Lead-Based Paint Disclosure

Tentunit Template Library · Version 1.0 · [TEMPLATE — review before use]

Important: This is a general-purpose template provided for convenience under the Tentunit Templates Disclaimer & Jurisdiction Notice. It is not legal advice and is not state-specific unless expressly labeled. Landlord–tenant requirements (notice periods, day counts, service methods, disclosures) vary by jurisdiction and change over time. Verify against current local law — or consult a licensed attorney — before use. Complete every [BRACKETED FIELD] and delete instructions in italics before sending.

REQUIRED for most housing built before 1978 under 42 U.S.C. § 4852d — EPA/HUD rules; penalties for non-compliance can be substantial. This disclosure must be completed and signed BEFORE the lessee is obligated under the lease. Attach it to the lease and give the tenant the EPA pamphlet. If the property was built in 1978 or later, this form is generally not required — confirm the year built before deleting it.

Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards

Property Address: [PROPERTY ADDRESS, UNIT #] Lessor (Landlord): [LANDLORD/OWNER NAME] Lessee (Tenant): [TENANT NAME(S)] Date of Lease: [LEASE DATE]

Lead Warning Statement

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.

1. Lessor’s Disclosure

(a) Presence of lead-based paint and/or lead-based paint hazards — check ONE:

• Known lead-based paint and/or lead-based paint hazards are present in the housing. (Explain below.) Explanation: [DESCRIBE LOCATION AND CONDITION OF KNOWN LEAD-BASED PAINT/HAZARDS]
• 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:

• Lessor has provided the lessee with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing. (List documents below.) Documents provided: [LIST REPORTS/RECORDS AND DATES]
• Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

2. Lessee’s Acknowledgment

• Lessee has received copies of all information listed in Section 1(b) above, if any.
• Lessee has received the EPA pamphlet “Protect Your Family From Lead in Your Home.”

3. Agent’s Acknowledgment (if applicable)

• Agent has informed the lessor of the lessor’s obligations under 42 U.S.C. § 4852d and is aware of the agent’s responsibility to ensure compliance.

If no agent is involved, write “N/A” across Section 3 and the agent signature line.

4. 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.

Retention: keep a signed copy for at least 3 years from the start of the lease term, as required by federal rules. Give the tenant a signed copy.

---

Provided by Tentunit — see the Templates Disclaimer & Jurisdiction Notice at help.tentunit.com/policies/templates-disclaimer.