2. The conditions existing in the dwelling unit or premises for which relief is sought must not have been [ ] PERSONAL SERVICE Tel. No. ....................................................
caused by Plaintiff(s) – Tenant(s), nor by the family, guests or invitees of Plaintiff(s) – Tenant(s).
[ ] Being unable to make personal service, a copy was delivered in
the following manner:
3. The Plaintiff(s) – Tenant(s) must not have unreasonably refused entry to the Defendant(s) – Landlord(s), or
[ ] Delivered to family member (not temporary sojourner or guest)
the agents of Defendant(s) – Landlord(s) when entry was sought to make the necessary repairs.
age 16 or older at usual place of abode of party named above
after giving information of its purport. List name, age of
4. Prior to commencement of the action, the landlord was served a written notice by the tenant of conditions recipient, and relation of recipient to party named above.
described on the front of this form, or was notified of such conditions by a violation or condemnation
notice from an appropriate state or municipal agency, and that the landlord has refused, or having a ..................................................................................................................
reasonable opportunity to do so, has failed to remedy the same through no fault on the Tenant’s part. Such ..................................................................................................................
written notice may be served by (a) regular mail (postage prepaid), with the sender retaining proof of [ ] Posted on front door or such other door as appears to be the main
mailing (such as a U.S. Postal Service certificate of mailing) or (b) hand delivery by the sheriff or a entrance of usual place of abode, address