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

  1. Purpose
    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. Please be advised: In lieu of filing a civil action, a Tenant may file an administrative complaint. A Landlord who demands, accepts, receives or retains any payment of Rent in excess of the Maximum Allowable Rent shall be liable for damages in the amount by which the payment or payments demanded, accepted, received, or retains exceeds the Maximum Allowable Rent (RMC 11.100.100(b)(1-2)).
  3. Instructions
  4. 1. Complete the following online form.
  5. 2. Upload a PDF copy of the Cashier's Check provided to the Tenant.
  6. 3. Click "Submit".
  7. Rental Unit Information
  8. Tenant Information (Name on Cashier's Check)
  9. Tenant Mailing Address (if different from Rental Unit address listed above)
  10. Landlord Information
  11. Landlord Mailing Address
  12. Rent History
  13. Enter the total amount of excess rent collected since December 30, 2016.
  14. Attach a copy of the cashier's check addressed to the Tenant.
  15. Please note: Any records included with this form and submitted to the City of Richmond, Rent Board, or Rent Program may be subject to disclosure pursuant to the California Public Records Act.
  16. Certification of Correctness of Information
  17. 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.
  18. Signature
  19. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
  20. Signature Verification*
  21. Form Resubmission?
  22. Leave This Blank:

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