Disclosure of Lead-Based Paint at a glance
What it is: Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards.
Who signs: Seller, Purchaser and Agent each sign and date.
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. 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 filled-in Disclosure of Lead-Based Paint example: a seller discloses no known lead-based paint
How to fill out Disclosure of Lead-Based Paint, box by box
Seller's Disclosure
Check (i) or (ii) for the presence of lead-based paint and/or lead-based paint hazards: (i) known lead-based paint and/or lead-based paint hazards are present in the housing, and you explain them, or (ii) the seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
Check (i) or (ii) for the records and reports available to the seller: (i) the seller has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing, and you list the documents. Or (ii) the seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.
Purchaser's Acknowledgment
The purchaser initials (c): Purchaser has received copies of all information listed, and initials (d): Purchaser has received the pamphlet Protect Your Family from Lead in Your Home.
The purchaser checks (i) or (ii): (i) received a 10-day 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.
Agent's Acknowledgment
The agent initials: Agent has informed the seller of the seller's obligations under 42 U.S.C. 4852(d) and is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The seller, the purchaser and the agent each sign and date; they certify, to the best of their knowledge, that the information they have provided is true and accurate.
Sources
[1] Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards, served form (no issuer file) (the Official source link on this page).