Fill and Sign the Children at Risk of Developing Lead Poisoning Form

Lead-Based Paint Disclosure (Sales) ________________________________________ ___________________ Minnesota _____________________ 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 or re
-examined prior work as applicable. (c) prior inspection of the seller (check (i) or (ii) below): (i) seller has performed an inspection of housing for lead-based paint hazards (list documents below). (ii) seller has no inspection results for lead-based paint hazards. (d) inspection results available to seller (check (i) or (ii) below): (i) (list documents below). (ii) any prior inspection results for lead-based paint hazards. (e) purchaser's exposure to lead (check (i) or (ii) below): (i) (list documents below). (ii) purchaser has no exposure to lead. (f) exposure limit (check (i) or (ii) below): (i) (list documents below). (ii) all household members in the unit have received a copy of the hazard information for lead-based paint and/ or lead- based paint hazards and any necessary precautionary measures. (g) lead and/or environmental agency (check (i) or (ii) as applicable) report and record of exposure to lead from prior work activities (check (i) or (ii) below): (i) seller has a report or record regarding prior exposure to lead in the housing in accordance with subsection (c) above. (ii) seller has a report or record of compliance with all applicable regulations to the extent the report or report is available to the seller. (h) the following disclosure statement (check (i) or (ii) below): the seller of any interest in residential real property on the unit for which the purchaser is the owner and/or lessee has made disclosure of exposure to lead from lead-based paints and/or lead-based paint hazards in the housing (list documents below). The disclosure does not apply to the buyer, unless the buyer was aware of the existence of a housing hazard as required by this subsection (11a) before he or she signed an offer to purchase and the disclosure statement applies only to the buyer. The disclosure statement under this subsection (11a) is in addition to all other disclosure required under this section. The disclosure statement provided has the same force and effect as any other disclosure statement by any person or on behalf of any person, by any agency or instrumentality thereof, and is binding upon and inure to the benefit of the seller. (i) seller's prior assessment of the lead-based paint hazard information system (