1. 414 North William Street_COA 2025-0310B PACKET

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mi ND ANA REALTORS*J LEAD -BASED PAINT CERTIFICATION AND ACKNOWLEDGMENT Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards (SALES) For use only by members of the Indiana Association of REALTORS® 1 PROPERTY ADDRESS: 414 North William Street, South Bend, IN 46601 2 3 LEAD WARNING STATEMENT Ir-r-ITr•1 E r • E E SB Real Estate 4 Every buyer of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that 5 such property may present exposure to lead from lead -based paint that may place young children at risk of developing lead 6 poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, 7 reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to 8 pregnant women. The seller of any interest in residential real property is required to provide the buyer with any information 9 on lead -based paint hazards from risk assessments or inspections in the seller's possession and notify the buyer of any 10 known lead -based paint hazards. A risk assessment or inspection for possible lead -based paint hazards is recommended 11 prior to purchase. 13 14 SELLER'S DISCLOSURE 15 (a.) Presence of lead -based paint and/or lead -based paint hazards: (check (i) or (ii) below) 16 17 (i) ❑ Known lead -based paint and/or lead -based paint hazards are present in the housing (explain): 18 19 20 (ii) ❑ Seller has no knowledge of lead -based paint and/or lead -based paint hazards in the housing. 21 22 23 (b.) Records and reports available to the seller: (check (i) or (ii) below) 24 (I) ❑ Seller has provided the buyer with all available records and reports including Seller's Residential Real Estate Sales 25 Disclosure form, if applicable, pertaining to lead -based paint and/or lead -based paint hazards in the housing (list and 26 attach documents below). 27 28 29 (ii) ❑ Seller has no reports or records pertaining to lead -based paint and/or lead -based paint hazards in the housing. 30 31 32 (c.) 1 Buyer has received copies of all information listed above. 33 (d.) 1 Buyer has received the pamphlet Protect Your Family From Lead In Your Home. 34 (e.) 1 Buyer has (check (i) or (ii) below): 35 (i) ❑ received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessment or inspection for 36 the presence of lead -based paint and/or lead -based paint hazards; 37 OR 38 (ii) ❑ waived the opportunity to conduct a risk assessment or inspection for the presence of lead -based paint and/or 39 lead -based paint hazards. BUYER'S ACKNOWLEDGEMENT (initial) 40 BROKER'S ACKNOWLEDGMENT (initial) 41 (f.) s Broker has informed the seller of seller's obligations under the Residential Lead -Based Paint Hazard Reduction Act 42 of 1992 (42 U.S.C. 4852d) and is aware of Broker's responsibility to ensure compliance.(NOTE: where the word 43 "Broker" appears, it shall mean "Licensee" as provided in I.C.25-34.1-10-6.8.) 44 45 414 North William Street, South Bend, IN 46601 (Property Address) Page 1 of 2 (Lead -Based Paint - Sales) COPYRIGHT IAR 2025