Orange County NC Website
Browse       Search
Page 1 of 1 <br />North Carolina Association of REALTORS, Inc. STANDARD FORM 430–T <br /> Revised 7/2002 <br />© 7/2022 <br />DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT AND LEAD-BASED PAINT HAZARDS <br />Landlord’s Disclosure (initial) <br />_____ (a) Presence of lead-based paint and/or lead-based paint hazards (check one below): <br />Known lead-based paint and/or lead-based paint hazards are present in the housing (explain). <br />______________________________________________________________________________________________ <br />______________________________________________________________________________________________ <br />Landlord has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. <br />_____ (b) Records and reports available to the Landlord (check one below): <br />Landlord has provided the lessee with all available records and reports pertaining to lead-based paint and/or <br />lead-based paint hazards in the housing (list documents below). <br />_______________________________________________________________________________________________ <br />_______________________________________________________________________________________________ <br />Landlord has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing. <br />Tenant’s Acknowledgment (initial) <br />_____ (c) Tenant has received copies of all information listed above. <br />_____ (d) Tenant has received the pamphlet Protect Your Family from Lead in Your Home. <br />Agent’s Acknowledgment (initial) <br />_____ (e) Agent has informed the Landlord of the Landlord’s obligations under 42 U.S.C. 4852(d) and is aware of <br />his/her responsibility to ensure compliance. <br />Certification of Accuracy <br />The following parties have reviewed the information above and certify, to the best of their knowledge, that the information <br />provided by the signatory is true and accurate. <br />THE NORTH CAROLINA ASSOCIATION OF REALTORS, INC. MAKES NO REPRESENTATION AS TO THE LEGAL <br />VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN ANY SPECIFIC TRANSACTION. <br />_______________________________________________ _________________________________________________________ <br />Landlord Date Landlord Date <br />_______________________________________________ _________________________________________________________ <br />Tenant Date Tenant Date <br />_______________________________________________ _________________________________________________________ <br />Agent Date Agent Date <br />Lead Warning Statement <br />Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not <br />taken care of properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 <br />housing, landlords must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. <br />Tenants must also receive a federally approved pamphlet on lead poisoning prevention. <br />BY <br />12/07/22 <br />8:36 PM EST <br />dotloop verified <br />BY <br />12/07/22 <br />8:36 PM EST <br />dotloop verified <br />Barbara Young dotloop verified <br />12/07/22 8:36 PM EST <br />SE4S-XY4M-A1LT-MORZ <br />dotloop signature verification: dtlp.us/JDgN-ws5V-F0hN <br />DocuSign Envelope ID: F2ACDD3E-B704-4133-806D-A96A438DB7CF <br />12/22/2022