Rental Lead Based Paint Disclosure Form

Renting out U.S. housing built before 1978? Then our lead based paint disclosure form and lead based paint brochure are here to complete your lease paper work.

Before Using Our Lead Based Paint Disclosure Form, You Should Know These Facts

As we have made it quite clear, the disclosure form we have here is tailored for landlords. If you happen to be a home seller, Click here for our Seller Lead Paint Disclosure Form instead.

For your lead based paint disclosure, you'll need to give your tenant not one, but two separate documents - a lead paint brochure and a lead base paint disclosure form.

Since the brochure has to be approved by EPA, it's a good idea to play safe and download it straight from the HUD website - Click here the official HUD Lead Based Paint Brochure.

Next step is to fill up your rental lead based paint disclosure form. The good news here is that landlords only have to disclose what they already know - So there's no need for you dash out and fork out money for lead paint testing. Just to clear up any confusion in the disclosure form below, the word "lessor" refers to the landlord while "lessee" refers to the tenant.

Before signing and finalizing your Residential Lease Agreement, be sure to tag on both lead paint forms as an attachment.

Lead Based Paint Disclosure Form

LEAD WARNING STATEMENT

Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing, lessors must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention.

LESSOR'S DISCLOSURE

A. Presence of lead-based paint and/or lead-based paint hazards [check (i) or (ii) below]:

(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 [check (i) or (ii) below]:

(i) [     ] Lessor has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing (list documents below).
______________________________________________________________________________
______________________________________________________________________________

(ii) [     ] Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

LESSEE'S ACKNOWLEDGMENT (INITIAL)

C. [     ] Lessee has received copies of all information listed above.

D. [     ] Lessee has received the pamphlet Protect Your Family from Lead in Your Home.

AGENT'S ACKNOWLEDGMENT

E. [     ] Agent has informed the lessor of the lessor’s obligations under 42 U.S.C. 4852d and is aware of his/her responsibility to ensure compliance.

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.


Lessor Name: ______________________________

Lessor Signature: ______________________________          Date: _______________


Lessee Name: ______________________________

Lessee Signature: ______________________________          Date: _______________


Agent Name: ______________________________

Agent Signature: ______________________________          Date: _______________

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