Fill and Sign the Landlord Tenant Handbook from the City of Fort Mountain N Plains Form

Landlord Tenant Questionnaire for Tenants Name of Tenant Street Address, Unit # City/Zip Code Telephone/Day Telephone/Evening Cell Phone/Pager Primary Language Is Any Member of Household Pregnant? Yes No Don’t know Total # of Occupants Total # of Children Under 6 Years Old Section 8 or Other Subsidy? Yes No Current Amount of Monthly Rent Paid LIST ALL OCCUPANTS Name: First Last Relationship Date(s) of Birth Name: First Last Relationship Date(s) of Birth Name: First Last Relationship Date(s) of Birth Name: First Last Relationship Date(s) of Birth Name: First Last Relationship Date(s) of Birth Do you have a lease? Yes No If yes, is the lease written or oral? WRITTEN LEASES What is the term of your lease? Is your name on the lease? Yes No If no, whose name is on the lease? Are you subletting the apartment? Yes No If yes, was it approved? Yes No Do you pay the rent? Yes No If no, who pays the rent? When do you pay rent? Did you pay a security deposit when you moved in? Yes No Has the landlord paid interest on the deposit each year?: Yes No D/K Some years When last paid? Has the landlord tried to remove you or your belongings? Yes No Has the landlord/sheriff given you any notices? Yes No When did you get the notice? How was the notice given to you? What type of a notice was it? Why was there no cure? Why was the notice given? Is this your first notice? Yes No If no, explain other notices Have you had a hearing over this notice? Yes No If yes, what was the result? Have you been to court over this issue/notice? Yes No If yes, what was the result? Have you been in court before with this landlord? Yes No If yes, when were in court before? Do you have a court date for this action? Yes No If yes, in which court is the proceeding? ORAL LEASES Is the term of your lease longer than one year? Yes No If yes, when did you sign the lease? Do you pay the rent? Yes No If no, who pays the rent? When do you pay rent? Did you pay a security deposit when you moved in? Yes No Has the landlord tried to remove you or your belongings? Yes No Has the landlord/sheriff given you any notices? Yes No When did you get the notice? How was the notice given to you? What type of a notice was it? Why was there no cure? Why was the notice given? Is this your first notice from the landlord/sheriff? Yes No If no, explain other notices Have you contacted anyone about the notice? Yes No If yes, who? Have you had a hearing over this notice? Yes No If yes, what was the result?   Have you been to court over this issue/notice? Yes No If yes, what was the result? Have you been in court before with this landlord? Yes No If yes, when were in court before? Do you have a court date for this action? Yes No If yes, in which court is the proceeding? NO LEASE Did you ever have a lease for this apartment? Yes No If no, did you have an oral agreement? Yes No If no, do you pay rent each month? Yes No Did you move in with someone who was already living there? Yes No If yes, who? When was the unit last vacant? Was it vacant when you moved in? Did you take over the unit from another tenant, rather than having the landlord rent the unit out? Yes No If yes, who? Do any of the original people still live there? Yes No If yes, who? Does the landlord know you live there? Yes No Do you negotiate with the landlord regarding issues at the building? Yes No Did the tenant who had a direct contractual relationship with the landlord ever tell the landlord in writing that you were there? Yes No Ever mention your name in writing? Yes No Did the landlord accept rent after that? Yes No From you? Yes No Did your lease for this apartment expire? Yes No If no, why isn’t there a lease? Are you still living in the apartment? Yes No Is your property still in the apartment? Yes No If yes, how long has it been there? Has the landlord tried to remove you or your property? Yes No Has the landlord/sheriff given you any notices? Yes No When did you get the notice? How was the notice given to you? What type of a notice was it? Why was there no cure? Why was the notice given? Is this your first notice from the landlord/sheriff? Yes No If no, explain other notices Have you contacted anyone about the notice? Yes No If yes, who? Have you had a hearing over this notice? Yes No If yes, what was the result?   Have you been to court over this issue/notice? Yes No If yes, what was the result? Have you been in court before with this landlord? Yes No If yes, when were in court before? Do you have a court date for this action? Yes No If yes, in which court is the proceeding? COMPLAINT What is the nature of your complaint? Have your personal belongings removed? Yes No If yes, do you know where the property is now located? Yes No If yes, have you asked the landlord about getting your property back? Yes No Have your personal belongings been damaged? Yes No If yes, explain the damage What was the reason for the removal or damage of your belongings? How would you like the problem resolved? Is there a specific problem with the apartment? Yes No If yes, describe Did you know of any of these problems before you moved in? Yes No If no, have you notified your landlord of the problems you are having with your apartment? Yes No If yes, how did you notify your landlord? Yes No Are you able to live in your apartment? Yes No Have you ever decided not to pay rent because of the condition of your apartment? Yes No Did you speak with an authority figure about the problems you have with your apartment? Yes No Have you reported the landlord to the City Housing Inspector? Yes No If yes, when did you make the report? How did you make your report? Has anyone responded to your complaint? Yes No Does your apartment need any repairs? Yes No If yes, what needs to be repaired? What caused the damage that needs the repair?      