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RESIDENTIAL LEASE/RENTAL AGREEMENT
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This agreement made this day of , 20, is between (hereinafter called “Management” or “us” or “we”) and (hereinafter collectively called “Resident” or “you”).  Management leases to Resident, and Resident rents from Management, residential unit located at (hereinafter called the “Property”), under the following conditions:

1.TERM: The initial term of this lease shall be () months,
beginning , 20, and ending , 20.  At the conclusion of this term, this lease shall automatically renew on a month-to-month basis.

2.RENT: Rent is payable monthly in advance without notice or demand at the rate of DOLLARS ($) per month, on the day of each and every month during the initial or any extended term of this Agreement, and shall be annually adjusted.  Rental payments shall be made by deposit to the Fifth Third Bank account of Management or such other place as Management may from time to time designate.  Rent shall be paid through deposit into Management’s account at Fifth Third Bank using the deposit tickets provided.  Deposits must be received by 5:00 pm to be credited to the account that day.  When the _ falls on a Saturday, Sunday or other bank holiday, Resident agrees to deposit their rent by 5:00 pm on the next business day. When the bank receives your payment and credits it to our account, your rent is considered paid.  Resident is responsible to notify Management when additional deposit tickets are needed.  Deposit tickets must include the Resident’s name or property address so that their account may be properly credited.

3.DISCOUNT FOR PROMPT PAYMENT: Time is of the essence in this Agreement.  If the rent, and any previous balance due, is received and accepted on or before the   day of the month (due date as described above) a TWENTY FIVE DOLLAR ($25.00) DISCOUNT will be credited to the rental payment.

4.ADDITIONAL RENT & RETURNED CHECKS: If Management elects to accept rent after the    day of the month, Resident agrees to pay $5.00 for each day after the day of the month as additional rent.  The additional rent shall continue to accrue at the rate of $5.00 per day until all rents, lost discounts, and any other amounts owing under this Agreement are paid in full.  In the event any check given by Resident to Management is returned by the bank unpaid, Resident agrees to pay Management $50.00 as additional rent, forfeit the rental discount for that month, and agrees to pay additional rent of $5.00 per day after the day of the month until Resident’s account is brought current.


5.HOW YOUR MONEY IS APPLIED TOWARD PAYMENT: Monies received are applied first to any lost rental discount; second to any outstanding additional rent; third to any unpaid fees or charges; then fourth to any current rent or rent to become due.  This could result in unpaid rent, which would be subject to additional rent as contained herein. This means if you pay your rent late and pay only the amount of your monthly rent, your rent is still unpaid because the money is used to cover lost rental discount and fees first and could result in initiation of the eviction process.

For Example: If your discounted rent is $_________ and is due on the 1st of the month and you don’t pay it in full,
on the 2nd of the month you will owe $____________
on the 3rd of the month you will owe $____________ (you will also receive a 3 –day eviction notice)
You will owe an additional $5.00 for every day the full amount owed remains unpaid.

The Best and CHEAPEST thing for you to do is to PAY YOUR RENT ON-TIME

6.EVICTION: If the rent called for in paragraph 2 hereof has not been paid by the ()  of the month, then Management shall automatically and immediately have the right to take out a Dispossessory Warrant and have Resident, his/her family and possessions evicted from the Property.

7.SECURITY DEPOSIT: Resident agrees to pay $ as a deposit and provide  a valid co-signer (as determined by Management) to indemnify owner against damage to the Property and for Resident’s fulfillment of the conditions of this agreement. Said deposit will be returned to Resident, thirty (30) days after residence is vacated if:

