Lease Addendum

for

Landlord:

Tenant:

Disclosure if Information on Lead-Based Paint and Lead-Based Paint Hazards

Lead Warning Statement

Every Tenant of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The Landlord of any interest in residential real property is required to provide the Tenant with any information on lead-based paint hazards from risk assessments or inspections in the Landlord's possession and notify the Tenant of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to renting.

Landlord's Disclosure

Initial both (a) and (b):

_______ (a) Presence of lead-based paint and/or lead-based paint hazards (check one below):

_____ Known lead-based paint and/or lead-based hazards are present in the housing (explain):

______________________________________________________________________

_____ Landlord has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

_______(b) Records and reports available to the Landlord (check one below):

_____Landlord has provided the tenant with all available records pertaining to lead-based paint and/or lead-based paint hazards in the housing (list documents below).

_______________________________________________________________________

_____Landlord has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

Tenant's Acknowledgment

Initial (c) (d) and (e):

_______(c) Tenant has received copies of all information listed above, if any.

_______(d) Tenant has received the pamphlet Protect Your Family from Lead in Your Home.

_______(e) Tenant has (check one below):

_____Received a 10-day opportunity (or mutually agreed upon period)to conduct a risk assessment or inspection for the presence of lead-based or lead-based paint hazards; or

_____Waived the opportunity to conduct a risk assessment or inspection for the presence of lead-based paint or lead-
based paint hazards.

Agent's Acknowledgment

_______(f) Agent has informed the Landlord of the Landlord'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 an certify, to the best of their knowledge, that the information provided by the signatory is true and accurate

________________________________________

Landlord	Date

_________________________________________	__________________________________________

Landlord	Date	Landlord's Agent	Date

_________________________________________

Tenant	Date

_________________________________________	__________________________________________

Tenant	Date	Tenant's Agent	Date