Landlord Certification Form

LANDLORD CERTIFICATION FORM

Certification Date:

Property Identification

Parcel / APN Number:

Landlord / Owner Information

Individual    LLC    Corporation    Trust    Other

Tenant / Occupant Information

Lease Start Date:    Lease End Date:

Lease and Financial Terms

Monthly Rent: $    Security Deposit: $

Rent Due Date (day of month):    Late Fee Provision:

Check / Money Order    ACH / Bank Transfer    Online Portal    Other

Property Condition and Disclosures

Is the property known to contain lead-based paint or lead hazards? (check one)    Yes    No

Are there known mold conditions or moisture intrusion issues? (check one)    Yes    No

Have there been material alterations, structural repairs, or renovations within the last three years? (check one)    Yes    No

Are utilities included in rent? (check all that apply)    Water    Gas    Electric    Other

Are there outstanding health or safety code violations on the property? (check one)    Yes    No

Certifications and Representations

I hereby certify, under penalty of perjury, that I am the lawful owner or authorized agent of the owner of the property identified above and that the information provided in this Landlord Certification Form is true, correct and complete to the best of my knowledge. I further certify that:

1. All rent, deposit and lease terms reported herein reflect the actual lease agreement in effect for the identified unit.
2. The unit is maintained in compliance with applicable habitability, health and safety standards, and there are no undisclosed conditions that materially affect habitability.
3. I will notify the other party in writing of any material change to the conditions or terms certified herein within ten (10) calendar days of such change.
4. I consent to inspection by authorized representatives for verification of the facts stated in this form, subject to providing reasonable notice consistent with the lease.
5. I understand that knowingly making a false statement in this certification may result in civil or criminal penalties and remedies available under law, including termination of tenancy or recovery of damages.

Governing Law: This certification and any dispute arising under it shall be governed by the laws of the state in which the property is located. This document constitutes the entire certification of the landlord regarding the matters stated herein and supersedes any prior oral or written statements on these matters.

Acknowledgment

By signing below, the Landlord certifies that they have the authority to execute this form and that the facts stated are accurate. The Tenant's signature acknowledges receipt of a copy of this certification and the disclosures contained herein.

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