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Proof of Permanent Relocation Payment Form (For: Landlords, Property Managers, and Authorized Agents)

  1. A Permanent Relocation Payment shall be provided by any Landlord who takes action to terminate tenancy for Owner Move-In or Withdrawal from the Rental Market (RMC Section 11.102.030(b)).

  2. Please list the name(s) of any other individuals on the lease or rental agreement.

  3. Attach a copy of the cashier's check or personal 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.