Application By Tenant To Deposit Rent With The Clerk
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1APPLICATION BY TENANT TO DEPOSIT RENT WITH THE CLERK
Case No. _____________________________
Clermont County Municipal Court
4430 State Route 222
Batavia, OH 45103
TO THE CLERK OF COURT
Name and Address of Tenant:
Name and Address of Landlord or Agent:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
In a ccordance w ith S ection 5321.07, pa ragraph (1) of t he O hio R evised C ode, I he reby make a pplication t o
deposit all rent that is due and hereafter becomes due the landlord, with the Clerk of the captioned Court.
Date_________________________ Signed____________________________________
**********************************************************************************
INFORMATION IN SUPPORT OF APPLICATION:
The undersigned says the following facts are true to the best of his knowledge:
Notice was given in writing to landlord as prescribed in Section 5321.07, paragraph (A). (Copy of this notice attached
hereto.) Service was made on landlord as follows:_______________________________________________
That payment of my rent due under the rental agreement is current and that my rent is due ________________________,
in the amount of $_____________________.
1.
_________________________________________________________________________________
__________________________________________________________________________________
APPLICANT STATES UNDER THE PENALTIES OF PERJURY AND FALSIFICATION THAT THE
ABOVE INFORMATION AND APPLICATION HAS BEEN READ AND IS BELIEVED TO BE TRUE.
SIGNED_________________________________________
1. Insert if applicable: “Landlord did NOT supply him with notice in writing that he was a party to any rental agreement which covered three or fewer
dwelling units. (Section 532107, paragraph (3)(C), ORC.”
**********************************************************************************
NOTICE TO LANDLORD OR AGENT
Sec. 5321.08 R.C.
Please be advised that the above applicant has this date deposited a rental payment with this
Court under the provisions of Section 5321.07 R.C. Said deposit has been placed in the Escrow Rental
Account and may be released to you upon your application and satisfaction of the provisions of Section
5321.09 R.C.
Timothy R. Rudd, Clerk
______________________________, Deputy Clerk
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