Docstoc Legal Agreements
This Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards is
intended to be used by the seller or 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 and sellers of real property located in Michigan.
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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, as per Section 4852(d), Chapter 63A, Title 42 of 2010 United States Code 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
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)
___________________________________. As per [STATUTE]
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 [Comment: these
numbers are not provided by the law, but can be any number the user chooses]
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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