Landlord Lead Disclosure Form

Regarding the rental property at ____________________________:

The housing on this property was built prior to 1978. All housing built prior to 1978 may contain lead-based paint, which can be hazardous to human health, especially children and those who are pregnant. All lead-based paint poses a hazard, including from paint chips and dust, unless the paint is managed properly. Tenants and landlords may seek prevention poisoning tips from the U.S. Environmental Protection Agency.

Landlords are required to disclose to tenants the presence of lead-based paint or the possibility of lead-based paint in a rental property before renting the property to the tenant.

• The landlord knows that there is lead-based paint or a lead-based paint hazard in this housing:
• The landlord has NO knowledge of lead-based paint or lead-based paint hazards in this housing.
• The tenant has been provided a copy of this statement and any other relevant documentation regarding lead-based paint or lead-based paint hazards in the aforementioned housing.
• The tenant has been provided literature on protecting occupants from lead-based paint hazards.

Landlord Signature: ______________________________

Date: _____________________

Tenant Signature: ________________________________

Date: _____________________