LeadWarningStatement
Everypurchaserofanyinterestinresidentialrealpropertyonwhicharesidentialdwellingwasbuiltpriorto1978isnotifiedthat suchpropertymaypresentexposuretoleadfromlead-basedpaintthatmayplaceyoungchildrenatriskofdevelopinglead poisoning.Leadpoisoninginyoungchildrenmayproducepermanentneurologicaldamage,includinglearningdisabilities, reducedintelligencequotient,behavioralproblems,andimpairedmemory.Leadpoisoningalsoposesaparticularriskto pregnantwomen.Thesellerofanyinterestinresidentialrealpropertyisrequiredtoprovidethebuyerwithanyinformationon lead-basedpainthazardsfromriskassessmentsorinspectionsintheseller’spossessionandnotifythebuyerofanyknownleadbasedpainthazards.Ariskassessmentorinspectionforpossiblelead-basedpainthazardsisrecommendedpriortopurchase.
Seller’sDisclosure
(a)Presenceoflead-basedpaintand/orlead-basedpainthazards(check(i)or(ii)below):
(i)Knownlead-basedpaintand/orlead-basedpainthazardsarepresentinthehousing(explain):
(ii)Sellerhasnoknowledgeoflead-basedpaintand/orlead-basedpainthazardsinthehousing.
(b)Recordsandreportsavailabletotheseller(check(i)or(ii)below):
(i)Sellerhasprovidedthepurchaserwithallavailablerecordsandreportspertainingtolead-basedpaint and/orlead-basedpainthazardsinthehousing(listdocumentsbelow):
NameofDocument(s)
Author Date
(ii)Sellerhasnoreportsorrecordspertainingtolead-basedpaintand/orlead-basedpainthazardsin thehousing.
Purchaser’sAcknowledgment(initial)
(c)Purchaserhasreceivedcopiesofallinformationlistedabove.
(d)PurchaserhasreceivedthepamphletProtectYourFamilyfromLeadinYourHome
(e)Purchaserhas(check(i)or(ii)below):
(i)receiveda10-dayopportunity(ormutuallyagreeduponperiod)toconductariskassessmentorinspection forthepresenceoflead-basedpaintand/orlead-basedpainthazards;or
(ii)waivedtheopportunitytoconductariskassessmentorinspectionforthepresenceoflead-basedpaint and/orlead-basedpainthazards.
Agent’sAcknowledgment(initial)
(f)Agenthasinformedtheselleroftheseller’sobligationsunder42U.S.C.4852(d)andisawareofhis/her responsibilitytoensurecompliance.
CertificationofAccuracy
Thefollowingpartieshavereviewedtheinformationaboveandcertify,tothebestoftheirknowledge,thatthe informationtheyhaveprovidedistrueandaccurate.
JuliaPaigeJalbert
Date:
Seller(s):
PropertyAddress:
