Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards

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 managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing, Lessors must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention.

Lessor's Disclosure
(a)	Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below):
(i)		Known lead-based paint and/or lead-based paint hazards are present in the housing (disclose below any additional information available, such as the basis for the determination that lead-based paint or lead-based paint hazards exist in the housing, their location, and the condition of the painted surfaces).
(ii)   	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 (i) or (ii) below):
(i)		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):
e.g., lead hazard evaluation, lead risk assessment, lead hazard reduction				
(ii)		Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

Lessee Acknowledgment (initial)
(c)	     	 Lessee has received copies of all information listed above.
(d)	     	 Lessee has received the HUD pamphlet Protect Your Family From Lead in Your Home. (Required at move-in or when application is made.)
(e)	     	 Lessee has received the EPA pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools. (Required within 30 days of commencement of rehab).

Lessor Acknowledgment (initial)
(f)	     	Agent (i.e. management company representative or realtor) has informed the Lessee of the Lessor's obligations under 42 U.S.C. 4852d 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 they have provided is true and accurate.

	Lessor	Date

	Lessee	Date

	Lessee	Date

	Agent	Date

Disclosure of Household Income and Composition

Tenant Income Certification:
(a)	On an annual basis, Lessee shall certify the household’s income and composition by signing a Tenant Income Certification as provided by Lessor.  
(b)	Lessee shall provide third party income and asset verification as necessary and reasonably requested by Lessor.
(c)	Lessor may terminate the lease or refuse to renew the lease of a household for failure to supply the items listed in (a) or (b), above, with written notice as described below.

Disclosure of Prohibited Lease Terms

Agreement to be sued:  This lease cannot contain a tenant agreement to be sued, admit guilt, or accept a judgment in favor of the property owner in a lawsuit brought in connection with the lease
Treatment of property:  This lease cannot contain a tenant agreement that the property owner may take, hold or sell personal property of household members without notice to the tenant and a court decision on the rights of the parties. This prohibition, however, does not apply to disposition of personal property remaining in the housing unit after the tenant has moved out. The property owner may dispose of this personal property in accordance with state law.
Excusing the property owner from responsibility:  This lease cannot contain a tenant agreement not to hold the property owner or the property owner’s agents legally responsible for actions or failure to act, whether intentional or negligent.
Waiver of notice:  This lease cannot contain a tenant agreement that the property owner may institute a lawsuit without notice to the tenant.
Waiver of legal proceedings:  This lease cannot contain a tenant agreement that the property owner may evict the tenant or household members without instituting a civil court proceeding in which the tenant has the opportunity to present a defense, or before a court decision on the rights of the parties.
Waiver of jury trial:  This lease cannot contain a tenant agreement to waive any right to a jury trial.
Waiver of right to appeal court decision:  This lease cannot contain a tenant agreement to waive the right to appeal or to otherwise challenge in court a decision in connection with the lease.
Tenant chargeable with cost of legal actions regardless of outcome:  This lease cannot contain a tenant agreement to pay attorney fees or other legal costs even if the tenant wins a court proceeding by the property owner against the tenant. The tenant, however, may be obligated to pay costs if the tenant loses.
Participation in services:  This lease cannot contain a requirement that a tenant participates in or receives supportive services as a condition of occupancy.
In addition, Lessor may not terminate tenancy or refuse to renew the lease except for: (i) serious or repeated violations of the terms and conditions of the lease (ii) for a violation of applicable federal, state, or local law; or (iii) for other good cause.  
Any termination or refusal to renew the lease must be preceded by the Lessor’s service upon the household of a written notice specifying the grounds for the action, at least thirty (30) days in advance of such action.  
If any provision in the lease or any other addendum to the lease conflicts with any provision in this Lease Addendum, the provisions of this Lease Addendum shall control.  Lessor or their authorized representative and the Lessee(s) have reviewed the above information and agree to the terms of this Lease Addendum and acknowledge the receipt of a signed and dated copy of the Lease Addendum.  

Acknowledgement and Signatures

I /we also certify that I/we have received/read/understand the basic requirements of the Uniform Relocation Act (URA) as outlined in the (check all applicable, unless the N/A box below is checked):   “General Information Notice” and/or  “Move-in Notice”. 
 N/A (Owner, check this box for any new move-ins after the start of the HOME/NHTF Affordability Period).

								
Lessee		Date 	Lessee	   	Date

Lessor or Authorized Representative	Date