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

  1. A Temporary Relocation Payment shall be provided by any Landlord who takes action to terminate tenancy for temporary vacation in Order to Undertake Substantial Repairs (RMC Section 11.102.030(a)).

  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.