The Georgia Lead Based Paint Disclosure Form is used in the following scenario; renting houses which were built before 1978 one must make sure to submit the Lead Based Paint Disclosure form as the housing may contain lean-based paint. Lead in the paint, paint chips and dust can cause health hazards if not maintained properly. This form can be used in the City of Atlanta, Georgia when renting pre-1978 housings. Also make sure you receive a federally approved pamphlet on lead poisoning prevention which will help you understand how to keep yourself and your family safe from the Lead Based paint.
Text Version of the Form
Lead-Based Paint Disclosure Notice
Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Housing Choice Voucher Program
Housing Authority of the City of Atlanta, Georgia
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 hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention. 42 U.S.C. 4582(d)
Presence of lead-based paint and/or lead-based paint hazards: (Check one below)
Known lead-based paint and/or lead-based paint hazards are present in the housing. (Explain)
Records and reports available to the Owner/Landlord: (Check one below)
Owner/Landlord has provided the Participant with all available records and reports pertaining to lead-based
Participant has received copies of all the information listed above.
Agent has informed the Owner/Landlord of the Owner/Landlord’s obligations under 42 U.S.C. 4852(d) and is aware
Certificate of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the information provided by the signatory is true and accurate.