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2. Purpose
   This form shall be used by Landlords and Authorized Agents to file a Change in Terms of Tenancy with the Rent Program. In order to comply with RMC 11.100.060(s)(1), a Proof of Service with time and date of service must be included with the copy of the notice filed with the Rent Board.
4. Link to Proof of Service Form
   Printable Proof of Service Form
6. NEW!
   This form may be used to file a notice of a change in terms of tenancy for MULTIPLE Rental Units. List each Rental Unit below or, if there are more than five (5) Rental Units receiving notice of a change in terms of tenancy, upload an Excel file with all required fields.
8. Property and Tenant Information
10. Rental Property Assessor Parcel Number (APN)*
12. Parent Street Address (associated with the APN above)*
14. City*
15. State*
16. Zip*
18. OPTIONAL: To File a Notice of Change in Terms of Tenancy on More Than Five (5) Rental Units
    If a Landlord seeks to file notice of a change in terms of tenancy on more than five (5) Rental Units, they may list ALL Tenants and Unit # or Unique Address in a separate Excel sheet and upload it below. Please note: only sheets in Excel format that match the fields identified below will be accepted. (Alternatively, this online form may be completed and submitted multiple times.)
20. Tenant Name (First, Last)*
21. Rental Unit # or Unique Address*
23. Tenant Name (First, Last)
24. Rental Unit # or Unique Address
26. Tenant Name (First, Last)
27. Rental Unit # or Unique Address
29. Tenant Name (First, Last)
30. Rental Unit # or Unique Address
32. Tenant Name (First, Last)
33. Rental Unit # or Unique Address
37. Change in Terms of Tenancy
39. Brief Description of Change(s) in the Terms of Tenancy*
41. Please attach ONE PDF file containing a copy of (1) ALL notices of a Change in Terms of Tenancy that will be served on the Tenant(s) of the Rental Unit(s) identified above AND (2) a completed Proof of Service form with time and date of service.*
45. Signature
    Declaration: I declare under penalty of perjury under the laws of the state of California that this information and every attached document, statement and form is true and correct. I certify that this property is in compliance with all provisions of the City of Richmond’s Fair Rent, Just Cause Eviction, and Homeowner Protection Ordinance, including, but not limited to, payment of all applicable registration fees and penalties. All rental properties within the City of Richmond must be enrolled with the Rent Program, and pay the accompanying annual fee. I attest that these fees will be paid when invoiced by the City of Richmond.
47. Owner or Authorized Agent Signature
49. First Name*
50. Last Name*
52. Signature Verification*

    1. By checking this box, you certify this is your valid signature for all legal purposes.
54. Form Resubmission?

    1. Check this box if you are resubmitting this form to correct an error.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field