DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT AND LEAD-BASED PAINT HAZARDS 221 Property Services, Inc.     303 NW "E" Street     Grants Pass, OR 97526     541-474-2881 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.

PROPERTYADDRESS:_________________________________________ Year Built ________________________________

Owner's Disclosure for pre-1978 housing (initial):

_____ (a) Presence of lead-based paint or lead-based paint hazards (check one below):
    { } Known lead-based paint and/or lead-based paint hazards are present in the housing (explain):

    _______________________________________________________________________________________
    { } Owner has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
_____ (b) Records and reports available to the Owner (check one below):
    { } Owner has provided the Agent with all available records and reports pertaining to lead-based paint and/or lead-based paint
    hazards in the housing (list documents below).

    _______________________________________________________________________________________
    { } Owner has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

Agent's Acknowledgment (initial)

______ (e) Agent has informed the owner of the owner's obligations under 42 U.S C. 4852 (d) and is aware of his/her responsibility to
    ensure compliance

THERE HAS BEEN A RECALL ON VINYL MINI BLINDS, AS IT HAS BEEN DETERMINED THAT THEY MAY CONTAIN LEAD BASED PAINT AND POSE A HAZARD. REPLACEMENT OF MINI BLINDS IS HEREBY AUTHORIZED BY OWNER_______YES_______ NO
_____________________________________________________________________________________________________
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.

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Agent................Date..............................................................Owner................Date
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Owner................Date .............................................................Owner................Date