......................................................................................................... _________________
DEFENDANT(S) – LANDLORD(S)
AMOUNT OF RENT PERIOD AND CONDITIONS OF PAYMENT _________________
due each .........................................................................................................
_________________
The following conditions, for which relief is sought, currently exist in the dwelling unit or premises:
.........................................................................................................
.................................................................................................................................................................................................
_________________
........................................................................................................................................................... , and these conditions ADDRESS/LOCATION OF DWELLING UNIT OR PREMISES SUBJECT _________________
TO THIS ACTION
[ ] constitute material non-compliance by Defendant(s) – Landlord(s) with the rental agreement as indicated _________________
below; [or] .........................................................................................................
[ ] constitute material non-compliance by Defendant(s) – Landlord(s) with the provisions of law, as _________________
indicated below; [or] .........................................................................................................
[ ] will constitute a fire hazard or serious threat to the life, health, or safety of occupant, if not properly _________________
corrected, as indicated below; .........................................................................................................