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3. Tenant Name
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Email Address
14. Landlord Name
16. Address
18. City
19. State
20. Zip Code
22. Contact Person
23. Phone Number
27. Description of Residential Unit
29. Type of Residential Unit

    1. House
    2. Studio
    3. Apartment Complex
    4. Mobile Manufactured Home
    5. Other
30. If other, please explain.
32. Rental Terms
34. Do you have a written agreement or lease with your landlord?

    1. Yes
    2. No
36. If yes, please specify term:

    1. Weekly
    2. Monthly

    1. Yearly
    2. Other
38. If "Yes," please provide a copy of the lease agreement with this complaint and any other documents applicable to the issue(s).
40. How long have you resided in this unit?
42. How many people currently occupy this unit with you?
44. Are you up-to-date with your rent payment?

    1. Yes

    1. No
46. If "No," please explain:
50. Nature of Complaint
52. Please state the reason for filing this complaint.

    1. Rent Increase - Please Complete Sections I and III
    2. Conditions - Please complete Sections II and III
54. Section I: Rent Increase
56. 1. What was your rent prior to filing complaint?
59. 2. What is the rental increase amount?
62. 3. What is the effective date of increase?
65. 4. How much was your last rent increase?
68. 5. When did this increase take effect?
71. 6. Have you discussed the increase in rent with your landlord?
72. 1. Yes
    2. No
74. If "Yes," when?
77. What type of complaint?
78. 1. Written Complaint

    1. Oral Complaint
80. What was your landlord's response?
84. Section II - Conditions
86. 1. Do you believe your landlord has maintained the property in accordance with the agreement/lease that was signed?
87. 1. Yes
    2. No
89. 2. Are there conditions that you consider unhealthy or unsafe?
90. 1. Yes
    2. No
92. If "Yes," please explain:
96. Have you brought any of these matters to your landlord's attention?
97. 1. Yes
    2. No
99. If "Yes," when?
102. What type of complaint?
103. 1. Written complaint

     1. Oral complaint
105. Section III
107. In the space provided below, explain why you believe the increase in rent is excessive or why your landlord's response to your property maintenance, health and/or concerns is inadequate.
111. Notice to Complainant
     When a complaint is filed, the Town strongly encourages the parties to the complaint to again discuss their differences, in an attempt to reach a mutually satisfactory resolution. If no agreement is reached in private session and the tenant wishes to continue the complaint, the parties should request the Fair Rent Commission Intake Person to schedule a meeting with the parties. If this meeting is not successful and the parties agree, the Intake Person may schedule a second informal meeting with the tenant, landlord and a member of the Commission (and/or with any other town official that may be helpful, e.g. Building Inspector), in another attempt at resolving the complaint. If a written agreement between the parties can not be reached in these informal meetings, then a formal hearing of the complaint will be scheduled by the Commission where a decision can be reached.
     
     Please note that it is the responsibility of the parties to this complaint to be proactive in scheduling meetings or participating in what ever process they chose to resolve the dispute prior to the necessity of a formal commission hearing. Do not wait for the Intake Person to call you. If you simply need a neutral place to meet you may reserve space at the town hall by calling the Intake Person.
     
     A copy of this complaint will be returned to you for your records. A copy of the complaint will be forwarded to your landlord for his/her response. You may provide any additional relevant information with this complaint form.
     
     I affirm under the penalties provided by law that the information I have provided is true to the best of my knowledge.
113. e-Signature
114. Date
     Date
Leave This Blank:


116. 1. Receive an email copy of this form.
117. Email address

     This field is not part of the form submission.

118. Submit

* indicates a required field