Page 1 of 1 P. LEAD-BASED PAINT DISCLOSURE
CR-4 Rev. 9/15 © 2015 Florida Realtors® and The Florida Bar. All rights reserved.
Comprehensive Rider to the
Residential Contract For Sale And Purchase
THIS FORM HAS BEEN APPROVED BY THE FLORIDA REALTORS AND THE FLORIDA BAR
If initialed by all parties, the clauses below will be incorporated into the Florida Realtors®/Florida Bar Residential Contract
For
Sale And Purchase between (SELLER)
and (BUYER)
concerning the Property described as
Buyer’s Initials ___________ ___________ Seller’s Initials ___________ __________
P. LEAD-BASED PAINT DISCLOSURE
(Pre-1978 Housing)
Lead-Based Paint 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 inspection 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 (INITIAL)
___________ (a) Presence of lead-based paint or lead-based paint hazards (CHECK ONE BELOW):
Known lead-based paint or lead-based paint hazards are present in the housing.
Seller has no knowledge of lead-based paint or lead-based paint hazards in the housing.
___________ (b) Records and reports available to the Seller (CHECK ONE BELOW):
Seller has provided the Buyer with all available records and reports pertaining to lead-based paint or
lead-based paint hazards in the housing. List documents: ____________________________________
Seller has no reports or records pertaining to lead-based paint or lead-based paint hazards in the
housing.
Buyer’s Acknowledgement (INITIAL)
___________ (c) Buyer has received copies of all information listed above.
___________ (d) Buyer has received the pamphlet Protect Your Family from Lead in Your Home.
___________ (e) Buyer has (CHECK ONE BELOW):
Received a 10-day opportunity (or other mutually agreed upon period) to conduct a risk assessment
or inspection for the presence of lead-based paint or lead-based paint hazards; or
Waived the opportunity to conduct a risk assessment or inspection for the presence of lead-based
paint or lead-based paint hazards.
Licensee’s Acknowledgement (INITIAL)
___________ (f) Licensee has informed the Seller of the Seller’s obligations under 42 U.S.C. 4852(d) and is aware of
Licensee’s responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the information
they have provided is true and accurate.
_____________________________ _______________ _____________________________ _______________
SELLER Date BUYER Date
_____________________________ _______________ _____________________________ _______________
SELLER Date BUYER Date
_____________________________ _______________ _____________________________ _______________
Listing Licensee Date Selling Licensee Date
Any person or persons who knowingly violate the provisions of the Residential Lead-Based Paint Hazard Reduction Act of
1992 may be subject to civil and criminal penalties and potential triple damages in a private civil lawsuit.
This software is licensed to [Cynthia Benchick - Charles Rutenberg Realty LLC] www.transactiondesk.com.
