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Sample Rental Agreement Form




Lead Based Paint Addendum to Rental Agreement


This Lead Based Paint Addendum to residential lease concerning the property at:

Address: _________________________

City: __________ State: ___ Zip: ____

Lead Based Paint Warning Statement:

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

Disclosure:

Presence of lead-based paint and / or lead-based paint hazards. (Check (a) or (b)).

___ (a) Landlord knows of the following lead-based paint and / or lead-based paint hazards in the Property:

________________________________

________________________________

________________________________

___ (b) Landlord has no knowledge of lead-based paint and / or lead-based paint hazards in the Property.

(2) Records and reports available to Landlord. (Check (a) or (b)).

___ (a) Landlord has provided Tenant with all available records and reports pertaining to lead-based paint and / or lead-based paint hazards in the Property which are listed here:

________________________________

________________________________

___(b) Landlord has no reports or records that pertain to lead-based paint and / or lead-based paint hazards in the Property.

Tenant's Acknowledgement:

___ (1) Tenant has received copies of all information listed in the Disclosure section above.

___ (2) Tenant has received the pamphlet entitled Protect Your Family from Lead in Your Home.

Agent's Notice to the Landlord and Acknowledgement:

The brokers and agents to the lease notify the Landlord and the Landlord must: (a) provide the Tenant with the EPA-approved pamphlet on lead poisoning prevention; (b) complete this Lead Based Paint Addendum; (c) disclose any known lead-based paint and / or lead-based paint hazard in the Property; (d) deliver all records and reports to Tenant pertaining lead-based paint and / or lead-based paint hazards in the Property; (e) retain a copy of this addendum for at least three years.

The brokers and agents to the lease advised the Landlord of the Landlord's obligations and hare hereby fully aware of his / her responsibility to ensure compliance.

Certification of Accuracy: The undersigned has reviewed the information above and hereby certify to the best of their knowledge that the information they have provided is true and correct.

Landlord:

_______________________ Date_____

Landlord:

_______________________ Date_____

Tenant:

_______________________ Date_____

Tenant:

_______________________ Date_____

Tenant:

_______________________ Date_____

Listing Broker:

_______________________ Date_____

Other Broker / Agent:

_______________________ Date_____




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