| PRE-RENOVATION LEAD-BASED PAINT INFORMATION |
| PRE-RENOVATION LEAD-BASED PAINT INFORMATION
Unavailable for Signature Form (Keep this form on file for 3 years.)
I certify that I have made a good faith effort to deliver the pamphlet, Protect Your Family From Lead In Your Home, to the unit listed below, and that the occupant was unavailable to sign the acknowledgment. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door.
___________________________________________
___________________________________________
___________________________________________
___________________________________________
|