Tenant Certification

Form (THC COPY) Apt. Street Address 345 Franklin Street - Cambridge Unit# 50
Required Federal Lead Warning Statement
Housing 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$posure is especially "armful to young c"ildren and
pregnant %omen &efore renting pre-1978 "ousing! lessors must disclose t"e presence of 'no%n lead-based
paint and(or lead-based paint "a#ards in t"e d%elling Lessees must also recei)e a federally appro)ed
pamp"let on lead poisoning pre)ention *"e +assac"usetts *enant Lead La% ,otification and -ertification
Form is for compliance %it" state and federal lead notification requirements
.%ner/s 0isclosure
1a2 3resence of lead-based paint and(or lead-based paint "a#ards 1c"ec' 1i2 or 1ii2 belo%24
1i2 5no%n lead-based paint and(or lead-based paint "a#ards are present in t"e "ousing 1e$plain2

1ii2 .%ner(Lessor "as no 'no%ledge of lead-based paint and(or lead-based paint
"a#ards in t"e "ousing
1b2 Records and reports a)ailable to t"e o%ner(lessor 1-"ec' 1i2 or 1ii2 belo%24
1i2 .%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
1circle documents belo%2
Lead 6nspection Report7 Ris' 8ssessment Report7 Letter of 6nterim -ontrol7 Letter of -ompliance
1ii2 .%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 8c'no%ledgment 1initial2
1c2 *enant "as recei)ed copies of all documents circled abo)e 1d2 99999999999999999999
*enant "as recei)ed no documents listed abo)e
1e2 99999999999999999999999999999 *enant "as recei)ed t"e +assac"usetts *enant Lead La%
,otification
8gent/s 8c'no%ledgment 1initial2
1f2 8gent "as informed t"e o%ner(lessor of t"e o%ner/s(lessor/s obligations under federal and state
la% for lead-based paint disclosure and notification and is a%are of "is("er responsibility to ensure
compliance
-ertification of 8ccuracy
*"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

8gent 0ate 8gent 0ate
.%ner(+anaging 8gent 6nformation for *enant 13lease 3rint24
*"e Hamilton -ompany ;9 &rig"ton 8)enue
,ame Street 8pt
8llston! +8 <=1;> 1?172 78;-<<;9
-ity(*o%n @ip *elep"one
6 1o%ner(managing agent2 certify t"at 6 pro)ided t"e *enant Lead La% ,otification( *enant
-ertification Form and any e$isting Lead La% documents to t"e tenant! but t"e tenant refused to sign
t"is certification
*"e tenant ga)e t"e follo%ing reason4
*"e +assac"usetts Lead La% pro"ibits rental discrimination! including refusing to rent to families %it"
c"ildren or e)icting families %it" c"ildren because of lead paint
-ontact t"e -"ild"ood Lead 3oisoning 3re)ention 3rogram for information on t"e a)ailability of t"is form
in ot"er languages
*enant and o%ner must eac" 'eep a completed and signed copy of t"is form

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Tenant Certification Form (TENANT COPY) Apt.Street Address 345 Franklin Street ! Cambridge" Unit# 50"
Required Federal Lead Warning Statement
Housing 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$posure is especially "armful to young c"ildren and
pregnant %omen &efore renting pre-1978 "ousing! lessors must disclose t"e presence of 'no%n lead-based
paint and(or lead-based paint "a#ards in t"e d%elling Lessees must also recei)e a federally appro)ed
pamp"let on lead poisoning pre)ention *"e +assac"usetts *enant Lead La% ,otification and -ertification
Form is for compliance %it" state and federal lead notification requirements
.%ner/s 0isclosure
1a2 3resence of lead-based paint and(or lead-based paint "a#ards 1c"ec' 1i2 or 1ii2 belo%24
1i2 5no%n lead-based paint and(or lead-based paint "a#ards are present in t"e "ousing 1e$plain2

