Bedbug Infestation Disclosure Form

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Bedbug Infestation Disclosure Form
Landlord’s Name: _____________________________________________________________________
Tenant’s Name: ______________________________________________________________________
Address of Rental Unit: ________________________________________________________________
________________________________________________________________
Property Manager/Landlord of the above unit does hereby disclose to the prospective tenant that
neither the unit that is being rented, nor any adjacent unit, are currently infested with, or are being treated
for bedbugs.
____________________________________________________________________________________
Tenant hereby confirms that none of the residential units in which they have lived during the last
twelve (12) months were infested with, or being treated for, bedbugs during that duration of time.
Date: ___________________________
____________________________________________
Property Manager/Landlord
Date: ___________________________
____________________________________________
Tenant
Date: ___________________________
____________________________________________
Tenant

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