Lead-Based Paint Disclosure - PMA
PRE-1978 HOUSING RENTAL AND LEASES
DISCLOSURE OF INFORMATION
LEAD-BASED PAINT AND/OR LEAD-BASED PAINT HAZARDS
Lease Dated: _____________________________________________________________
Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing, lessors must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention.
(a) Presence of lead-based paint and/or lead-based paint hazards (check one below):
[ ] Lessor certifies that this structure was built in 1978 or later
[ ] Lessor certifies that this structure was built before 1978, but Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing
[ ] Known lead-based paint and/or lead-based paint hazards are present in the house (explain)
(b) Records and reports available to Lessor (check one below)
[ ] Lessor has provided the Lessee with all available records and reports pertaining to lead-based and/or lead-based paint hazards in the housing
[ ]Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing
If you checked the 1st box under item (b) please list the records and documents provided:
Lessee’s Acknowledgment (initial appropriate blanks)
___________Lessee has received copies of all information listed above
___________Lessee has received the pamphlet Protect Your Family from Lead in Your Home
Agent’s Acknowledgement (initial)
JVO (digital) Listing Agent has informed the Lessor of the Lessor’s obligation under 42 U.S.C. 48252d and is aware 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.
(signed digitally below)
Lessee:__________________________________ Date: ________________
Agent: Joseph V. Ord, Broker – AMOSO Realty LLC
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Your legal name
Your email address
Signed by Joseph Ord
Signed On: March 19, 2019
If you have questions about the contents of this document, you can email the document owner.
Document Name: Lead-Based Paint Disclosure - PMA
Agree & Sign