2. Termination of Tenancy/Eviction Report Form

4. Pursuant to EC 8.425 (18) a landlord is required to report to the City, a termination of tenancy that results in the tenant moving out of the rental unit.  

6. Rental Dwelling Unit Information

8. Rental Dwelling Unit Address *
10. City*
11. State*
12. Zip Code*
14. Number of bedrooms
    -- Select One --Studio1-bedroom2-bedrooms3-bedrooms4-bedrooms5 or more bedrooms
15. Rental unit type (select one)
    -- Select One --Single family detachedDuplex, Triplex, quadplexApartment or condoCottage clusterAdditional Dwelling Unit (ADU)Manufactured home or mobile homeRoom in shared home
16. How many tenants in the rental unit were terminated?
18. Rental Agreement type (select one)
    -- Select One --Month-to-monthFixed-term
19. Date Tenancy Began*
    Date Tenancy Began
20. Fixed-term rental agreement end date
    Fixed-term rental agreement end date

22. Property Owner Information

24. First Name*
25. Last Name*
27. Property Owner's Legal Entity Name (if applicable)
29. Email*
30. Phone*
32. Mailing Address *
34. City*
35. State*
36. ZIP*

38. Property Management (if applicable)

40. Company Name
41. Email
42. Phone

44. Termination Notice Information

46. Notice Delivery Method
    -- Select One --First Class MailHand DeliveredPosted on tenant's door
47. Delivery Date
    Delivery Date
49. Type of Notice
    -- Select One --90-day notice30-day notice10-day notice24-hour noticeOther
50. If Type of Notice is "Other," please explain
52. Termination Date Given in Notice*
    Termination Date Given in Notice
53. Date Tenant Moved Out*
    Date Tenant Moved Out
55. Termination Reason*

    1. For-Cause
    2. No-Cause (within the first year of tenancy)
    3. Qualifying Landlord-Based Reason
    4. Non-Renewal of Fixed Term Lease
    5. Tenant Notice (when a tenant gives notice but is unable to moved out by the date provided)
    6. Other (explain below)
57. If For-Cause Termination, select a reason
    -- Select One --Non-payment of RentFirst Violation of rental agreementPet ViolationRepeat Violation of rental agreementThree-Strikes ViolationDangerous or Extreme Behavior
58. If No-Cause, are you selling the property?
    -- Select One --YesNo
59. If Qualifying Landlord-Based Reason, select a reason
    -- Select One --1 The landlord intends to either demolish the unit or use the unit for something other than a residence2 The landlord intends to make repairs or renovations to the unit, and property will be unsafe to live in3 The landlord or landlord’s immediate family member plans to move in4 The landlord has sold the unit to someone who plans to move in
61. If Other, please explain
63. Did you engage in any negotiation with the tenant?

    1. Yes
    2. No
64. If yes to negotiation, did you use a mediator?

    1. Yes
    2. No
66. Upload a copy of the Termination Notice
67. Forcible Entry or Detainer (F.E.D)

    If the landlord filed an F.E.D, please provide the court case number

69. Electronic Signature

71. This form is designed to be completed and signed by the legal owner(s) of the rental dwelling. If someone other than the property owner/landlord is completing this form on behalf of the owner/landlord, the undersigned certifies that they are legally authorized to act on behalf of the property owner/landlord to complete this form. 

73. I am the:*

    1. Property Owner
    2. Property Owner's Agent
75. Electronic Signature*

    1. Sign

    By checking this box, I am providing an electronic signature.

76. Full Name*

78. IMPORTANT: Once you click Submit, you will not be able to edit your submission. Click "Save Progress" if you are not finished and you want to come back and edit.

Leave This Blank:


80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit Submit and Print

* indicates a required field