a.Lease term (initial 12 months) has been expired or agreement has been terminated by both parties.
b.All monies due to Management by Resident have been paid.
c.Management is in receipt of copies of paid final bills on all utilities including gas, electric, water, sewer, trash, telephone and cablevision.
d.Resident has scheduled and attended an exit interview at the unit with a representative of Management. Keys must be returned in person to a representative of Management during the exit interview. Resident agrees to pay a $50.00 fee if they fail to schedule or attend an exit interview.
e.Property is not damaged and is left in its original condition, normal wear and tear excepted.
f.Carpets, walls, floors, appliances, bathroom fixtures and other areas of the premises have been cleaned and are ready for the new Resident.  Management shall arrange for carpets to be professionally treated for ticks and fleas if detected or if pets were present at Resident’s expense. Carpets MUST be cleaned by Management (rates are at or below market price for professional carpet cleaning).  Resident may not rent a carpet cleaner and clean the carpets themselves.
g.Trash and other debris (including abandoned furniture, clothes or vehicles) have been removed from the Property.
h.Resident agrees to pay to replace or refinish any appliances, fixtures, or surfaces marred by the Resident or their guests. Examples include but are not limited to: bath tub stained with hair dye or nail polish, sinks burned by cigarettes, or cabinet doors marked with ink, paint, crayons, or markers.
i.Written notice to vacate has been given to Management at least 30 days prior to vacating.
j.Rent, or daily rate of $25/day if applicable, is owed until ALL keys have been returned and ALL trash and debris (including furniture and vehicles) have been removed.
k.Resident agrees to pay rent at a daily rate of $25/day for each day required to clean and repair the damage you did to the unit until the unit is in rentable condition.

Example: You tell us you are going to be out by the 30th but then you decide you need three extra days so your friends can help you move over the weekend. After you leave and give us the keys, it takes our cleaning crew three days to clean and repair the doors you damaged and the holes in the wall. You will owe an additional $150 ($25/day X 3 extra days to move out, $25/day X 3 days to clean) which will be deducted from your security deposit or billed directly to you if your deposit does not cover the labor and materials to clean and repair your apartment.

Deposit may be applied by Management to satisfy all or part of Resident’s obligations and such act shall not prevent Management from claiming the damages in excess of the deposit. 
              
Resident may not apply the deposit to any of the rent payment.

It is our sincere desire to refund your entire deposit amount because that would mean you have returned the unit in the same condition you received it and have fulfilled all the terms of this Agreement.

*The cleaning checklist included in your tenant folder shows you what we expect to be cleaned after move-out in order to receive your full deposit refund.


8.EARLY RELEASE AND/OR RETURN OF PROPERTY:  Resident may be released from the obligation to pay the rents contained herein, as of the last day of a rental month, before the expiration of the initial term or any extensions by:
a.Resident provides Management with written notification 30 days prior to move-out.
b.Paying all monies due through date of release (this means you pay all rent through the day you move out).
c.Returning Premises in a clean, undamaged ready-to-rent condition (see paragraph 7 above)
d.Rent is owed until ALL keys have been returned to Management and all trash and debris (including vehicles) have been removed from the premises.
e.If you have not completed the initial 12 months term of this lease, you agree to pay an amount equal to one month’s discounted rent as an Early Release Option.
f.If you have completed the initial term and your lease has converted to a month-to-month basis and you fail to give written notice 30 days prior to move-out, you agree to pay an amount equal to one month’s discounted rent as a Non-Thirty-Day Notice Option to Management. Written notice must be received by Management before rents are due for your last month in the unit. Last month’s rent is not prorated.

9.SUBLET:  Resident may not sublet the Property or assign this lease.

10.CONDITION: Resident accepts Property in its present “AS-IS” condition and acknowledges that Resident has received a “Move-In Inspection Form” and accepts the responsibility to complete said form within seven (7) days of taking possession and return a completed, signed copy to Management.  Failure to do so shall be Resident’s acknowledgement that Property is in perfect condition in every particular and that any damages, including breakage, burns and wear or otherwise not shown shall be Resident’s responsibility and expense.

