Complaint For Eviction Page 2
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2LJ_EA_00002_04182012ST
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7. For complaints other than for non-payment of rent: State the reason for the termination of the tenancy with specific
facts, including the date, place, and circumstances of the reason for termination, so the tenant has an opportunity to
prepare a defense:_______________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
8. Has the defendant been served with a proper notice to vacate?
Yes (you must attach a copy of the notice to the complaint.)
No
If “Yes”, service was by:
hand-delivery, on this date: ____________________
registered/certified mail, mailed on this date: ___________, received on this date: ________
9. Plaintiff requests a judgment for possession of the premises.
Yes
No
Plaintiff requests that a Writ of Restitution be issued by the court:
five (5) days from the date of the judgment
12 to 24 hours from the time of judgment (material and irreparable breach only)
10. Plaintiff requests a money judgment against defendants for the following sums:
Yes
No
a.
rent. $ _________
Total
State: The frequency with which the rent is to be paid:
weekly
monthly
other ______________
The due date for each payment: _________
The amount of rent due on each payment: _________
b.
Late fees. $ _________
State the method of calculating late fees:__________________________________________________________
c.
Other fees, charges, or damages. $ _________
Specify fees, charges, or damages and state the method of calculating:___________________________
____________________________________________________________________________________
Total of rent, late fees, and other fees (a + b + c) that are due on the date of filing $ __________
d.
Amount of any rent concessions that Plaintiff contends must be reimbursed: $ _________
State the nature of the rent concessions:__________________________________________________________
e.
Attorney fees, due to Plaintiff in the event of a default by Defendant: $ _________
Total of all sums (a + b + c + d + e) claimed by Plaintiff $ _________
By signing this complaint, I verify that the assertions are true and correct to the best of my knowledge and belief
and they are based on a reasonably diligent inquiry.
Date: _____________
________________________________________
Signature
LJ_EA_00002_04182012ST
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