Eviction Request Form Page 2

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ENANT INFORMATION
TENANT INFORMATION
Please list the full names and dates of birth for the tenants known to be residing at this
property.
Date of Birth,
Contact Phone
Driver’s License #,
Number(s) for Tenant
Full Name (First, Middle, Last)
Or State ID #, AND
SSN#
INFORMATION ABOUT OTHERS IN THE PROPERTY
Please list the full names and dates of birth for others known to be residing at this property.
1) Date of Birth,
Contact Phone
Driver’s License #,
Number(s) for Tenant
Full Name (First, Middle, Last)
Or State ID #, AND
2) SSN#
Number of children and approximate ages _______________________________________________________________________
____________________________________________________________________
Reason(s) for the eviction:
Are there any detached storage units or garages?
YES
NO
List types of pets known to be living at the residence:
______________
Do the tenants have any disabilities/mental health
YES
NO
conditions that will require special accommodations?
 If yes, please include other agencies to be contacted, caseworker’s name:
______________________________________________________
HAZARD INFORMATION
To your best knowledge: Do the tenants pose a threat to detectives involved
in the physical eviction? (Drug activity, criminal activity, known to be armed,
YES
NO
mentally disturbed, history of assaults or threats etc).
___________________________________________________________________

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