Lead-Based Paint Notification

Lease Addendum


This notice is intended to help conform to Federal lead paint notification requirements.

The undersigned hereby acknowledges and agrees to the following:

1. That the undersigned was informed that the premises they are renting at: _____________________ may contain lead-based paint.

2. That the undersigned are aware that lead-based paint can poison and is hazardous to one's health, particularly children under 6 years of age, and can cause permanent damage if ingested.

3. That the undersigned was given a pamphlet issued by EPA, labeled: form EPA747-K-94-001, May 1995, that explains lead-based paint hazards.

4. That the undersigned takes full responsibility for any injury caused by lead-based paint to themselves, or anyone residing in , or visiting the premises, while in the undersigned's control.

5. That the undersigned shall hold ____________________________________, landlords, or their officers or agents harmless for any injury caused by lead based paint.


6. That the undersigned will inform the landlord if they suspect a lead-based problem, especially with chipping, flaking or pealing paint.

Dated: ___________________


[Occupant's Signature]

[Occupant's Signature]

State of __________________ )
County of ________________ )

This day, before me, a Notary Public in said County, personally came __________________________,

and ________________________________, and acknowledged the signing of this document to be a voluntary act.

IN WITNESS WHEREOF I have hereunto set my hand and official seal.

My commission expires: __________________

Notary Public