Landlord-Tenant Intake LANDLORD-TENANT INTAKE All fields with an * are required. Are you a Landlord or Tenant ? LandlordTenant NOTE: If owner is an entity (LLC, LLP, Corporation, Trust etc.) then please provide names of all members/shareholders, all formation documents, internal operating documents and EIN number Written Lease with the Tenant/Landlord ? YesNo Is the Lease governed by Virginia Common Law or the Virginia Residential Landlord Tenant Act ? YesNoI don’t know If you are a Landlord, do you own two or more rental properties ? YesNo If you are a Landlord, do you keep a rent ledger/summary? YesNo INFORMATION ON TENANTS Name of Tenant Tenant Occupation SSN Tenant’s DOB* Add Tenant Is Tenant or Any Dependent of the Tenant in Active Duty or Reserve Military Service? YesNoI’m not sure Lease Start Date Monthly Rent Lease Term End Date of Month Rent is Due 12345678910111213141516171819202122232425262728293031 Late Fee BASIS FOR LEGAL ACTION Tenant Non-payment of Rent. If so, please indicate arrears below Date Delinquent Amount Add More Tenant Violation/Breach of the Lease that is NOT rent related (example: unauthorized pet on property, damage to property etc.) YesNo Landlord’s breach of the Lease (Example: failure to return security deposit, or failure to maintain property etc.) YesNo Landlord’s failure to provide a habitable premises (example: mold infestation, bedbugs, no hot water/AC, drugs/thefts on premises etc.) YesNo Nuisance Claims – noisy conditions, loud construction or heavy YesNo Notice Served ? YesNo Notice Date IF DISPUTE INVOLVES MAINTENANCE/PROPERTY DAMAGE ISSUES Did the parties (landlord and tenant) conduct a joint MOVE-IN inspection? Or did the parties prepare a move in inspection report, or take any pictures to document the condition of the property before Tenant took possession? If Yes,Please Explain Did the parties (landlord and tenant) conduct a joint MOVE-OUT inspection? Or did the parties prepare a move out inspection report, or take any pictures to document the condition of the property before Tenant took possession? If Yes,Please Explain
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