Docstoc Legal Agreements
This Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards is
intended to be used by the lessor of any residential property in order to be in compliance
with governing federal laws pertaining to lead-based paint hazards. This document
contains the necessary information regarding the presence of lead-based paint on the
property and the risks associated with lead exposure, as required by law. This form should
be used by lessors of real property located in Washington.
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DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT AND/OR LEAD-BASED
Lead Warning Statement
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.
1. Lessor’s Disclosure
a. Presence of lead-based paint and/or lead-based paint hazards
[Instruction: Select the clause by inserting “X”]
i. _____________ Known lead-based paint and/or lead-based paint hazards are present
in the housing (explain)
ii. _____________ Lessor has no knowledge of lead-based paint and/or lead-based paint
hazards in the housing.
b. Records and reports available to the Lessor [Instruction: Select the clause by inserting
i. _____________ Lessor has provided the Lessee with all available records and reports
pertaining to lead-based paint and/or lead-based paint hazards in the housing (list
ii. _____________ Lessor has no reports or records pertaining to lead-based paint and/or
lead-based paint hazards in the housing.
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2. Lessee's Acknowledgment (initial)
a. _____________ Lessee has received copies of all information listed above.
b. _____________ Lessee has received the pamphlet Protect Your Family from Lead in
c. Lessee has [Instruction: Select the clause by inserting “X”] :
i. _____________ received ___________ (___) [◊ Fourteen (14)] days opportunity (or
mutually agreed upon period) to conduct a risk assessment 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.
3. Agent's Acknowledgment (initial)
_____________ Agent has informed the Lessor of the Lessor’s obligations under 42 U.S.C.
4852(d) and is aware of his/her responsibility to ensure compliance.
4. 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.
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