Eviction Transmittal Form

Eviction Transmittal Form

A simple and easy way to submit your eviction request.
Type of Property*
Has the tenant indicated either verbally or in writing that they are withholding rent due to an unresolved repair issue or other complaints?*
Please contact our office at (800) 253-8428, press 5 for the Eviction Department, and state that the tenant is withholding rent.

Please do NOT submit the eviction at this time.
Please specify each complaint made by the tenant, the date each issue was reported, and the date each issue was resolved.*
Community / Real Estate Company*
Contact Person*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Extension
Email Address*
example@example.com
Eviction Property Address*

Street Address

Street Address Line 2

City

Zip Code
Does the property have a gate/security code to enter?

NoYes
Please enter the gate/security code

Tenant Information

Please be sure that all listed information is correct.
Remember: You must block/turn off the tenant's capability to make electronic payments and/or direct deposits.
Why do you want to evict the tenant?*
Why do you want to evict the tenant?*
Date of latest notice served.*

MonthDayYear
Date
If the notice was served via email, you must provide us with the special lease addendum required for email service.
To avoid delays, please be sure to include each tenant’s email address the notice was emailed to, at the bottom of the notice including the date sent.
What reason does the tenant give for not paying rent?
Please state the reason for non-renewing.*
Please list the reason for "Other".*
Is the tenant your relative or friend?
In which county is the rental property located?*
For the following counties we may need the social security number and/or date of birth of each Tenant:

Bay, Broward, Escambia, Flagler, Highlands, Palm Beach, Santa Rosa, and Volusia.

We will be contacting you for the social security number and/or date of birth upon review, if needed.
How many adult tenants?*
Tenant 1 Name*

First NameLast Name
Tenant 2 Name

First NameLast Name
Tenant 3 Name

First NameLast Name
Tenant 4 Name

First NameLast Name
Tenant 5 Name

First NameLast Name
Is any tenant active military?*
Which tenant is active military?
Did you ever allow the tenant to make a repair and deduct the cost from the rent?
Did you ever not complete a repair because you did not receive the rent?
Has the tenant ever done any work on the property in exchange for rent?

Property Information

Please verify all information with the notice being used for filing.
Have you provided any documents to a rental assistance program for the tenant via online application or otherwise?*
Please state the name of the rental assistance program.*
What date did you submit documents to the rental assistance program?*

MonthDayYear
Date
Please upload any documents related to the rental assistance application in the upload documents section.
Are you aware of any pending rental assistance that would pay past the non-renewal expiration date?*
Do you have any payment plans with the tenant?
Please upload the payment plan in the upload documents section.
Are you holding last month's rent?
How much is the last month's rent?
Are you holding a security deposit?
Is this property covered under the CARES Act?*
CERTIFICATION THAT THE RENTAL PROPERTY OR UNIT

IS NOT CARES ACT COVERED

I represent the information below is correct and the property or tenancy subject to this eviction is NOT CARES ACT COVERED.

The property is paid off 100% with no mortgage interest on the property OR, if financed, the loan is not supplemented, insured, protected, or assisted in any way by HUD, Fannie Mae, Freddie Mac, FHA, VA, nor do I have a loan that was purchased or securitized by the Federal Home Loan Mortgage Corporation or the Federal National Mortgage Association, or any loan that is secured by a first or subordinate lien that is made, insured, guaranteed, or assisted in any way by any officer or agency of the Federal Government.

The property owner is not participating in any of the following programs regarding this tenancy: The Rural Housing Voucher Program, VAWA, section 202 Supportive Housing for the Elderly Program, Section 811 Housing for Persons with Disabilities Program, Housing Opportunities for Persons With AIDS (HOPWA), McKinney-Vento Homelessness Assistance Program, Section 236, Section 8 Housing Choice Voucher (HCV) Program, or Low Income Housing Tax Credit (LIHTC).

I agree to totally hold harmless and indemnify the Law Offices of Heist, Weisse & Wolk, PLLC, including attorneys Harry Heist, David Weisse, Brian Wolk, Kirk Eason, and Jeffery Wilkins, individually from and against damages, costs, losses, litigation, and expenses including attorney’s fees, resulting from misrepresentations or errors as to CARES Act coverage.

