Verified Complaint Landlord/tenant Page 2

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9A. There is due, unpaid and owing from tenant(s) to plaintiff/landlord rent as follows:
$
base rent for
(specify the week or month)
$
base rent for
(specify the week or month)
$
base rent for
(specify the week or month)
$
late charge* for
(specify the week or month)
$
late charge* for
(specify the week or month)
$
late charge* for
(specify the week or month)
$
attorney fees*
$
other* (specify)
$
TOTAL
0.00
* The late charges, attorney fees and other charges are permitted to be charged as rent for purposes of this
action by federal, state and local law (including rent control and rent leveling) and by the lease.
9B. The date that the next rent is due is
(mm/dd/yyyy)
If this case is scheduled for trial before that date, the total amount you must pay to have this complaint
dismissed is $
0.00
.
(Total from line 9A)
If this case is scheduled for trial on or after that date, the total amount you must pay to have this
complaint dismissed is $
.
(Total from line 9A plus the amount of the next rent due )
These amounts do not include late fees or attorney fees for Section 8 and public housing tenants.
Payment may be made to the landlord or the clerk of the court at any time before the trial date, but on
the trial date payment must be made by 4:30 p.m. to get the case dismissed.
CHECK PARAGRAPHS 10 AND 11 IF THE COMPLAINT IS FOR OTHER THAN OR IN ADDITION TO
NON-PAYMENT OF RENT. ATTACH ALL NOTICES TO CEASE AND NOTICES TO QUIT/DEMANDS
FOR POSSESSION.
10
Landlord seeks a judgment for possession for the additional or alternative reason(s) stated in the notices
attached to this complaint. STATE REASONS:
(Attach additional sheets if necessary.)
11.
The tenant(s) has (have) not surrendered possession of the premises and tenant(s) hold(s) over and
continue(s) in possession without the consent of landlord.
WHEREFORE, plaintiff/landlord demands judgment for possession against the tenant(s) listed above, together
with costs
DATED:
(Signature of Filing Attorney or Landlord Pro Se)
(Printed or Typed Name of Attorney or Landlord Pro Se)
Effective 9/1/2009, CN 11252-English (Appendix XI-X)
page 2

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