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Lead Base Disclosure Form

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LEAD BASE DISCLOSURE FORM

This Lead Base Disclosure Form and Service Agreement (the Agreement) documents: (a) disclosures regarding the presence or absence of lead-based paint or lead-based paint hazards at the property identified below; and (b) the terms under which any inspection, testing, risk assessment, remediation, or abatement services will be provided. The parties agree that the disclosures and contractual terms set forth in this form are binding.

Property Address:    Year Built:

RECITALS

WHEREAS, Seller / Service Provider represents that it provides or arranges for inspection, testing, risk assessment, mitigation, abatement, and related services with respect to lead-based paint and lead-based paint hazards; and

WHEREAS, Buyer / Client has requested disclosure of any known lead-based paint or lead-based paint hazards at the Property and may request inspection, testing, or abatement services under the terms of this Agreement; and

WHEREAS, the parties desire to set forth their respective rights, responsibilities, and acknowledgments regarding disclosure, records, scope of work, payment, and confidentiality.

DISCLOSURE OF LEAD-BASED PAINT

Indicate the Seller / Provider's current knowledge regarding lead-based paint and lead-based paint hazards at the Property (check the appropriate box or boxes and provide required descriptions).

RECORDS AND REPORTS

The following records and reports relating to lead-based paint or lead-based paint hazards are:

SCOPE OF WORK

Describe the inspection, testing, risk assessment, mitigation, abatement, or other services to be performed, including specific areas, methods, and required clearances. Attach technical specifications or work orders as needed.

PAYMENT TERMS

Payments are due as described above. Buyer / Client will be responsible for all costs of collection, including reasonable attorneys' fees, for unpaid amounts. Cash, check, or other methods agreed in writing are acceptable.

TERM AND TERMINATION

Agreement Term Start Date:    Term End Date (if applicable):

Either party may terminate this Agreement for material breach by the other party upon written notice and expiration of the notice period specified above if the breach remains uncured. Termination does not relieve the Buyer / Client of payment for services performed or costs incurred prior to termination.

CONFIDENTIALITY

Each party shall treat as confidential all non-public information received from the other party in connection with this Agreement, including but not limited to technical data, proprietary methods, laboratory results, and remediation plans (Confidential Information). Confidential Information shall not include information that is or becomes publicly known through no wrongful act of the receiving party, or that is required to be disclosed by law or court order. The obligations of confidentiality shall survive termination of this Agreement for a period of three (3) years.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This Agreement, including any attachments or reports expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings. Any amendment to this Agreement must be in writing and signed by both parties.

CERTIFICATIONS AND ACKNOWLEDGMENTS

The undersigned Seller / Provider certifies, to the best of its knowledge, the accuracy of the disclosures above and affirms that any provided reports are genuine copies of records in Seller / Provider's possession. The undersigned Buyer / Client acknowledges receipt of the disclosures, any attached reports indicated above, and the opportunity to obtain an independent inspection or risk assessment prior to contracting for abatement services.

Buyer / Client acknowledges receipt of the required lead hazard information pamphlet and other legally-required notices, where applicable.

Seller / Service Provider - Print Name:

Seller / Service Provider - Signature:

Date:

Buyer / Client - Print Name:

Buyer / Client - Signature:

Date:

Enter text✕

What the Lead Base Disclosure Form Is and When it Applies

The Lead Base Disclosure Form documents seller or lessor knowledge about lead-based paint or lead-based paint hazards for residential property built before 1978 and provides required consumer information. It confirms delivery of the EPA/HUD lead-paint pamphlet and records any known lead conditions, testing, or maintenance plans. The form supports purchaser and renter decision-making, establishes factual disclosure for the transaction record, and creates a retrievable record that may be required by federal or state enforcement or during title and closing processes.

Why this disclosure matters for sellers, landlords, and buyers

Completing the Lead Base Disclosure Form meets federal disclosure obligations, protects parties by documenting known hazards, and reduces post-closing liability by creating an auditable record.

