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Tenant Certification

Form(THC COPY) Apt. Street Address 345 Franklin Street - Cambridge Unit# 50

Required Federal Lead Warning StatementHousing built before 1978 may contain lead-based paint Lead from paint! paint c"ips! and dust can pose"ealt" "a#ards if not managed properly Lead e$posure is especially "armful to young c"ildren andpregnant %omen &efore renting pre-1978 "ousing! lessors must disclose t"e presence of 'no%n lead-basedpaint and(or lead-based paint "a#ards in t"e d%elling Lessees must also recei)e a federally appro)edpamp"let on lead poisoning pre)ention *"e +assac"usetts *enant Lead La% ,otification and ertificationForm is for compliance %it" state and federal lead notification requirements

.%ner/s 0isclosurea2 3resence of lead-based paint and(or lead-based paint "a#ards c"ec' i2 or ii2 belo%24

i2 5no%n lead-based paint and(or lead-based paint "a#ards are present in t"e "ousing e$plain2

ii2.%ner(Lessor "as no 'no%ledge of lead-based paint and(or lead-based paint "a#ards in t"e "ousing

b2 Records and reports a)ailable to t"e o%ner(lessor "ec' i2 or ii2 belo%24i2 .%ner( Lessor "as pro)ided t"e tenant %it" all a)ailable records and reports

pertaining to lead -based paint and(or lead-based paint "a#ards in t"e "ousing circle documents belo%2

Lead 6nspection Report Ris' ssessment Report Letter of 6nterim ontrol Letter of ompliance

ii2 .%ner(Lessor "as no reports or records pertaining to lead-based paint and(or lead-based paint "a#ards in t"e "ousing

*enant/s c'no%ledgment initial2

c2 *enant "as recei)ed copies of all documents circled abo)e d2 *enant "as recei)ed no documents listed abo)ee2 *enant "as recei)ed t"e +assac"usetts *enant Lead La%,otification

gent/s c'no%ledgment initial2f2 gent "as informed t"e o%ner(lessor of t"e o%ner/s(lessor/s obligations under federal and statela% for lead-based paint disclosure and notification and is a%are of "is("er responsibility to ensurecompliance

ertification of ccuracy*"e follo%ing parties "a)e re)ie%ed t"e information abo)e and certify! to t"e best of t"eir 'no%ledge!t"at t"e information t"ey "a)e pro)ided is true and accurate

:osep" ./+a"oney

.%ner(Lessor 0ate *enant 0ate

,ancy 0insmore

*enant 0ate *enant 0ate

gent 0ate gent 0ate

.%ner(+anaging gent 6nformation for *enant 3lease 3rint24

*"e Hamilton ompany ;9 &rig"ton )enue

,ame Street pt

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*enant and o%ner must eac" 'eep a completed and signed copy of t"is form>(

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cities! suburbs or t"e countryside pri)ate "ousing or state or federal public "ousing*"e older t"e "ome! t"e more li'ely it is to "a)e lead paint *"e older t"e paint! t"e"ig"er its lead content is li'ely to be

an regular "ome repairs cause lead poisoningA

*"ere is a danger of lead poisoning any time painted surfaces inside or outside t"e "omeare scraped for repainting! or %ood%or' is stripped or remo)ed! or %indo%s or %alls areremo)ed *"is is because lead paint is found in almost all +assac"usetts "omes built

before 1978! and so many of +assac"usetts/ "omes are old Special care must be ta'en%"ene)er "ome repair %or' is done ,o one s"ould use po%er sanders! open flame torc"es!or "eat guns to remo)e lead paint! since t"ese met"ods create a lot of lead dust and

fumes s' t"e o%ner of your "ome if a lead inspection "as been done *"e inspectionreport %ill tell you %"ic" surfaces "a)e lead paint and need e$tra care in setting up forrepair %or'! doing t"e repairs! and cleaning up after%ards *emporarily mo)e your familyespecially c"ildren and pregnant %omen2 out of t"e "ome %"ile "ome repair %or' is beingdone and cleaned up 6f t"is is not possible! tape up plastic s"eets to ompletely sealoff t"e area %"ere t"e %or' is going on ,o one s"ould do repair %or' in older "omes

%it"out learning about safe %ays to do t"e %or' to reduce t"e danger of lead dustHundreds of cases of c"ild"ood and adult lead poisoning "appen eac" year from "ome repair

%or'

W"at can you do to pre)ent lead poisoningA *al' to your c"ild/s doctor about lead Ha)e your c"ild tested for lead at least once a year until "e(s"e is four years old

s' t"e o%ner if your "ome "as been deleaded or call t"e state "ild"ood Lead3oisoning 3re)ention3rogram L3332 at 1-8

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n o%ner of a "ome in +assac"usetts built before 1978 must "a)e t"e "ome inspected forlead if a c"ild under si$ years old li)es t"ere 6f lead "a#ards are found! t"e "ome must

be deleaded or broug"t under interim control .nly a licensed deleader may do "ig"-ris'deleading %or'! suc" as remo)ing lead paint or repairing c"ipping and peeling lead

paintCou can get a list of licensed deleaders from t"e state 0epartment of Labor andWor'force 0e)elopment 0eleaders are trained to use safe met"ods to prepare to %or'! dot"e deleading! and clean up Bit"er a deleader! t"e o%ner or someone %"o %or's for t"eo%ner %"o is not a licensed deleader can do certain ot"er deleading and interim control

%or' .%ners and %or'ers must "a)e special training to perform t"e deleading tas's t"eymay do fter t"e %or' is done! t"e lead inspector or ris' assessor c"ec's t"e "ome Heor s"e may ta'e dust samples to test for lead! to ma'e sure t"e "ome "as been properlycleaned up 6f e)eryt"ing is fine! "e or s"e gi)es t"e o%ner a Letter of ompliance or

Letter of 6nterim ontrol fter getting one of t"ese letters! t"e o%ner must ta'e careof t"e "ome and ma'e sure t"ere is no peeling paint

W"at is a Letter of omplianceA

6t is a legal letter under state la% t"at says eit"er t"at t"ere are no lead paint"a#ards or t"at t"e "ome "as been deleaded *"e letter is signed and dated by a licensedlead inspector

W"at is a Letter of 6nterim ontrolA

6t is a legal letter under state la% t"at says %or' necessary to ma'e t"e "ometemporarily safe from serious lead "a#ards "as been done *"e letter is signed and dated

by a licensed ris' assessor 6t is good for one year! but can be rene%ed for anot"eryear *"e o%ner must fully delead t"e "ome and get a Letter of ompliance before t"eend of t"e second year

W"ere can 6 learn more about lead poisoningA

+assac"usetts 0epartment of 3ublic Healt" Cour local lead poisoning pre)entionprogram"ild"ood Lead 3oisoning 3re)ention 3rogram L3332 or your local &oard of Healt"For more copies of t"is form! as %ell as a full rangeof information on lead poisoning pre)ention! tenants/ rig"ts ES onsumer 3roduct Safety ommissionand responsibilities under t"e + Lead La%! "o% to 6nformation about lead in consumer

products2clean lead dust and c"ips! "ealt"y foods to protect your 1-8=G-