Fill and Sign the D Purchaser Has Received the Pamphlet Protect Your Family from Lead in Your Home Form

Lead-Based Paint Disclosure (Sales) ________________________________________ ___________________ Arkansas _____________________ 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-
To paint hazards (explain). (ii) the purchaser has read and understands seller's disclosure described in paragraph (a)(1) above and is satisfied that a reasonable person would be satisfied with: (a) the seller will disclose that the purchase of the residential real property will not include residential real property on which lead-based paint had been present prior to 1978, and/or (b) the purchaser will be provided with the required records or reports that would indicate the nature of, and information concerning, the lead-based paint hazards and the seller's knowledge of such hazards. Note: the seller's disclosure may include a reference statement to paragraph (b)(2) of this section. (c) seller's disclosure does not include any other statements regarding potential risks such as: (i) known hazards which may exist in any other part of a building not contained within the dwelling; (ii) lead-based paint hazards, which may be present in a different part of the building, but which are not contained within the dwelling; or (iii) potential problems that have not been disclosed to potential buyers. If a seller does not disclose any of the above, the purchaser is not required to assume that the seller cannot, or will not, disclose a lead-based paint hazard to sellers that are at risk because the purchaser is not advised of any hazard that applies in the seller's other parts of the building. Seller's disclosure statement (a) presence of lead-based paint and/or lead-