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Lead-Based Paint Disclosure Form Template
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Lead-Based Paint Disclosure Form Template
This Lead-Based Paint Disclosure Form (“Disclosure”) is made on [Date] in connection with the following transaction:
Transaction Type: ☐ Sale ☐ Lease
Property Address: [Property Address]
City, State, ZIP Code: [City, State, ZIP Code]
Year Built (if known): [Year]
Seller / Lessor: [Full Name]
Buyer / Lessee: [Full Name]
1. Lead Warning Statement
Use the applicable federally required warning statement for the transaction type.
For Sale Transactions:
Insert the federally required lead warning statement applicable to a pre-1978 residential property sale.
For Lease Transactions:
Insert the federally required lead warning statement applicable to a pre-1978 residential housing lease.
2. Seller’s / Lessor’s Disclosure
Initial one option in each subsection.
(a) Presence of lead-based paint and/or lead-based paint hazards
___ (i) Known lead-based paint and/or lead-based paint hazards are present in the housing.
Describe what is known:
[Describe location, condition, prior testing results, or other known information]
___ (ii) Seller / Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b) Records and reports available to the Seller / Lessor
___ (i) Seller / Lessor has provided all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing.
List documents below:
[Inspection reports, risk assessments, repair records, disclosure reports, other records]
___ (ii) Seller / Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.
3. Buyer’s / Lessee’s Acknowledgment
Initial all applicable items.
(c) Receipt of records and reports
___ (i) Buyer / Lessee has received copies of all records and reports listed above.
___ (ii) Buyer / Lessee has not received any records or reports regarding lead-based paint and/or lead-based paint hazards in the housing.
(d) Receipt of pamphlet
___ Buyer / Lessee has received the pamphlet Protect Your Family From Lead in Your Home.
(e) Sale transactions only — inspection opportunity
Complete this section only if the transaction is a sale.
___ (i) Buyer has received a 10-day opportunity, or another mutually agreed written period, to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
___ (ii) Buyer has waived the opportunity to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
4. Agent’s Acknowledgment
Complete if an agent is involved.
___ Seller’s / Lessor’s Agent has informed the Seller / Lessor of the Seller’s / Lessor’s obligations under applicable lead-based paint disclosure law and is aware of the agent’s responsibility to help ensure compliance.
___ Buyer’s / Lessee’s Agent has informed the Seller / Lessor of the Seller’s / Lessor’s obligations under applicable lead-based paint disclosure law and is aware of the agent’s responsibility to help ensure compliance.
5. Certification of Accuracy
The parties below have reviewed the information in this Disclosure and certify, to the best of their knowledge, that the information provided is true and accurate.
6. Signatures
Seller / Lessor
Signature: __________________________
Name: [Full Name]
Date: [Date]
Seller / Lessor (if applicable)
Signature: __________________________
Name: [Full Name]
Date: [Date]
Buyer / Lessee
Signature: __________________________
Name: [Full Name]
Date: [Date]
Buyer / Lessee (if applicable)
Signature: __________________________
Name: [Full Name]
Date: [Date]
Seller’s / Lessor’s Agent (if applicable)
Signature: __________________________
Name: [Full Name]
Date: [Date]
Buyer’s / Lessee’s Agent (if applicable)
Signature: __________________________
Name: [Full Name]
Date: [Date]
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Lead-Based Paint Disclosure Form Template
LEAD-BASED PAINT DISCLOSURE FORM TEMPLATE FAQ
What is a lead-based paint disclosure form?
A lead-based paint disclosure form is a document used in certain residential real estate sales and leases to disclose known information about lead-based paint and lead-based paint hazards. EPA states that this rule applies to most pre-1978 private housing, public housing, federally owned housing, and housing receiving federal assistance.
Why do you need a lead-based paint disclosure form?
You need this form because federal law generally requires sellers, landlords, agents, and property managers to give buyers or renters specific lead-related information before a contract or lease is signed. That includes known hazard information, available records and reports, the EPA pamphlet, and a lead warning statement; for sales, buyers must also get a 10-day opportunity to conduct a lead inspection or risk assessment unless waived.
When should you use a lead-based paint disclosure form?
Use this form before signing a contract for the sale of most pre-1978 housing or before a lease begins for covered pre-1978 housing. EPA also lists key exceptions, including certain zero-bedroom units, leases of 100 days or less, some elderly or disability housing without a child under six, lead-free certified housing, foreclosure sales, and housing built after 1977.
How to write a lead-based paint disclosure form?
Start by identifying whether the transaction is a sale or lease, then list the property and the parties. Add the required lead warning statement for the transaction type, disclose any known lead-based paint or hazards, list any available records or reports, confirm receipt of the EPA pamphlet, and include buyer or lessee acknowledgments. If it is a sale, add the buyer’s inspection opportunity section. EPA provides separate sample seller and lessor forms that follow this structure.
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