Initial to confirm receipt of Move-In Inspection Form:___________________
11.APPLIANCES: Any appliance on premises at the signing of this Agreement shall be returned by Resident upon move-out in the same condition as at the signing of this Agreement, normal wear and tear excepted. 
Appliances present:
Requests to repair appliances will only be received during normal business hours (M-F 9:00 am – 6:00 pm)

12.ALTERATIONS: Resident shall not make, or allow to be made, any alterations (including painting), installations, repairs or redecoration of any kind to the Property without prior written permission of Management, provided, however, that notwithstanding such consent, Resident agrees that all alterations including, without limitation, any items affixed to the Property, shall become the property of Management upon the termination of this Agreement.  This includes, but is not limited to: ceiling fans, mini-blinds, carpeting, fencing, lighting fixtures, shrubs, flowers etc.  Removal of these items shall be considered theft subject to civil and criminal prosecution.
You are allowed to hang pictures using finishing nails. Any decorations requiring use of a power tool, such as a drill, are expressly prohibited.

13.FIRE AND CASUALTY:  Management shall maintain a fire and extended coverage insurance policy for the liability/contents of the Property.  Resident shall secure and pay for tenant's insurance to protect their personal property during the term of this agreement.  Management shall not be responsible in any manner for Resident's personal property during the term of this agreement.  If residence becomes uninhabitable by reason of fire, explosion, or by other casualty, Management may, at its option, terminate rental agreement or commence repairs within 60 days.  If Management does not do repairs within this time or if building is fully destroyed, the rental agreement hereby created is terminated.  If Management elects to repair damage, rent shall be abated and prorated from the date of the fire, explosion, or other casualty to the date of re-occupancy, providing during repairs, Resident has vacated and removed Resident's possessions as required by Management.  The date of re-occupancy shall be the date of notice that residence is ready for re-occupancy.

For Example: The pipes burst in the apartment above your unit and some of your possessions are damaged by the water. Management is not responsible for the loss of your possessions. This is why You should buy Renter’s Insurance.

For Example: There is a fire and your apartment is burned. Thankfully, no one is injured but all your possessions are lost. Our insurance covers us to replace the building but does not cover replacement of your possessions. You have nothing. This is why you should buy Renter’s Insurance.

14.SMOKE DETECTORS: Resident acknowledges the presence of a working smoke detector in the premises, and agrees to test the detector weekly for proper operation, and further agrees to replace any batteries (if so equipped) when necessary.  Resident further acknowledges that he/she understands how to test and operate the smoke detector in this Property.  Resident also agrees to repair or replace any inoperative smoke detector immediately should it fail to operate properly during any test. Resident will be charged a replacement fee for any missing smoke detector or batteries at move out.
Initials:

15.RENTERS INSURANCE: Resident agrees to purchase comprehensive insurance, known as a Renter’s Insurance Policy, against all perils, including but not limited to insurance on personal property or property of other persons from protection of loss due to or caused by theft, vandalism, bursting or breaking pipes, by or from fire, windstorm, hail, flooding, leakage, steam, snow or ice, by or from running water, backing up of drainage pipes, seepage, or the overflow of water or sewage on the Property.  Said policy shall include a liability coverage of $300,000.00 minimum.  Failure to obtain and maintain a Renter’s Insurance Policy may be interpreted by Management as a violation of this Agreement.


16.WASTE: Resident shall not commit any waste on the Property and is responsible to notify Management of any condition that may result in waste and additional costs.

Example: You notice your toilet continues to run after you flush. This wastes water. You are responsible to contact Management during normal business hours to request the necessary repair.

Example: It’s -10 degrees outside and you suspect a water line has frozen because your washer won’t fill with water. You are responsible to call the emergency number immediately to report this condition.

17.RIGHT OF ACCESS:Management shall have the right of access to the Property for inspection and repair or maintenance during reasonable hours.  In case of emergency, Management may enter at any time to protect life and prevent damage to the Property.

