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Lead-Base Paint Disclosure (Lessee)

Lead Warning Statement

Download PDF of Disclosure Form

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. Click here for Protect your Family Pamphlet.

    Lessee's Acknowledgment (initial)

    Lessee has received copies of all information listed above.

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


    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.

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