This Lead-Based Paint Disclosure Statement 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.
LEAD BASED PAINT DISCLOSURE STATEMENT
Disclosure Information on Lead Based Paints and Health Hazards Associated
Lead Warning Statement
Many housing units in the State of California may and still contain lead based paint.
Lead based paint is banned for use in residential dwellings since 1978.
The federal Real Estate Disclosure and Notification Rule requires sellers or lessors of
residential dwellings/properties which were built prior to the year 1978 to disclose to each and
every potential purchaser of a residential dwelling/property, notification that the residential
dwelling/property may contain lead based paint which poses health hazards to young children.
Young children exposed to lead based paint can and may develop lead poisoning. Young
children which have been exposed to lead based paint may develop learning disabilities,
permanent neurological damage, delayed development and/or behaviour disorders and impaired
memory. Lead poisoning also poses potential health hazards to pregnant women.
Lead based paint can deteriorate into dust which is contaminated and can peel and chip
,which becomes a hazard to the occupants of the dwelling.
Any seller or lessor of a residential dwelling built prior to 1978 must and will disclose to
its/his/her agent, the potential purchaser and the purchaser’s agent, any and all information on
lead based paint hazards and the health risks associated with same or any information the seller
may have in its/his/her possession from risk assessments or inspections performed on the said
residential dwelling. Each and every potential purchaser is hereby recommended to have a risk
assessment or inspection completed prior to the purchase of such residential dwelling.
The seller or lessor of a residential dwelling built prior to 1978 shall also disclose
information on lead based paint hazards and the health risks associated with same to any lessees
The federal Real Estate Disclosure and Notification Rule in the State of California
defines a residential dwelling as a single family dwelling or a single family dwelling unit in a
structure that contains more than one separate residential dwelling unit.
The sellers and lessors of multifamily dwellings built prior to 1978 must provide
potential purchasers and lessees with any and all available records and reports pertaining to lead
based paint and lead based paint hazards in areas used by all of the occupants of the multifamily
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The seller or lessor will provide to the potential purchaser or lessee _____ (___) days for
the potential purchaser or lessee to inspect the dwelling for lead base paint and lead based paint
hazards. Any extension or reduction of the inspection time will be mutually agreed upon by the
seller/lessor and the potential purchaser/lessee.
The federal Environmental Protection Agency in the State of California requires that
sellers or lessors provide to any potential purchasers or lessees the pamphlet published by the
federal Environmental Protection Agency entitled “Protect Your Family From Lead In Your
Home” prior to a potential purchaser or lessee signs an agreement with the seller or lessor.
The seller or lessor will require the potential purchaser’s or lessee’s signature on this
disclosure statement as an acknowledgment of the potential purchaser’s or lessee’s
understanding of this disclosure statement, the receipt of the pamphlet provided to them and of
the offer of inspection period or waiver of such inspection period. The seller/lessor and the
potential purchaser/lessee will each sign and date this disclosure statement.
The seller/lessor and its/his/her agents shall retain this executed disclosure statement for a
period of three (3) years and its/his/her agents shall retain this disclosure statement for a period
of three (3) years from the date of the sale transaction or from the commencement of the lease or
Any violation of the federal Real Estate Disclosure and Notification Rule may result in
civil and/or criminal charges.
DATED this ______ day of ________________, 20_____.