18.USE:  The Property shall be used for residential purposes only and shall be occupied only by the persons named in Resident's application to lease.  The presence of an individual residing on the Property who is not a signature on the rental agreement will be sufficient grounds for termination of this agreement.  Babysitters/care givers providing services on the premises are not considered a Resident or a Guest and must submit a completed rental application to Management and be approved by Management. Property shall be used so as to comply with state, county, and municipal laws and ordinances.  Resident shall not use residence or permit it to be used for any disorderly or unlawful purpose or in any manner so as to interfere with other Residents’ or neighbors’ quiet enjoyment of their residence.  Acts of guests in violation of this Agreement or Management’s rules and regulations may be deemed by Management to be a breach of this Agreement by Resident.

19.PROPERTY LOSS:  Management shall not be liable for damage to Resident's property for any type for any reason or cause whatsoever.  Resident acknowledges that he/she is aware that he/she is responsible for obtaining any desired insurance for fire, theft, liability etc. on personal possessions, family, and guests.

20.PETS:  Animals, birds, or pets of any kind, permanent or visiting (this includes “pet sitting”, even for one day), shall not be permitted inside the residential unit at any time unless the prior written approval of Management has been obtained. Any such pets, if allowed, requires the payment of a Non-refundable Pet Charge of $50.00 per pet, plus additional rent of  $ per pet per month (this amount may not be included in paragraph 2 above).  In no instance will more than two (2) pets be allowed.  Authorized pets must be listed below.  By listing, Resident agrees to be fully liable for damages and injuries to property and/or people, which might be caused by pets.  Resident agrees that if said pets should at any time become annoying, bothersome, or in any way a nuisance to neighbors (this includes the presence of pet waste), Resident will, upon notice of Management, immediately remove said pets from the Property. You must clean up after your pet immediately and dispose of the waste responsibly. Any unauthorized pets found on the Property shall be removed by Resident and above stated pet fees and pet rent, retroactively to the date of this Agreement, shall be paid immediately to Management. If pet charges or rent are owed, the next money received by Management shall be applied first toward pet charges and pet rent, then toward rent owed. This may result in late fees as described in paragraph #5 above. The presence of unauthorized animals or pets of any kind and/or non-payment of pet charges and pet rent is a violation of this agreement and Management will initiate the eviction process.

Example: Your lease began 10 months ago and you decide to get a cat or dog or pet sit for one day and not tell us about it. We discover the pet (we always do sooner or later), you immediately owe us $50 Non-refundable pet charge and $250 pet rent ($25/month pet rent X 10 months). The next money we receive from you will be applied first toward the $300 ($50 + $250) you now owe which may result in unpaid rent and additional late charges.

Example: Your lease began 10 months ago and you decide to get a dog or cat. You notify us and we give written permission. You owe $50 Non-refundable pet charge and $25 pet rent each month beginning that month.
   
    Only the pets listed herein are authorized on the Property:

21.INDEMNIFICATION:  Resident releases Management from liability for and agrees to indemnify and hold harmless Management against losses, incurred by Resident as a result of (a) Resident's failure to fulfill any condition of this agreement; (b) any damage or injury happening on or about the Property to Resident, Resident's invitees or licensees or such person's property; (c) Resident's failure to comply with any requirements imposed by any governmental authority; and (d) any judgment, lien, or other encumbrance filed against residence as a result of Resident's action.

22.UTILITIES:  Resident is responsible for payment of utilities to include:. Resident agrees to pay a $5/day/utility charge for each day utilities are not in Resident’s name while Resident is in possession of the property. Resident is considered to be in possession of the property until ALL keys have been returned to Management. Failing to pay the utility bills will be interpreted as a default and violation of this Agreement and will result in initiation of the eviction process.  Resident shall be permitted to install additional cable locations at Resident’s expense.  Any installation costs, red tags or repairs due to turn-offs  are the responsibility of the Resident.  Any wall jacks, telephone or cable installation shall remain with the Property. The following utilities must be placed in Resident’s name before taking possession of property:

23.REMEDIES (Money You Owe Us for Rent, Damages, and Fees): All remedies under this agreement or by law or equity shall be cumulative.  If a suit for any breach of this agreement establishes a breach by Resident, Resident shall pay to Management all expenses incurred in connection therewith including legal fees. Resident agrees to pay 18% interest on all monies owed to Management upon termination of this Agreement.

