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Section 1018 the Real Estate Notification & Disclosure Rule
Tip/Complaint Form

* Denotes a required field.

Directions: Complete as much as possible.

1.

(a.) Name & Address of Alleged Violator(s)

* Title:
* Name:
* Street:
* City: * State: * ZIP:
* Phone:
Alternate Phone:

Did sale or rental involve a Seller's Agent or Lessor's Agent?
Yes No

Agent Name:
Street:
City: State: ZIP:
Phone:
Alternate Phone:

(b.) Address of Sale or Rental Property

Street:
City: State: ZIP:

(c.) Your Name & Address

You are a:
Name:
Street:
City: State: ZIP:
Phone:
Alternate Phone:
E-mail:

 

2. General Information

* Age of Property or Year Built:
   
* Ages of Children Residing in the Apartment/House:
   
* Are there children with elevated blood lead levels at this address?
   
* Type of Housing:

 

3. Sales Transaction

Please provide the date the purchase & sale agreement obligated purchase of property?

 

4. Rental Transaction

Is the lease agreement written or unwritten? written unwritten
   
Date of Initial Lease:
   
How long has the Tenant resided at the unit?
   
* How many units are in the Tenant's building?
   
Number of pre-1978 residential units owned/managed by the Lessor/Agent:

 

5. Disclosure

* Did the buyer/tenant receive any information about lead-based paint/lead-based paint hazards?
   
* Did the buyer/tenant receive an EPA-approved lead hazard information pamphlet?

 

6. Comments

 

Serving Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, & Tribal Nations

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