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Owner's First Name

Owner's Last Name

Owner's Street Address

City

State

Zip Code

Primary Contact #

Secondary Phone #

Owner's Email Address

Tenant #1 Name:

Tenant #1

Phone #1

Email #1

Tenant #2 Name:

Tenant #2

Phone #2

Email #3

Tenant Street Address

City

Zip Code

County:

Do you have a Rental License for your rental property

Yes, No

Is this property Government Subsidized?

Yes, No

Type of Rental Property:

Number of bedrooms

Number of levels:

Lease

This section is for properties built before 1950. For more information visit www.MarylandEvictionsOnline.com/mde.html The Property is:

The Property is:

Inspection Certificate Number

Was the property built before 1978

Monthly Rent Amount:

Rent is due on

Type of Period

Months late

January,February,March,April,May,June,July,August,September,October,November,December

List any prior judgments against the tenant

Are there any outstanding repairs the tenant can complain about in court?

Yes, No

Comment: (you can also email us your comment)

Lease Agreement

Rental License

Rental History/Statement

Other

Name: I do solemnly declare and affirm under the penalty of perjury that the matters and facts set forth above are true to the best of my knowledge and belief: *

Title

Today's Date

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