Lead-Based Paint Disclosure for Rental Housing Template

General template, not legal advice. Have an attorney in your state review before use. Last reviewed October 29, 2026.

Lead-Based Paint Disclosure for Rental Housing

Use this attachment for any lease of housing built before 1978, unless an exemption applies. Complete it, give the tenant the EPA pamphlet Protect Your Family From Lead in Your Home, and have everyone sign before the tenant is bound by the lease. Each landlord and agent must keep a signed copy for at least three years from the date the lease term begins. Common exemptions include leases of 100 days or less, units with no separate bedroom (such as studios and dorms), housing a certified inspector has found free of lead-based paint, and housing for older adults or people with disabilities unless a child under six lives there or is expected to. A renewal does not need a new disclosure unless new information has come to light.

Property address and unit

Year built (if known)

Lease start date

Landlord (lessor) name

Agent name, if any

Tenant (lessee) names

Lead Warning Statement

Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing, lessors must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention.

Landlord's disclosure

(a) Presence of lead-based paint or lead-based paint hazards. The landlord checks one and initials: Landlord initials

• Known lead-based paint and/or lead-based paint hazards are present in the housing. Explain where, what is known and the condition: Details
• The landlord has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

(b) Records and reports available to the landlord. The landlord checks one and initials: Landlord initials

• The landlord has given the tenant all available records and reports about lead-based paint and/or lead-based paint hazards in the housing. List them: Reports, with dates and who prepared them
• The landlord has no reports or records about lead-based paint and/or lead-based paint hazards in the housing.

Tenant's acknowledgment

Each tenant initials both lines: Tenant initials

• (c) I have received copies of all information listed above.
• (d) I have received the pamphlet Protect Your Family From Lead in Your Home.

Agent's acknowledgment (if an agent is involved)

Agent initials: Agent initials

• (e) The agent has informed the landlord of the landlord's obligations under the federal lead disclosure rule (42 U.S.C. 4852d) and is aware of the agent'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.

Record keeping

Date pamphlet given

Copy kept by landlord until (at least three years after the lease starts)

Copy kept by agent until

Where the signed copy is filed

State and local rules may add to these federal requirements, such as lead inspections, registration of older rental units or a different disclosure form. Rule checked for the state where the property is located: Rule and source, or none found

General template, not legal advice. Have an attorney in your state review before use.