Residential Eviction In-Take Form

In order for us to proceed on your eviction, please fill out the information below and send us (1) a copy of any terminations notice you served (2) A copy of the Lease (if any) ; (3) A copy of the tenant's Application (if any); and (4) a copy of your up-to-date rent ledger. Please email all documents to Evictions@loncarlaw.com Please allow 48 hours for processing.

Plaintiff Company Name ?

Plaintiff First Name

Plaintiff Middle Initial

Plaintiff Last Name

Address

City

State

Zip Code

Phone Number

Fax Number

E-Mail Address

Matter Type *

Tenants (Name All over 18 Years Old) * ?

Property Address * ?

Titleholder or Agent? * ?

Titleholder
Agent

Owner-Occupied 2-6 Units? *

Yes
No

When did the Tenant move into the Property? *

Monthly Rent Amount *

What day is rent due each month? *

Is there a Security deposit * ?

Past Due Rent Amount * ?

Are Late Charges Included in Amount Owed? *

Yes
No

Is tenant a Section 8 voucher holder? *

Yes
No

If yes, itemize portion of rent paid by CHAC, portion paid by Tenant.

Lease Termination Date ?

Is Tenant claiming to be withholding rent for repairs?

Yes
No

Name and Address where Rent is delivered ?

Type of Notice Given ?

5 Day Notice
10 Day Notice
30 Day Notice
60 Day Notice
Waiver
Demand for Immediate Possession
Other

Date of Notice ?

Who was served? ?

Who served the notice? ?

Date Notice Was Served

Best Time to Serve Tenants

Is Tenant Working?

Yes
No
I don't know

If yes, is Tenant easier to serve on job?

Yes
No
I don't know

If known, provide: name, address and phone number of employer along with Tenant's title and name of Supervisor

Please provide a physical description of Tenant for purpose of facilitating service. Provide race, sex, age, height, weight, hair color, facial hair, eye color, whether Tenant wears glasses or has any distinguishing marks, tattoos or scars.

Does Tenant have any disabilities?

Yes
No
I don't know

Cancel

Please fill in all the required fields before submitting this form.