Why this disclosure matters for sellers, landlords, and buyers

Who typically completes and relies on this form

This form is used in residential real estate sales, rentals, and certain lease transactions where the property was constructed before 1978.

  • Sellers and lessors — Provide material facts about known lead hazards and distribute the EPA/HUD pamphlet to buyers/tenants.
  • Buyers and tenants — Review disclosures to assess inspection or remediation needs prior to closing or move-in.
  • Agents and closing professionals — Collect and retain signed disclosures as part of transaction files.

Retain signed copies in transaction records and include disclosure status in closing checklists to show compliance.

Primary signers and responsible parties

Seller — Homeowner

The seller signs to attest to knowledge of lead-based paint or hazards and to confirm delivery of the EPA/HUD information pamphlet. Signing shows disclosure to prospective buyers and is typically required before executing a purchase contract or closing.

Agent — Licensed Agent

A listing or leasing agent often facilitates delivery and collection of the completed form, documents the date of delivery, and retains the signed form in the transaction file to demonstrate compliance.

Essential data elements for the form

Property address: Include street, city, state, ZIP
Construction year: Enter four-digit year built
Known hazards: Yes/No; summarize if Yes
Pamphlet provided: EPA/HUD pamphlet acknowledged
Signature block: Full name and date required
Agent contact: Name and phone/email

Consequences of failing to provide correct disclosure

Civil penalties: Administrative fines and enforcement actions
Contract rescission: Buyer may have grounds to rescind
Liability claims: Increased exposure for remediation costs
Delays to closing: Transactions can be postponed for remediation or inspection
Regulatory enforcement: State or federal agency notices possible
Reputational risk: Professional credibility and listings impacted

Common mistakes to avoid when preparing the form

  • Failing to confirm the property's year of construction and mistakenly omitting the disclosure when the property predates 1978.
  • Providing incomplete contact or signature information that prevents reliable attribution of consent or delivery.
  • Neglecting to attach or document delivery of the EPA/HUD pamphlet, leaving the disclosure technically incomplete.
  • Relying on unsigned drafts or electronic copies without secure e‑signature evidence of intent and attribution.

How the Lead Base Disclosure Form is used in practice

Two short scenarios illustrate common uses and outcomes when the form is completed correctly.

Sale with known remediation

Seller discloses prior lead-abatement work

  • Buyer requests post-remediation test report
  • The signed form and report were retained in the closing file to limit post-closing disputes and support title insurance underwriting.

Rental of older unit

Landlord provides the EPA pamphlet at lease signing

  • Tenant acknowledges by e-signature
  • Electronic retention enabled rapid proof of delivery when a later inquiry arose about unit condition.

Step-by-step: filling out the Lead Base Disclosure Form

Follow these steps to complete, sign, and preserve a valid disclosure record.

  • 01
    Confirm applicability: Verify the building year and determine whether disclosure is required
  • 02
    Provide pamphlet: Deliver the EPA/HUD lead information pamphlet to the buyer or tenant
  • 03
    Complete fields: Enter property details, known hazards, and any test dates
  • 04
    Sign and retain: All parties sign; keep a dated copy in transaction records

Routing and submission options for the completed form

The form can be completed and delivered by paper or electronically; route copies to the buyer/tenant, agent, and closing/lease file.

  • Seller to buyer: Original or signed copy provided prior to contract acceptance
  • Agent files: Agent retains a copy in the transaction folder
  • Closing escrow: Escrow receives disclosure for closing ledger
  • Digital archive: Store a PDF/A or equivalent copy for recordkeeping

Core sections to include in a professional disclosure form

Ensure each section is present and clearly labeled so the record stands up to regulatory or transactional review.

Property details

Full street address, unit number, city, state, and ZIP to identify the subject property unambiguously for title and inspection records.

Construction date

Year built or best available estimate; this field determines whether federal lead-based paint disclosure obligations are triggered.