Additionally, I hereby confirm that the owner is NOT under Active Mortgage Forbearance.

Understanding the above, by checking the box below, I direct the Law Offices of Heist, Weisse & Wolk, PLLC to file the eviction case.
Please confirm:

Yes, I agree and understand

Upload Documents for Filing

Please be sure to include all documents required for filing.
Please scan and upload the original notice NOT a photo of the notice.
Upload latest notice.*

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If the lease has expired, please still upload the expired lease.
Type of Lease*
What is the current monthly rent?
Upload lease agreement.*

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Though this eviction is NOT based on non-payment of rent, we will need to view any monies owed at the time of filing.
* Please be sure to upload all supporting addenda for charges on the ledger. *
Upload account ledger.*

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Upload addenda supporting amounts owed.

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Upload other supporting documents.

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Upload any documents related to rental assistance.

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Upload any payment plan you have with the tenant.

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If you have written any letters to the tenant, or the tenant has written letters to you, please attach them below.
Upload correspondence with the tenant.

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Have you received correspondence from an attorney on behalf of the tenant?
Upload correspondence from tenant's attorney, if applicable.

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Property Owner Information
Owner's Name as it appears on the Deed*
Owner's Address*
Is the property in foreclosure, near foreclosure or Lis Pendens filed against property?*
Are you current on HOA/Condo Association fees/assessments, if applicable?*
Who is the local person who serves notices and views the property?
Who referred you to our office?

Real Estate AgentOther
Real Estate Company
Agent's Name
Agent's Email Address

Owner Information for Managed Individual Units
Owner's Name as it appears on the Deed*
Owner's Address and Phone Number*
1. I hereby affirm and assure that the above information is correct.

2. I am aware of the approximate fees and costs for this eviction. If the eviction is contested, additional charges will apply.

3. I am authorized by the owner of the property to request that an eviction be filed on the above-mentioned tenant(s).

4. I understand that the filing of the eviction in no way obligates the Law Offices of Heist, Weisse & Wolk, PLLC, to litigate count two (if any) of a complaint, do collections, file, and litigate appeals, and/or handle a jury trial. The Law Offices reserves the right to withdraw from representation if the case becomes complex or involves issues other than getting possession of the premises.
Is the property in foreclosure?*
Is the property owner delinquent on homeowner's/condo association fees and assessments?*

Information / Comments
Please address the following before you submit.
By submitting this information for an eviction filing, I and/or the management company and/or ownership entity agree to totally hold harmless and indemnify the Law Offices of Heist, Weisse & Wolk, PLLC, and attorneys Harry Heist, David Weisse, Brian Wolk, Kirk Eason, and Jeffery Wilkins individually from and against damages, costs, losses, litigation, and expenses including attorney’s fees, resulting from misrepresentation(s), error(s), omission(s), or failure(s) to support the amount(s) alleged or information provided.

By submitting this eviction request I am confirming I am providing the entire lease, if applicable, and all other available addenda, documents, and information to support the amounts owed or information alleged upon which the eviction will be based.
The attorney fees for most evictions of this type are $900. Court costs are in addition to that and vary depending on the county and the number of defendants. There can be additional fees and costs if the tenant fights the eviction. If the tenant refuses to move even after a judgment has been entered, the sheriff will remove them for a cost, usually in the amount of $90 (using a writ of possession). Please note that the lawsuit we file aims at getting possession of the premises as quickly as possible. We do not pursue a money judgment or do collections.
I am authorizing and instructing the Law Offices of Heist, Weisse & Wolk, PLLC to proceed with filing the eviction lawsuit.*

Yes, I understand and agree.
If you have any further information to share, please include it below.
ADA
Clerk of Court
Summons Address for Clerk
County CAPS
Defendant Defendants
Should be Empty:

Eviction Transmittal Form

Tenant Information

Property Information

Upload Documents for Filing

Property Owner Information

Owner Information for Managed Individual Units

Information / Comments