Name 名字 *

First Name

Last Name

Is this an owner-occupied property? 屋主是否居住在内 *

Yes

No

Is there a mortgage on your home? 是否有房屋贷款 *

Yes

No

Is this property under an "order to correct?" 房屋是否有收到政府的纠正号令 *

(An Order to Correct is an order issued by Inspectional Services to Correct Lead Paint Violations)

Yes

No

Is there a child under the age of six (6) that resides in the home or spends at least three hours per day on two separate days in a week? 是否有6岁以下儿童居住或频繁探访（起码每周两天，每天最少3小时 *

Yes

No

Is there an expectant mother who resides in the home? 是否有孕妇

Yes

No