Ri Housing Resources Commission

HOUSING RESOURCES COMMISSION LEAD HAZARD MITIGATION APPLICATION FOR PRESUMPTIVE COMPLIANCE

INFORMATION Owner: City: Telephone: Address 1: State: Address 2: Zip Code: Contact Person: Title:

List All Registered Trade Names: 1. 2. 3. 4. QUALIFIED PROPERTIES Address: City: Zip Code: 1. 2. 3. 4. 5.

Property #1 Date Constructed: Date Acquired: #. of Units: City: Plat: Lot:

Property #2 Date Constructed: Date Acquired: #. of Units: City: Plat: Lot:

Property #3 Dated Constructed: Date Acquired: #. of Units: City: Plat: Lot:

Please mail this application with the appropriate You must attach to this application the following documents in order to be documents to: considered for Presumptive Compliance. RI Housing Resources Commission  Evidence of lead hazard awareness education. Office of Healthy Housing and Lead One Capitol Hill, 3rd Floor Attach one Certificate of Conformance for each  Providence, RI 02908 passed unit.  If previously cited for Minimum Housing Code violations, provide proof that violations have been corrected.

I certify that the information provided above is accurate and to the best of my knowledge.

______Print Name

______Signature Title Date

HRC Presumptive Compliance (rev. 06.30.16)