Addendum Disclosure Of Information And Acknowledgment About Lead-Based Paint And/or Lead-Based Paint Hazards Leases
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1ADDENDUM
DISCLOSURE OF INFORMATION AND ACKNOWLEDGMENT ABOUT
LEAD-BASED PAINT AND/OR LEAD-BASED PAINT HAZARDS
LEASES
I.
LEAD PAINT WARNING
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.
II.
PROPERTY ADDRESS:
III. LESSOR'S DISCLOSURE (initial) (To be completed and signed at time of listing)
(a)
Presence of lead-based paint and/or lead-based paint hazards (check one below):
Known lead-based paint and/or lead-based paint hazards are present in the housing (explain):
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 one below):
Lessor has no reports or records pertaining to lead-based paint and/or lead-based hazards in the housing.
Lessor has the following reports or records pertaining to lead-based paint and/or lead-based paint hazards
in the housing, all of which lessor has provided to its listing agent, and has directed its listing agent to
provide lessee or lessee's agent with these records and reports prior to lessor accepting any offer to
lease (list documents below):
(c)
If there is any change in the above information prior to lessor accepting an agreement from the lessee to
lease, lessor will disclose all changes to the lessee prior to accepting the lease.
IV. LESSOR'S CERTIFICATION OF ACCURACY
Lessor(s) have reviewed the Lessor's Disclosure in Section III and certify, to the best of his/her/their knowledge, that the
information they have provided is true and accurate.
Lessor
Date
/ /
Lessor
Date
/ /
V.
LISTING AGENT'S CERTIFICATION OF ACCURACY
Listing Agent certifies that he/she 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.
Listing Agent
Date
/ /
VI. LESSEE'S ACKNOWLEDGMENT (initial) (The Lessor's Disclosure in Section III and Certification in Section IV
and the Listing Agent's Certification in Section V to be completed and signed prior to lessee signing this Addendum.)
(a)
Lessee has received copies of all information listed in Section III above.
(b)
Lessee has received the pamphlet Protect Your Family From Lead in Your Home.
VII. LESSEE'S CERTIFICATION OF ACCURACY
Lessee(s) have reviewed the Lessee's Acknowledgment in Section VI and certify, to the best of his/her/their knowledge,
that the information they have provided is true and accurate.
Lessee
Date
/ /
Lessee
Date
/ /
VIII. LEASING/LESSEE'S AGENT'S CERTIFICATION OF ACCURACY
Leasing/Lessee's Agent certifies that the lessee has received the information in section VI (a) and (b).
Leasing/Lessee's Agent
Date
/ /
NJAR Addendum A-6/01
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