24.FAILURE OF MANAGEMENT TO ACT: Failure of Management to insist upon strict compliance with the terms of this Agreement shall not constitute a waiver of any violation, nor shall any acceptance of a partial payment of rent be deemed a waiver of Management’s right to full amount.

25.NOTICES:  Any notice required by this agreement shall be in writing and shall be delivered personally or mailed by registered or certified mail.  Notices shall be sent to the following address:

Management:  Resident:

16 E. Market St., STE 4
Tiffin, Ohio 44883


26.REPAIRS:  Resident acknowledges that the premises are in good order and repair, unless otherwise indicated herein.  Resident shall, at his own expense and at all times, maintain the premises in a clean and sanitary manner, including all equipment and appliances therein and shall surrender the same, at the termination hereof, in as good a condition as received, normal wear and tear excepted.  Resident shall be responsible for damages caused by his negligence and that of his family or invitees and guests.  Resident should call 419-448-5506 ( Mon.-Fri. 9:00 am -6:00 pm) to request maintenance or report any damage to the Property.

27.ABANDONMENT:  Anytime the Property is left unoccupied for more than seven (7) days while rent remains unpaid without notice to Management, Management may consider the Property abandoned.  Management may, at its option, declare this Agreement forfeited and re-rent said premises without any liability whatsoever.  Resident shall be obligated to pay based on the balance of the rental agreement or the early termination requirement, whichever is greater. Resident shall be responsible for payment of costs to remove abandoned furniture, personal items and debris left at the Property.  Management shall also have the right to remove, store or dispose of any of Resident's personal property remaining on the premises after the termination of this agreement.  Any such personal property shall be considered Management's property, and title thereto shall vest in Management.

28.LEAD, ASBESTOS, MOLD AND/OR RADON: If Property was constructed prior to 1980 it may contain lead and/or asbestos containing materials.  This shall serve as constructive notice that this Property was constructed in approximately .  Resident may have Property tested for lead, asbestos, mold and/or radon levels prior to occupancy.  Should Resident determine that the levels of lead, asbestos, mold and/or radon are unacceptable to Resident, Resident may void this Agreement prior to taking possession of Property, but not later than three (3) days after entering into this Agreement with Management.  Resident herewith acknowledges receipt of the Federal Pamphlet Protect Your Family From Lead in Your Home and the Lessor's disclosure form attached hereto and made a part hereof by reference.


29.RULES AND REGULATIONS:
a.Signs:  Resident shall not display any signs, exterior lights, or markings.  No awnings or other projections shall be attached to the outside of the building.
b.Locks:  Resident is prohibited from adding locks to, changing, or in any way altering locks installed on the doors.  All keys must be returned to Management upon termination of the occupancy.
c.In the event Resident locks themselves out, Management will unlock the residence at Management’s convenience, at no charge during regular business hours (Mon. – Fri. 9:00 am – 6:00 pm). Lock out calls after hours, nights, weekends, or holidays will be $20 charge per occurrence payable at the time the residence is unlocked or $30 per occurrence if paid with next rent due. Management does not guarantee service after hours, weekends, or holidays.
d.Entrances, hallways, walks, lawns, and driveways shall not be obstructed or used for any purpose other than ingress and egress.

