Lead Paint Hazard Notice Form

Lead Paint Hazard Notice Form
Complete this form to disclose and acknowledge any known lead-based paint hazards for residential properties.
Property Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Type of Transaction
Other
Owner/Agent Full Name
First NameLast Name
Owner/Agent Email Address
example@example.com
Owner/Agent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Tenant/Buyer Full Name
First NameLast Name
Tenant/Buyer Email Address
example@example.com
Are you aware of any lead-based paint or lead-based paint hazards in the property?
Have you provided any records or reports regarding lead-based paint to the tenant/buyer?
Additional Comments or Details (optional)
Tenant/Buyer Signature
Powered by Jotform SignClear
Date of Acknowledgment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: