This section for BLB Resources, Inc. use only
BLB Resources Processed by: ________________________ Date:______________
Approved Denied
3P Rev 10-11-16 All previous versions are obsolete. © BLB Resources, Inc. 2016 All rights
3P: CT, ME, MA, NH, NJ, NY, RI, VT
Additional LBP Information Receipt Addendum
This form is required for properties built before 1978.
Completed form must be submitted with original contract package upon bid acceptance. Form may also be
required after contract ratification if additional LBP information becomes available. If form is submitted separately
from original contract package, please fax to (248) 301-6647 or email to
3Paddenda@blbresources.com.
FHA Case Number __________________________________
Property Address (include city, state, zip)
______________________________________________________________________________________________________________
Purchaser(s) ______________________________________________________________________________
Selling Broker _____________________________________________________________________________
Selling Agent __________________________________ Agent Phone ________________________________
BLB Resources has provided all available LBP information on this property to the Selling Broker. Purchaser(s)
must initial to indicate receipt of this information, which includes the following (as applicable):
_____ LBP Disclosure Form HUD 9545-Y Seller has records or reports pertaining to LBP and/or LBP hazards
OR
_____ LBP Disclosure Form HUD 9545-Z Seller has no records or reports pertaining to LBP and/or LBP hazards
_____ Property Condition Report (PCR), full copies of all of LBP inspection reports, risk assessment reports,
and/or other reports and records pertaining to LBP and/or LBP hazards
_____ Copy of the EPA-approved pamphlet, “Protect Your Family from Lead in Your Home”
Additional information on the Lead Disclosure Rule may be obtained from the National Lead Information Center
by calling 1-800-424-LEAD (5323) or by visiting EPA’s website at
http://www2.epa.gov/lead.
Acknowledgement and Agreement
By signing below, Selling Broker acknowledges that BLB Resources has provided the LBP information on this
property to Selling Broker, and that Selling Broker has provided this information to the purchaser(s).
By signing below, Purchaser(s) acknowledge that Selling Broker has provided this information to purchaser(s) and
that Purchaser(s) have reviewed the available LBP information.
________________________________________________________ __________________
Purchaser Signature (Required) Date
________________________________________________________ __________________
Purchaser Signature (Required) Date
________________________________________________________ __________________
Selling Broker Signature (Required) Date