Known conditions

Clear statement about any known lead-based paint or hazards, including testing dates, results, and remediation status if applicable.

Pamphlet acknowledgment

A checkbox or statement confirming the buyer/tenant received the EPA/HUD information pamphlet as required by federal guidance.

Signatures and dates

Signature lines and date fields for seller/lessor, buyer/tenant, and agent where appropriate to show intent and timing.

Attachments

Space to list attached reports, test results, or abatement records that support the disclosure content and may be relied on by buyers.

File formats and supporting documents to include

Provide multiple file formats and supporting documents so recipients can review, archive, and use disclosures effectively.

Signed PDF

A completed, signed PDF (preferably PDF/A) provides a durable, timestamped record suitable for long-term storage and printing.

EPA/HUD pamphlet

Attach or confirm delivery of the required EPA/HUD lead information pamphlet; note the delivery method on the form.

Test reports

Include laboratory test results or risk assessment reports that substantiate any claims of remediation or absence of lead hazards.

Closing exhibits

Add the signed disclosure to closing or lease exhibits so it becomes part of the official transaction package retained by escrow or property manager.

Practical tips for accurate and efficient completion

Adopt consistent practices to reduce errors and make disclosures useful for buyers, tenants, and regulators.

Start early in the transaction
Begin disclosure checks when the property is listed or the lease is advertised so any required testing or remediation can be scheduled without delaying closing.
Use checklists
Include the disclosure on a closing or leasing checklist that names the party responsible for delivery and retention to avoid last-minute omissions.
Keep supporting evidence
Attach test reports, invoices for abatement, and the pamphlet receipt to the signed form so later inquiries can be answered quickly and precisely.
Use secure e‑signing
When e-signing, ensure the method captures signer intent, attribution, and a tamper-evident audit trail to meet ESIGN and state law evidentiary needs.

Timing and critical delivery points to observe

Certain delivery points are time-sensitive; confirm these early to prevent contractual or regulatory issues.

Pre-contract delivery:

Provide disclosure and pamphlet before buyer executes the purchase contract if required by transaction terms

At lease signing:

Landlords should deliver and obtain tenant acknowledgment at or before lease execution

Before closing:

Escrow should hold a copy of the signed disclosure before recording or funding

Upon request:

Respond promptly to title or lender requests for disclosure copies during underwriting

Retention start date:

Retention begins on the date of signature or closing, as applicable

Digital workflow settings to capture valid e‑signatures and evidence

Configure signature routing and authentication to meet recordability and attribution requirements under ESIGN and state law.

Field Configuration
Signer authentication Email link or SMS code; stronger methods for high-risk transactions
Consumer disclosure Present ESIGN consumer disclosure and obtain consent before e-signing
Attach pamphlet Include EPA/HUD pamphlet as required attachment to the signing session
Retention format Save completed file as PDF/A with audit trail embedded

How paper disclosure compares with an electronic execution

Understand legal and practical differences when choosing between paper and electronic disclosures.

Criteria Paper Electronic
Legal status valid valid under esign/ueta (15 u.s.c. §7001)
Proof of delivery manual receipt audit trail with timestamps
Storage physical file digital archive (pdf/a)
Convenience in-person only remote signing allowed

Key milestones from listing to closing

A typical disclosure timeline shows the principal milestones and their sequencing through the transaction.

01

Listing opened

Seller/agent confirms property year and schedules inspections if needed

02

Disclosure provided

Deliver pamphlet and complete form before or on contract signing

03

Buyer review

Buyer reviews disclosure, orders tests, and negotiates remediation if tests indicate hazards

04

Closing

Signed disclosure is filed with closing package and retained by escrow

Representative eSignature pricing and capability comparison

Below is a concise vendor comparison for basic pricing and key features relevant to disclosure workflows; signNow is listed first per vendor ordering standards.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about completing and e-signing the form

Answers to common questions about validity, eSignature evidence, attachments, notarization, and revocation options.


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