Fill and Sign the Code Pfd Form

Subscribed and sworn to before me this ______ day of ____________________ , 2_______. My commission expires: ____________________ , 2_______. ___ __________________________________ ___ _______________________________Title AOC-216 Doc. Code: PFD Rev. 1-15 Page 1 of 1 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 383.200 FORCIBLE DETAINER COMPLAINT lex et justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Provide Name and Address for both Plaintiff (Landlord) and Defendant (Tenant) LANDLORD/PLAINTIFF Name: Addr ess: TENANT/DEFENDANT Name: Ad dress: Comes the Plaintiff and for his/her complaint states that: 1. On the _________ day of __________________, _______, Defendant(s) contracted to lease __________________ ________________________________________________________________________\ ____________________ located at ________________________________________________________________________\ ____________ under a [ ] written OR [ ] oral lease with Plaintiff as lessor; 2. Under the lease terms, Defendant(s) agreed to pay $___________ per [ ] day [ ] week [ ] month, payable on the _____________ day of each [ ] week [ ] month [ ] year \ as rent; 3. Defendant(s) has/have breached the lease by not paying rent for the [\ ] day [ ] week [ ] month [ ] year of ____________________________________ in the amount(s) of $_______________ and has/have not paid late fee for the [ ] day [ ] week [ ] month [ ] year of ____________\ ___________________________ in the amounts of $_____________________. 4. As of _________________________, _____ the total amount of back rent and\ late fee(s) owed to the Plaintiff from the Defen dant(s) is: ___________________. 5. Defendant(s) has/have breached the lease because of the following: ___________________________________\ ________________________________________________________________________\ ____________________ ________________________________________________________________________\ ____________________ ________________________________________________________________________\ ____________________ 6. Plaint iff gave Defendant(s) written notice to vacate on __________________, __\ ___. Defendant(s) has/have not vacated. WHEREFORE, Plaintiff alleges Defendant(s) unlawfully and forcibly detain the premises, and demand(s) possession of the premises be delivered to Plaintiff, as well as any and all other relief to which he/she may be entitled. I hereby certify I am the owner/attorney of the above-named property. ______ _____ _____________________________________ _____________________________________ Landlord/Attorney Signature Phone Number _____ ___________________________________________ ______________________________________ Landlord/Attorney Name (Please Print) Landlord/Attorney Address VS. Case No. ____________________ Court ____________________ County ____________________ Division ____________________ Signature date