How long has the repair been needed? Have you told your landlord that a repair was needed? If yes, when did you tell him you needed repairs made? Has your apartment been repaired in the past? If yes, explain the repairs made    Do you owe any rent on the apartment? Yes No How would you like the problem resolved? EVICTION Have you received any documents from the landlord/sheriff? Yes No If yes, what type of document was it? Before you got the summons, did you get any notice(s)?: Yes No How many notices did you receive? When did you receive it/them? How did you receive the notice(s)? Posted/taped to door In mail Handed to     Other What type(s) of notice(s) did you get? (if defendant(s) didn’t get notice, what type was attached to complaint?): 3-day 10-day 14-day 30-day 60-day 90- day What reason was given in the notice(s)? If nonpayment, how much rent demanded? What is your response? Are any of the allegations true? If amount not correct, do you have proof of payment? Yes No Have you received any documents from the court? Yes No Why do you believe you will be evicted? Have you received a summons for small claims court? Yes No If yes, what is the date of the hearing? Have you already attended a hearing regarding the eviction? Yes No If yes, what was the result? Have you been to court? Yes No If yes, what was the result? If no do you have a court date? Yes No Have you been in court with this landlord before? Yes No If yes, when were you in court? How would you like to resolve this problem? SECURITY DEPOSITS Did you pay a security deposit when you moved in? Yes No If no, who paid the security deposit? Do you have a receipt for your security deposit? Yes No Are you going to move out of the apartment? Yes No If yes, did you tell your landlord you were moving? Yes No Have you already moved out of the apartment? Yes No If yes, did you give your landlord notice in writing of your new address? Yes No Has your landlord kept your security deposit? Yes No If yes, how long has it been since you moved out? If yes, did the landlord give you a letter indicating why he kept the security deposit? Yes No If yes, did the landlord give you a detailed list of all the damages with the apartment when you moved out? Yes No If yes, why did the landlord say he is keeping the security deposit? Do you agree that you owe money on the apartment? Yes No If yes, why didn’t you pay? If no, do you have records or receipts that you paid? Yes No Did you ever complain to the landlord about the condition of your apartment? Yes No If yes, when did you complain? If yes, how did you complain? Did the landlord respond to your complaints? Yes No Were there problems the landlord didn’t repair? Yes No How would you like to resolve this problem? RENT PAYMENTS How much was the rent when you first moved in?: $ per due on . How much is your current rent?: $ per due on . When do you pay rent? How do you pay rent? Check Cash Money Order/Cashier’s check Other Do you get receipts from landlord?: Yes No Sometimes Did you save them?: Yes No Sometimes Can you get your cancelled checks?: Yes No Rent History: Date Increase $ Date Increase $ Date Increase $ Date Increase $ If not sure of rent history, can you bring in notices of rent increase or other documents (such as receipts) to show date and amount of each rent increase?: Yes No Did you serve a written 30-day notice of each rent increase(s)?: Yes No (Regardless of grounds for notice) How much rent is owed now? owed through     If any rent unpaid, why wasn’t rent paid on time? BREACH OF THE WARRANTY OF HABITABILITY infestation of rodents/cockroaches/insects defective plumbing roof leaks damp walls falling plaster/sheet rock peeling paint cracks missing or defective smoke detectors unsafe stairways/railings defective electrical system inadequate heat inadequate security holes in walls floors in disrepair windows leak air/don’t seal/don’t open properly gaps around doors inadequate trash receptacles/collection common areas unclean defective appliances no secure mail receptacle inadequate hot water Other Did you ask the landlord/agent to make repairs (actual notice)? Yes No Did the landlord/agent have reason to know about the problems (constructive notice)? Yes No Were repairs made? Yes No: REPAIR AND DEDUCT Did the you make or pay for repairs?: Yes No If yes, does the landlord know?: Yes No D/K Did the landlord give you credit? Yes No Did you ask for credit? Yes No If yes, when? How much money? $ TENDER OF RENT Did you offer to pay any rent before expiration of notice which the landlord/agent wouldn’t accept or returned to you? Yes No If yes, when? Amount offered: Form and manner of tender WAIVER Did your landlord/agent do anything to cancel or contradict the notice upon which this action is based, such as: Say you could ignore it? Yes No Tell you payment could be made after its expiration? Yes No Tell you he/she would accept payment plan for amount demanded? Yes No Give you another notice after it? Yes No Say you could have more time? Yes No Other Has the landlord/agent accepted rent from you after the notice(s) to quit expired?: Yes No If yes, amount $ Rent for what period? Form, date, and manner of payment Has the landlord/agent ever: Allowed you to pay rent late? Yes No Let you get behind in payments and get caught up? Yes No Let you breach the covenant (if applicable)? Yes No If yes, explain Other: RETALIATION Do you think the landlord/agent is retaliating against you for asserting your rights as a tenant?: Yes No If yes, why?: For demanding repairs For calling inspectors For going to Rent Board Other When did you call inspectors or go to Rent Board? DISCRIMINATION Do you think the landlord/agent is discriminating against you? Yes No If yes, on what basis?: Race sex national origin HIV status marital status sexual orientation age occupation having children disability Other: MISCELLANEOUS Have you ever been harassed by the landlord/agent?: Yes No If yes: Verbal harassment Physical harassment Sexual harassment Entry without notice Interferes with mail Interferes with guests Do you have problems with any of the following on the property? Excessive noise Drug dealing Prostitution Abusive neighbors WHO HAVE YOU ALREADY NOTIFIED? Resident Manager Date Verbal Writing Property Manager Date Verbal Writing Property Owner Date Verbal Writing Conflict Resolution and Mediation Center Date Verbal Writing Other: Date Verbal Writing