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
intelligence quotient, behavioral problems, and impaired memory.
Lead poisoning also poses a particular risk to pregnant women.
The seller of any interest in residential real property is required
to provide the buyer with any information on lead-based paint
hazards from risk assessments or inspections in the seller's possession
and notify 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
(a) Presence of lead-based paint and/or lead-based paint hazards
(check (i) or (ii) below):
(i) ______ Known lead-based paint and/or lead-based paint hazards
are present in the housing (explain).
_______________________________________________________________________________________
(ii) _____ 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 (i) or
(ii) below):
(i) ______ Seller has provided the purchaser with all available
records and reports pertaining to lead-based paint and/or lead-based
paint hazards in the housing (list documents below).
_______________________________________________________________________________________
(ii) _____ Seller has no reports or records pertaining to lead-based
paint and/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 pamphlet Protect Your
Family from Lead in Your Home.
(e) Purchaser has (check (i) or (ii) below):
(i) _____ received a 10-day opportunity (or mutually agreed upon
period) to conduct a risk assess-ment
or inspection for the presence of lead-based paint and/or lead-based
paint hazards; or
(ii) _____ waived the opportunity to conduct a risk assessment
or inspection for 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 U.S.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, that the information
they have provided is true and accurate.
__________________________________________________ __________________________________________________
Seller Date Seller Date
__________________________________________________ __________________________________________________
Purchaser Date Purchaser Date
__________________________________________________ __________________________________________________
Agent Date Agent Date
What does it mean if this form was not given prior to the execution of an offer to purchase?