Fillable LEAD-BASED PAINT DISCLOSURE FOR RESIDENTIAL RENTALS ADDENDUM (Northeast Florida Association of Realtors)

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LEAD-BASED PAINT DISCLOSURE FOR RESIDENTIAL RENTALS ADDENDUM (Northeast Florida Association of Realtors)

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LEAD-BASED PAINT DISCLOSURE FOR
RESIDENTIAL RENTALS ADDENDUM
DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT AND
LEAD-BASED PAINT HAZARDS
LPDFRRA (Rental)
11/17
This Addendum is made by the undersigned Lessee and Lessor and is incorporated into and made a part of
the lease between Lessee and Lessor (the “Lease”). This Addendum is referenced in the Lease and pertains
to the following Property:___________________________________________________________________
_______________________________________________________________________________________.
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 taken care of properly. Lead exposure is especially harmful to young children
and pregnant women. Before renting pre-1978 housing, landlords must disclose the presence of known lead-
based paint and lead-based paint hazards in the dwelling. Tenants must also receive a federally approved
pamphlet on lead -poisoning prevention.
Lessor’s Disclosure (initial)
_____ (a) Presence of lead-based paint 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 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).
_________________________________________________________________________
_________________________________________________________________________
Lessor has no reports or records pertaining to lead-based paint and/or lead-based
paint hazards in the housing.
Lessee’s Acknow
ledgment (initial)
_____ (c)
Lessee has received copies of all information listed above.
_____ (d) Lessee has received the pamphlet Protect Your Family from Lead in Your Hom
e.
Licensee’s Acknowledgment (initial)
_____ (e)
Licensee has informed the lessor of the lessor’s obligations under 42 U.S.C. 4582(d) and is
aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the
information provided by the signatory is true and accurate.
__________________________________ ___________ _________________________________ ____________
LESSOR DATE LESSEE DATE
__________________________________ ___________ _________________________________ ____________
LESSOR DATE LESSEE DATE
__________________________________ ___________ _________________________________ ____________
LICENSEE DATE
LICENSEE DATE
Any person or persons who knowingly violate the provisions of the Residential Lead-Based Paint Hazard Reduction Act of 1992 may be
subject to civil and criminal penalties and potential triple damages in a private civil lawsuit.
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LEAD-BASED PAINT DISCLOSURE FOR RESIDENTIAL RENTALS ADDENDUM (Northeast Florida Association of Realtors)

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Completed 12 May 2021

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