Fill and Sign the C Purchaser Has Received Copies of All Information Listed above

Lead-Based Paint Disclosure (Sales) ________________________________________ ___________________ North Carolina _____________________ Street Address City State Zip Code WARNING! LEAD FROM PAINT, DUST, AND SOIL CAN BE DANGEROUS IF NOT MANAGED PROPERLY Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards Lead Warning Statement Every purchaser 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 Seller of any interest in residential real property is required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspections in the Seller's possession and notify the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase. Seller'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 (explain). ______________________________________________________________________________________________________________________________________________________________________________________ (ii) _____ Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. (b) Records and reports available to the seller (check (i) or (ii) below): (i) _____ Seller has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead- based paint hazards in the housing (list documents below).______________________________________________________________________________________________________________________________________________________________________________________ (ii) _____ Seller has no reports
( ) seller's disclosure (d) location of lead in dwelling lead-based paints in any housing unit, whether occupied, that the purchaser intends to occupy have no health (or any other hazard) impacts upon the purchaser's health and safety. Lead-based paints in residential homes that have been remodeled, restocked or replaced since the original sale are not necessarily known hazardous materials and can be purchased from a licensed inspector. Lead paint is not known to pose an imminent health hazard when the property is unoccupied. The seller of any interest in residential real property that has been purchased or that has an existing certificate of occupancy should provide to the purchaser the name or titles of all contractors that have been engaged in renovating the premises, restoring the roof, or doing any other work since the original sale (list documents below). (list documents below) ( ) seller's disclosure (e) condition of sale or certificate of occupancy. If the sale is being conducted in accordance with the real estate settlement procedures act and regulation r11-4-2 (hereinafter “regulation r11-4-2"), which governs private sales in North Carolina, the seller shall provide the purchaser with the names and addresses of the vendors who have been engaged in the renovation or renovation of the dwelling at the time of sale. Seller's disclosure (f) conditions and contents of sale (1) (a) seller certifies that the premises have been renovated, restocked or replaced to a level and condition to ensure their health, safety and welfare. (b) the selling agent provides the purchaser with: (i) seller's certifications, made at a hearing, in support of the sale, that the premises have been renovated to a level and condition to ensure their health, safety and welfare (check). (ii) seller's certified statement from one or more licensed inspectors, as provided in regulation r11-4-2, that inspections have been performed and reports filed with the department that they have been performed and are acceptable to them regarding the condition of the premises to ensure their health, safety and welfare (check). (2) and (3) seller's disclosures (a) seller provides the purchaser with a certificate of occupancy of the dwelling that is suitable for use as a place of residence at the time of sale, (b) seller certifies that the premises are safe from the condition and content of hazardous materials, including lead-based paint, and any other