1ii2 .%ner(Lessor "as no 'no%ledge of lead-based paint and(or lead-based paint
"a#ards in t"e "ousing
1b2 Records and reports a)ailable to t"e o%ner(lessor 1-"ec' 1i2 or 1ii2 belo%24
1i2 .%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
1circle documents belo%2
Lead 6nspection Report7 Ris' 8ssessment Report7 Letter of 6nterim -ontrol7 Letter of -ompliance
1iii2 .%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 8c'no%ledgment 1initial2
1c2 *enant "as recei)ed copies of all documents circled abo)e 1d2 9999999999999999999
*enant "as recei)ed no documents listed abo)e
1e2 99999999999999999999999999 *enant "as recei)ed t"e +assac"usetts *enant Lead La% ,otification
8gent/s 8c'no%ledgment 1initial2
1f2 8gent "as informed t"e o%ner(lessor of t"e o%ner/s(lessor/s obligations under federal and state
la% for lead-based paint disclosure and notification and is a%are of "is("er responsibility to ensure
compliance
-ertification of 8ccuracy
*"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

8gent 0ate 8gent 0ate
.%ner(+anaging 8gent 6nformation for *enant 13lease 3rint24
*"e Hamilton -ompany ;9 &rig"ton 8)enue
,ame Street 8pt
8llston +8 <=1;> 1?172 78;-<<;9
-ity(*o%n @ip *elep"one

6 1o%ner(managing agent2 certify t"at 6 pro)ided t"e *enant Lead La% ,otification( *enant
-ertification Form and any e$isting Lead La% documents to t"e tenant! but t"e tenant refused to sign
t"is certification
*"e tenant ga)e t"e follo%ing reason4
*"e +assac"usetts Lead La% pro"ibits rental discrimination! including refusing to rent to families %it"
c"ildren or e)icting families %it" c"ildren because of lead paint
-ontact t"e -"ild"ood Lead 3oisoning 3re)ention 3rogram for information on t"e a)ailability of t"is form
in ot"er languages
*enant and o%ner must eac" 'eep a completed and signed copy of t"is form

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*enant Lead La% ,otification
W"at lead paint forms must o%ners of rental "omes gi)e to ne% tenantsA
&efore renting a "ome built before 1978! t"e property o%ner and t"e ne% tenant must sign t%o
copies of t"is *enant Lead La% ,otification and *enant -ertification Form! and t"e property
o%ner must gi)e t"e tenant one of t"e signed copies to 'eep 6f any of t"e follo%ing forms
e$ist for t"e unit! tenants must also be gi)en a copy of t"em4 lead inspection or ris'
assessment report! Letter of -ompliance! or Letter of 6nterim -ontrol *"is form is for
compliance %it" bot" +assac"usetts and federal lead notification requirements
W"at is lead poisoning and %"o is at ris' of becoming lead poisonedA
Lead poisoning is a disease 6t is most dangerous for c"ildren under si$ years old 6t
can cause permanent "arm to young c"ildren/s brain! 'idneys! ner)ous system and red blood
cells B)en at lo% le)els! lead in c"ildren/s bodies can slo% gro%t" and cause learning
and be"a)ior problems Coung c"ildren are more easily and more seriously poisoned t"an
ot"ers! but older c"ildren and adults can become lead poisoned too Lead in t"e body of a
pregnant %oman can "urt "er baby before birt" and cause problems %it" t"e pregnancy
8dults %"o become lead poisoned can "a)e problems "a)ing c"ildren! and can "a)e "ig"
blood pressure! stomac" problems! ner)e problems! memory problems and muscle and Doint
pain
Ho% do c"ildren and adults become lead poisonedA
Lead is often found in paint on t"e inside and outside of "omes built before 1978 *"e
lead paint in t"ese "omes causes almost all lead poisoning in young c"ildren *"e main
%ay c"ildren get lead poisoning is from s%allo%ing
lead paint dust and c"ips Lead is so "armful t"at e)en a small amount can poison a
c"ild Lead paint under layers of nonleaded paint can still poison c"ildren! especially
%"en it is disturbed! suc" as t"roug" normal %ear
and tear and "ome repair %or'
Lead paint dust and c"ips in t"e "ome most often come from peeling or c"ipping lead
painted surfaces7 lead paint on mo)ing parts of %indo%s or on %indo% parts t"at are
rubbed by mo)ing parts7 lead paint on surfaces t"at get bumped or %al'ed on! suc" as
floors! porc"es! stairs! and %ood%or'7 and lead paint on surfaces t"at stic' out %"ic" a
c"ild may be able to mout" suc" as %indo% sills
+ost lead poisoning is caused by c"ildren/s normal be"a)ior of putting t"eir "ands or
ot"er t"ings in t"eir mout"s 6f t"eir "ands or t"ese obDects "a)e touc"ed lead dust!
t"is may add lead to t"eir bodies 8 c"ild can also get lead from ot"er sources! suc" as
soil and %ater! but t"ese rarely cause lead poisoning by t"emsel)es Lead can be found in
soil near old! lead-painted "omes 6f c"ildren play in bare! leaded soil! or eat
)egetables or fruits gro%n in suc" soil! or if leaded soil is trac'ed into t"e "ome from
outside and gets on c"ildren/s "ands or toys! lead may enter t"eir bodies +ost adult
lead poisoning is caused by adults breat"ing in or s%allo%ing lead dust at %or'! or! if
t"ey li)e in older "omes %it" lead paint! t"roug" "ome repairs

