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Eviction Diversion Program (EDP) Owner/Landlord Application
Owner/Landlord Information
Full Name
Social Security Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if Different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number to reach you
Contact Name to leave messages
Contact Number to leave messages
Email Address
example@example.com
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Eviction Diversion Program (EDP) Owner/Landlord Application
Tenant Information
Full Name(s)
Contract Unit Address (Number and Street Name, Apt., etc.)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Bedrooms in Unit
Move-in Date
Contract Rent Amount
Number of Months Arrears
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Eviction Diversion Program (EDP) Owner/Landlord Application
Payment History
January 1, 2020 to February 28th, 2020, if applicable
Month
Contract Rent Amount
Payment Amount (if applicable)
Payment Date (if applicable)
Amount Past Due or Delinquent (if applicable)
1
2
Total amount past due or delinquent (without late fees)
March 1, 2020 to December 31, 2020, if applicable
Month
Contract Rent Amount
Payment Amount (if applicable)
Payment Date (if applicable)
Amount past due or delinquent (without late fees)
1
2
3
4
5
6
7
8
9
10
Total amount past due or delinquent (without late fees)
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Eviction Diversion Program (EDP) Owner/Landlord Application
Owner/Landlord Signature
Signature
*
Date
-
Month
-
Day
Year
Date
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Eviction Diversion Program (EDP) Owner/Landlord Application
Checklist
Please submit any required documents here or mail to the address below.
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