e.Radio or television aerials or satellite dishes shall not be placed or erected on the roof or exterior.
f.Parking:  Non-operative vehicles or trailers are not permitted on the Property. No vehicle or trailer without a current license is allowed on the Property. Any such non-operative/unlicensed vehicle or trailer may be removed by Management at the expense of Resident owning same, for storage or public or private sale, at Management's option, and Resident owning same shall have no right of recourse against Management therefore. All vehicles in A+ Rentals parking lots must have A+ Rentals parking sticker prominently displayed on the rear of the vehicle.
g.Guests are not permitted to use A+ Rentals parking lots and will be subject to immediate towing.
h.Storage:  No goods or materials of any kind or description which are combustible or would increase fire risk, shall be stored on the Property.  Any storage (including basement if applicable) shall be at Resident’s risk and expense, Management shall not be responsible for any loss or damage.
i.Walls: No nails, screws, or  adhesive hangers except standard picture hooks, shade brackets, and curtain rod brackets may be placed in walls, woodwork, or any part of residence. Absolutely no tape of any kind may be applied to walls or woodwork for any reason.
j.Guest:  Resident shall be responsible and liable for the conduct of his/her guests.  Acts of guests in violation of this agreement or Management's rules and regulations may be deemed by Management to be a breach by Resident.  No guest may stay longer than two (2) days per month without permission of Management. Guests staying longer than two (2) days without permission of Management constitute a violation of this Agreement and Management may initiate the eviction process. Babysitters are not considered guests and may not stay over night. All babysitters/care givers providing care on the premises must complete a rental application and be approved by Management. Failure to do so is grounds for eviction.
k.Noise:  All radios, television sets, phonographs, etc. must be turned down to a level of sound that does not annoy or interfere with neighbors.
l.GOOD HOUSEKEEPING IS EXPECTED OF EVERYONE: Resident agrees to keep the Property in a clean and sanitary condition and to remove any trash or rubbish as it accumulates.
m.Resident's Guide: Management reserves the right at any time to prescribe such additional rules and make such changes to the rules and regulations set forth and referred to above, as Management shall, in its judgment determine to be necessary for the safety, care, and cleanliness of the Property, for the preservation of good order or for the comfort or benefit to Residents generally.
n.Pest Control: Resident is responsible for all pest control in their residence. Resident agrees to pay for extermination immediately in the event of any pest infestation. If your residence is found to be infested, Management reserves the right to hire a professional exterminator immediately at Resident’s expense. Failure to pay for extermination by a professional exterminator or failure to fully participate in the extermination process is a violation of this Agreement and cause for immediate eviction. If residence is found to be infested after Resident moves out, Resident agrees to pay prorated rent for each day until the infestation has been irradicated and a professional exterminator deems the property habitable.  Any infestation shall constitute a default of this Agreement and may result in initiation of the eviction process.
o.Drains/Plumbing: Resident agrees to maintain all drains and plumbing in the Property in good working order through the proper disposal of organic and waste materials.  Resident shall not deposit tobacco, coffee grounds, cooking grease or unnecessary food or other wastes or materials including sanitary napkins, diapers, dental floss or other small objects down sinks or commodes.  Resident shall be responsible for all costs associated with restoring drains and plumbing to good working order. Plumbing service call rates are as follows: unplug sink, tub, or toilet - $30 during normal business hours if paid at time of service call, $70 if paid with next rent due; $50 for service calls after business hours if paid at time of service call and $75 if paid with next rent due. Management does not guarantee service after hours, weekends, or holidays.
p.Smoke Alarm: Resident shall keep smoke alarm(s) and fire extinguisher (if provided) in working order including replacing the battery as needed.  Resident accepts any liability associated with the use and upkeep of all such devices and understands how to and agrees to test same.
q.Kerosene Heaters and Electric Heaters: Resident agrees not to use any form of kerosene space heater or electric heater in the dwelling. Use of electric or kerosene heaters is grounds for immediate eviction.
r.Water Beds: Resident shall not have or keep any water bed in the dwelling.
s.No grill of any kind (gas, charcoal, electric, etc.) may be used or stored on a porch or patio if there is an overhang above it. No grill of any kind may be used within ten feet of the unit structure.


30.ENTIRE AGREEMENT: This agreement and any attached addendum constitute the entire agreement between the parties and no oral statements shall be binding.  It is the intention of the parties herein that if any part of this rental agreement is invalid, for any reason, such invalidity shall not void the remainder of the rental agreement.

31.BINDING EFFECT:  This agreement and all its terms shall inure to the benefit of and be binding upon the executors, administrators, heirs or successors of the parties.