Ho% can you find out if someone is lead poisonedA
+ost people %"o are lead poisoned do not "a)e any special symptoms *"e only %ay to find
out if a c"ild or adult is lead poisoned is to "a)e "is or "er blood tested -"ildren in
+assac"usetts must be tested at least once a year from t"e time t"ey are bet%een nine
mont"s and one year old until t"ey are four years old Cour doctor! ot"er "ealt" care
pro)ider or &oard of Healt" can do t"is 8 lead poisoned c"ild %ill need medical care 8
"ome %it" lead paint must be deleaded for a lead poisoned c"ild to get %ell
W"at 'ind of "omes are more li'ely to "a)e lead paintA
6n 1978! t"e Enited States go)ernment banned lead from "ouse paint Lead paint can be
found in all types of "omes built before 19784 single-family and multi-family7 "omes in
cities! suburbs or t"e countryside7 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 "ome
are scraped for repainting! or %ood%or' is stripped or remo)ed! or %indo%s or %alls are
remo)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 8s' t"e o%ner of your "ome if a lead inspection "as been done *"e inspection
report %ill tell you %"ic" surfaces "a)e lead paint and need e$tra care in setting up for
repair %or'! doing t"e repairs! and cleaning up after%ards *emporarily mo)e your family
1especially c"ildren and pregnant %omen2 out of t"e "ome %"ile "ome repair %or' is being
done and cleaned up 6f t"is is not possible! tape up plastic s"eets to ompletely seal
off t"e area %"ere t"e %or' is going on ,o one s"ould do repair %or' in older "omes
%it"out learning about safe %ays to do t"e %or' to reduce t"e danger of lead dust
Hundreds of cases of c"ild"ood and adult lead poisoning "appen eac" year from "ome repair
%or'
W"at can you do to pre)ent lead poisoningA
F *al' to your c"ild/s doctor about lead
F Ha)e your c"ild tested for lead at least once a year until "e(s"e is four years old
F 8s' t"e o%ner if your "ome "as been deleaded or call t"e state -"ild"ood Lead
3oisoning 3re)ention
3rogram 1-L3332 at 1-8<<-G;=-9G71! or your local &oard of Healt"
F *ell t"e o%ner if you "a)e a ne% baby! or if a ne% c"ild under si$ years old li)es
%it" you
F 6f your "ome %as deleaded! but "as peeling paint! tell and %rite t"e o%ner 6f "e(s"e
does not respond! call -L333 or your local &oard of Healt"
F +a'e sure only safe met"ods are used to paint or ma'e repairs to your "ome! and to
clean up after%ards
F 6f your "ome "as not been deleaded! you can do some t"ings to temporarily reduce t"e
c"ances of your c"ild becoming lead poisoned Cou can clean your "ome regularly %it"
paper to%els and any "ouse"old detergent and %arm %ater to %ipe up dust and loose paint
c"ips Rub "ard to get rid of more lead W"en you are done! put t"e dirty paper to%els in
a plastic bag and t"ro% t"em out *"e areas to clean most often are %indo% %ells! sills!
and floors Was" your c"ild/s "ands often 1especially before eating or sleeping2 and %as"
your c"ild/s toys! bottles and pacifiers often +a'e sure your c"ild eats foods %it" lots
of calcium and iron! and a)oid foods and snac's t"at are "ig" in fat 6f you t"in' your
soil may "a)e lead in it! "a)e it tested Ese a door mat to "elp pre)ent dirt from
getting into your "ome -o)er bare leaded dirt by planting grass or bus"es! and use mats!
bar' mulc" or ot"er ground co)ers under s%ings and slides 3lant gardens a%ay from old
"omes! or in pots using ne% soil Remember! t"e only %ay to permanently lo%er t"e ris' of
your c"ild getting lead poisoned is to "a)e your "ome deleaded if it contains lead paint
Ho% do you find out %"ere lead paint "a#ards may be in a "omeA
*"e only %ay to 'no% for sure is to "a)e a lead inspection or ris' assessment done *"e
lead inspector %ill test t"e surfaces of your "ome and gi)e t"e landlord and you a
%ritten report t"at tells you %"ere t"ere is lead in amounts t"at are a "a#ard by state
la% For interim control! a temporary %ay to "a)e your "ome made safe from lead "a#ards!
a ris' assessor does a lead inspection plus a ris' assessment 0uring a ris' assessment!
t"e "ome is c"ec'ed for t"e most serious lead "a#ards! %"ic" must be fi$ed rig"t a%ay
*"e ris' assessor %ould gi)e t"e landlord and you a %ritten report of t"e areas %it" too
muc" lead and t"e serious lead "a#ards Lead inspectors and ris' assessors "a)e been
trained! licensed by t"e 0epartment of 3ublic Healt"! and "a)e e$perience using t"e
state-appro)ed met"ods for testing for lead paint *"ese met"ods are use of a sodium
sulfide solution! a portable $-ray fluorescence mac"ine or lab tests of paint samples
Cou can get a list of licensed lead inspectors and ris' assessors from -L333
6n +assac"usetts! %"at must t"e o%ner of a "ome built before 1978 do if a c"ild under si$
years old li)es t"ereA

