <br />required to provide the buyer with any Information on lead-based paint hazards from risk assessments or Inspections <br />In the sellers possession and notifY the buyer of any known lead-based paint hazards. A risk assessment or Inspection <br />for possible lead-based paint hazards Is recommended prior to purchase. <br /> <br />Seller's Disclosure <br />(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (Ii) below): <br />(I) _ Known lead-based paint and/or lead-based paint hazards are present in the housing <br />(explain). <br /> <br />(ii) _ 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 (I) or (Ii) below): <br /> <br />(I) _ Seller has provided the purchaser with all available records and reports pertaining to lead- <br />based paint and/or lead-based paint hazards in the housing (list documents below). <br /> <br />(ii) _ Seller has no reports or records pertaining to lead-based paint and/or lead-based paint <br />hazards in the housing. <br /> <br />Purchaser's Acknowledgment (initial) <br />(c) Purchaser has received copies of all information listed above. <br /> <br />(d) Purchaser has received the pamphlet Proted Your Family from Lead In Your Home. <br /> <br />(e) Purchaser has (check (I) or (Ii) below): <br /> <br />(i) _ received a lO-day opportunity (or mutually agreed upon period) to conduct a risk assess- <br />ment or inspection for the presence of lead-based paint and/or lead-based paint hazards; or <br /> <br />(Ii) _ waived the opportunity to conduct a risk assessment or inspection for the presence of <br />lead-based paint and/or lead-based paint hazards. <br /> <br />Agenfs Acknowledgment (Initial) <br />(I) Agent has informed the seller of the seller's obligations under 42 U.s.c. 4852(d) and is <br />aware of his/her responsibility to ensure compliance. <br /> <br />Certification of Accuracy <br /> <br />The following parties have reviewed the Information above and certify, to the best of their knowledge, that the <br />Information they have provided is true and accurate. <br /> <br />Seller <br /> <br />Date <br /> <br />Seller <br /> <br />Date <br /> <br />Purchaser <br /> <br />Date <br /> <br />Purchaser <br /> <br />Date <br /> <br />Agent <br /> <br />Date <br /> <br />Date <br /> <br />Agent <br />