This is a Lead-Based Paint disclosure form to be incorporated into a standard rental lease or a lease agreement. Landlords are legally obligated to provide information related to lead-based paint hazards. This disclosure form has been created to comply with 42 U.S.C. 4852d.

Steps to Fill the General Lead Based Paint Disclosure Form

1. Landlord indicates whether there is known to be lead-based paint or lead-based paint hazards on the premises and describes them.
2. Landlord indicate if there are any records related to lead-based paint or lead-based paint hazards on the premises and describes them.
3. Tenant indicates receipt of any records or disclosures and the “Protect Your Family from Lead in Your Home” pamphlet.
4. Agent indicates that landlord has been informed of all relevant obligations and responsibility to comply.

General

• The landlord, tenant, and agent must all sign and date this Lead-Based Paint disclosure form in compliance with 42 U.S.C. 4852d and certify its accuracy.