8n o%ner of a "ome in +assac"usetts built before 1978 must "a)e t"e "ome inspected for
lead 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 and
Wor'force 0e)elopment 0eleaders are trained to use safe met"ods to prepare to %or'! do
t"e deleading! and clean up Bit"er a deleader! t"e o%ner or someone %"o %or's for t"e
o%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"ey
may do 8fter t"e %or' is done! t"e lead inspector or ris' assessor c"ec's t"e "ome He
or s"e may ta'e dust samples to test for lead! to ma'e sure t"e "ome "as been properly
cleaned 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 8fter getting one of t"ese letters! t"e o%ner must ta'e care
of 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 licensed
lead 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 "ome
temporarily 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"er
year *"e o%ner must fully delead t"e "ome and get a Letter of -ompliance before t"e
end 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)ention
program
-"ild"ood Lead 3oisoning 3re)ention 3rogram 1-L3332 or your local &oard of Healt"
1For more copies of t"is form! as %ell as a full range
of information on lead poisoning pre)ention! tenants/ rig"ts ES -onsumer 3roduct Safety -ommission
and responsibilities under t"e +8 Lead La%! "o% to 16nformation about lead in consumer
products2
clean lead dust and c"ips! "ealt"y foods to protect your 1-8<<-?;8-=77=
c"ildren! financial "elp for o%ners! safe deleading and
reno)ation %or'! and soil testing2 ES Bn)ironmental 3rotection 8gency!
Region 6
?17-7G;-8><<! 1-8<<-G;=-9G71 16nformation about federal la%s on
lead2
?17-G?G-;>=<
+assac"usetts 0epartment of Labor and
Wor'force 0e)elopment ,ational Lead 6nformation -enter
1List of licensed deleaders2 1Heneral lead poisoning information2
?17-9?9-7177! 1-8<<->=G-<<<> 1-8<<-LB80-FC6