Residential Real Property Disclosure Statement Form
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2Residential Real Property Disclosure Statement
MAINE WARNING: LEAD-BASED PAINT HAZARDS
Any residence built before 1978 may contain lead sufficient to poison
children and sometimes adults. Lead poisoning poses a particular risk if
you are pregnant or may become pregnant. Lead poisoning in young
children may produce permanent neurological damage, including
learning disabilities, a reduced intelligence quotient (IQ), impaired
memory and behavioral problems such as attention deficit hyperactive
disorder and a propensity for violence.
Every tenant or lessor 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 landlord or other lessor of any interest in
real property is required to provide the tenant or lessee with any information on
lead-based paint hazards from risk assessments or inspections in the landlord's or
lessor's possession and notify the tenant or lessee of any known lead-based paint
hazards.
The only way to know with certainty whether lead-based paint hazards
are present on the property is to test the property for the presence of lead.
Acknowledgement of State Disclosure Statement.
The signature below acknowledges that the lessor or potential lessor has disclosed to me
information about lead-based paint hazards as required by 22 M.R.S.A. Section 1328. This
acknowledgement does not constitute a waiver of any rights.
______________________________
__________________________________
Lessor Signature
Date
Lessee Signature
Date
_______________________________
__________________________________
Lessor Name printed
Lessee Name printed
_______________________________
__________________________________
Lessor Signature
Date
Lessee Signature
Date
_______________________________
__________________________________
Lessor Name printed
Lessee Name printed
Maine Health & Human Services, Public Health
1
9/22/2005
Property Lease Form
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