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Excess Rent Refund Form (For: Landlords, Property Managers, and Authorized Agents)

  1. This form shall be submitted by Landlords and Authorized Agents after the complete excess rent refund is provided to the Tenant. This form applies only to Landlords of Controlled Rental Units for which there is a Maximum Allowable Rent.

  2. Enter the total amount of excess rent collected since December 30, 2016.

  3. Attach a copy of the cashier's check addressed to the Tenant.

  4. Certification of Correctness of Information*

    Under penalty of perjury under the laws of the state of California, I hereby certify that the foregoing information and that contained in any attached sheets is true and correct to the best of my knowledge and belief.

  5. Signature Verification*

  6. Form Resubmission?

  7. Leave This Blank:

  8. This field is not part of the form submission.