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Arizona Lead Based Paint Disclosure Form


Arizona Lead Based Paint Disclosure Form
Arizona Lead Based Paint Disclosure Form
DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT
AND LEAD-BASED PAINT HAZARDS (RENTALS)
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. Lead poisoning in young children may produce permanent neurological damage, including learning
disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. 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.
LANDLORD'S DISCLOSURE (Landlord must complete and initial sections A, B and C below)
A. Lead-based paint and/or lead-based paint hazards (check A.1 or A.2 below):
A.1 Landlord is aware that lead-based paint and/or lead-based paint hazards are present in the residence(s) and/or
building(s) included in this rental. (Explain)
A.2 Landlord has no knowledge of any lead-based paint and/or lead-based paint hazards in the residence(s) and
building(s) included in this rental.
Landlord's initials required
B.2
B.
B.1
Records and reports available to the landlord (check B.1 and B.2 below):
Landlord has provided the tenant with all available records and reports relating to lead-based paint and/or lead-
based paint hazards in the residence(s) and building(s) included in this rental. (List documents).
Landlord has no records or reports relating to lead-based paint and/or lead-based paint hazards in the
residence(s) and building(s) included in this rental.
Landlord's initials required
C. Landlord acknowledges his obligation to disclose to any real estate agent(s) to whom the landlord directly or
indirectly is to pay compensation with regard to the transaction contemplated by this disclosure any known
lead-based paint or lead-based paint hazards in the premises to be rented, as well as the existence of any reports
or records relating to lead-based paint or lead-based paint hazards in the premises to be rented. Landlord further
acknowledges that this disclosure accurately reflects the entirety of the information provided by the landlord to the
agent(s) with regard to lead-based paint, lead-based paint hazards, and lead-based paint risk-assessment or
inspection reports and records.
Landlord's initials required
TENANT'S ACKNOWLEDGMENT (Tenant must complete and initial sections D and E below):
D. Tenant has read the information set forth above, and has received copies of the reports, records, or
other materials referenced above, if any.
E. Tenant has received the pamphlet Protect Your Family from Lead in Your Home.
AGENT'S ACKNOWLEDGMENT (Any real estate agent who is to receive compensation from the landlord or the property
manager with regard to the transaction contemplated in this disclosure must initial section F below.)
F. The agent(s) whose initials appear below has (have) ensured the landlord's compliance under the Residential
Resale Lead-Based Paint Hazard 1992 by the landlord's use and completion of this disclosure form.
Agent's initials required:
Property Manager/Listing Agent Leasing Agent
CERTIFICATION OF ACCURACY
By signing below, each signatory acknowledges that he or she has reviewed the above information, and certifies that, to the
best of his or her knowledge, the information provided by the signatory is true and accurate.
Landlord:
Landlord:
Property Manager/Listing Agent:
Tenant:
Tenant:
Leasing Agent:
Date
Date
Date
Date
Date
Date
This form is available for use by the entire real estate industry. The use of this form is not intended to identify the user as a REALTOR®. REALTOR® is a registered collective membership mark
which may be used only by real estate licensees who are members of the NATIONAL ASSOCIATION OF REALTORS® and subscribe to its Code of Ethics.
©ARIZONA ASSOCIATION OF REALTORS® FORM LBPD(RENTAL) 04/97
Property Address:
Phone: Fax:
Produced with ZipForm™ by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, www.zipform.com
Arizona Lead Based Paint Disclosure Form
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