32.SEVERABILITY:  If any provision of this agreement or the application thereof to any person or circumstance shall to any extent be held in any proceeding to be invalid or unenforceable, the remainder of this agreement, or the application of such provision to persons or circumstances other than those to which it was held to be invalid or unenforceable, shall not be affected thereby, and shall be valid and be enforceable to the fullest extent permitted by law.

33.NUMBER OF RESIDENTS LIVING WITHIN THE PREMISES: __()_


34.SPECIAL STIPULATIONS: The following stipulations shall control in the event of conflict with any of the foregoing:

A.Keys are not given until each Resident has submitted a complete application and been approved by Management, all co-signer paperwork (if applicable) has been received and approved, all utilities have been transferred into the Resident’s name, and security deposit and rent and any pet charges (if applicable) have been paid in full.
B.Resident is responsible for payment of utilities until all keys have been returned to Management.
C.Resident agrees to pay $5.00/day/utility for utilities removed from Resident’s name before keys were returned to Management.
D. are jointly and severally liable for fulfillment of the terms of this agreement including, but not limited to payment of rent, fees and damages.

E. Resident agrees to pay for the replacement of all carpets, windows, doors, or any other items(including light bulbs) on the premises damaged or removed by Resident, their pets, children, or visitors without proration.

F. Resident acknowledges receipt of the move out cleaning check list: ______________________

G. Management does not guarantee service after hours, weekends, or holidays.

H. Resident agrees to pay for the removal of all furniture and debris left in the unit, on the property, and in or near the dumpsters on the property.




IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed in person or by a person duly authorized, the day and year above written.  If this Agreement is not signed by all the Residents named herein and/or on rental application, the one(s) signing warrants that he or she has the authority and is acting as agent to sign for the other.
_________________________________________________(SEAL)  ___________________________________________
RESIDENT:DATESocial Security Number:
_________________________________________________(SEAL)  ___________________________________________
RESIDENT:DATESocial Security Number:





___________________________________________________________
MANAGEMENT (Authorized Representative)


THIS IS INTENDED TO BE A LEGALLY BINDING CONTRACT 
If not fully understood, please seek the advice of an attorney before signing.

DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT AND LEAD-BASED PAINT, ASBESTOS, MOLD AND RADON HAZARDS
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 taken care of properly.  Lead exposure is especially harmful to young children and pregnant women.  Before renting pre-1978 housing, landlords must disclose the presence of known lead based paint and lead-based paint hazards in the dwelling.  Tenants must also receive a Federally approved pamphlet on lead poisoning prevention.
Lessor's Disclosure (initial):
_____ (a)Presence of lead-based paint or lead-based paint, asbestos, mold and radon hazards (check all that apply):
0Known lead-based paint and/or lead-based paint are present in the housing (explain).
___________________________________________________________________________
___________________________________________________________________________
0Known asbestos 0; mold 0; and/or radon 0 hazards are present in the housing (explain).
___________________________________________________________________________
0Lessor has no knowledge of lead-based paint and/or lead-based paint hazard in the housing.
0 Lessor has no knowledge of asbestos 0; mold 0; or radon 0 hazards in the housing.
_____ (b)Records and reports made available to the lessor (check one below):
0Lessor has provided lessee with all available records and reports pertaining to lead-based paint and/or lead-based paint, asbestos, mold and/or radon hazards in the housing (list documents below).
___________________________________________________________________________
___________________________________________________________________________
0Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint, asbestos, mold and/or radon hazards in the housing.

Lessee's Acknowledgment (initial):
_____ (c)Lessee has received copies of all information listed above, if applicable.
_____ (d)Lessee has received the pamphlet Protect Your Family From Lead in Your Home.

Agent's Acknowledgment (initial):
_____ (e)Agent has informed the lessor of the Lessor’s obligations under 42 U.S.C. 4582(d) and is aware of his/her 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 provided by the signatory is true and accurate.
_________________________________________________________________________________
LessorDateLessorDate
_________________________________________________________________________________
LesseeDateLesseeDate
_________________________________________________________________________________
AgentDateAgentDate