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Owner's Information

Name(Required)

Owner's First Name Owner's Last Name

Owner's Address(Required)

Street Address City State Zip Code

Primary Contact Number(Required)

Secondary Phone Number

Owner's Email Address(Required)

Tenant Information

Tenant(Required)

Name

DOB

Phone

Email

Start Date for the Lease(Required)

MM slash DD slash YYYY

End Date for the Lease(Required)

MM slash DD slash YYYY

Lease(Required)

Is this property Government Subsidized?

Property Information

County of Rental Property(Required)

Tenant's Address(Required)

Street Address Unit# / Apt # / Floor City Zip Code

State(Required)

Do you have a Rental License for your rental property?(Required)

Type of Rental Property(Required)

Name of the Complex or Property Name

Number of bedrooms

Number of levels

Was the property built before 1978

Inspection Certificate Number

The Owner is unable to state Certificate Number because

The Property is

The Property is

This section is for properties built before 1978. For more information visit www.MarylandEvictionsOnline.com/mde/

Case Information

Monthly Rent Amount:(Required)

Rent is due on(Required)

Type of Period(Required)

Months late(Required)

January

February

March

April

May

June

July

August

September

October

November

December

Total Amount of Rent Due(Required)

Total Amount of Late Fees Accrued(Required)

The Landlord requests future rent between the date of complaint and date of judgment in the amount of $

Please enter a number from 0 to 9999999.

List any prior judgments against the tenant(Required)

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

Military Service(Required)

Are all the tenants on the lease listed above(Required)

Have you sent a 10/day Letter of Intent to your tenant ?(Required)

Comment: (you can also email us your comment)

Lease Agreement

Max. file size: 1 GB.

Rental License

Max. file size: 1 GB.

Rental History/Statement

Max. file size: 1 GB.

Other

Max. file size: 1 GB.

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:(Required)

Signature (not required on some devices)

Title(Required)

Today's Date(Required)

MM slash DD slash YYYY

How did you hear about us:

Total

Payment Method(Required)

American Express

Discover

MasterCard

Visa

Maestro

Supported Credit Cards: American Express, Discover, MasterCard, Visa, Maestro

Card Number Expiration Date Security Code Cardholder Name

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