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Relocation Assistance Payment Report

  1. Relocation Assistance Payment Report Form

  2. Pursuant to EC 8.425 (17)(e) a landlord must report a relocation payment to the City within 60 days of the payment date.

  3. Rental Dwelling Unit Information

  4. Property Owner Information

  5. For example: Natural person, Trust, LLC

  6. Property Management (if applicable)

  7. Relocation Assistance Payment Information

  8. Who made the payment?
  9. Electronic Signature

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

    I hereby certify that the above information, to the best of my knowledge is true and complete. I understand that I must inform Rental Housing Code Compliance immediately and in writing of any changes. I understand that a Landlord that fails to comply with any of the requirements set forth in EC 4.25(17)  shall be liable to the Tenant for an amount up to 3 times the monthly Rent as well as actual damages, Relocation Assistance, reasonable attorney fees and costs.

  11. I am the:*
  12. Electronic Signature*
    By checking this box, I am providing an electronic signature.
  13. 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.

  14. Leave This Blank:

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