Summary Ejectment Information Sheet (MF) (Feb 2023)

Summary Ejectment Questionnaire
Directions to Complete this Questionnaire

When filling out the questionnaire, there are a number of things we want you to take into consideration:

1. Despite the fact you may have discussed some of the things in the questionnaire with us on the telphone, please ensure you still capture everything about your case. Our attorneys and intake people speak with numerous clients throughout the day, so it is impossible to remember the facts and circumstances surrounding our consults;

2. When typing in the fields, please ensure you structure the information properly. For example, do not type in all lower case such as "123 main street," you should type it as "123 Main Street." While it may seem like common sense, you would be suprised;

3. To the extent you know the tenant's full name, please include it. This will assist in the judgment being rendered against the proper party. The same holds true for the telephone number, as well as the email address.
PLAINTIFF INFORMATION
Do you have a form prefill? NOTE: If you are one of our current clients, or have used us in the past, select "Yes."*

YesNo
Prefill: Enter your email to prefill some areas of the questionnaire, YOUR EMAIL MUST BE IN ALL LOWERCASE*
Monarch: Which Complex?*
Complex County*
What is the type of court? NOTE: If this is an appeal, select District. If this is not an appeal, select Magistrate*

Magistrate CourtDistrict Court
Did we handle the magistrate/small claims court proceeding?*

YesNo
PROPERTY MANAGER CONTACT INFORMATION

This will be not only for our office, but also for purposes of the scheduling of the Writ.
Property Manager First Name*
Property Manager Last Name*
Property Manager Email*
Property Manager Phone Number*
Property Manager Street Line 1*
Property Manager Street Line 2 (Suite, Unit, Etc
Property Manager City*
Property Manager State*
Property Manager Zip Code*
Property Manager County*
Is the property owned by an individual landlord, or by a company plaintiff?*

Individual LandlordCompany
Is the mailing address, and contact information, DIFFERENT for the landlord, than it is for the property manager? NOTE: Select "No" if the property manager is employed directly for the company that owns the property.*

YesNo. The property is owned by the company I work for
Plaintiff Information
Plaintiff Company Name*
Plaintiff First Name*
Plaintiff Last Name*
Plaintiff Phone Number*
Please enter a valid phone number.
Plaintiff Email*
example@example.com
Plaintiff Street Line 1*
Plaintiff Street Line 2 (Apartment, Suite, Unit, etc)
Plaintiff City*
Plaintiff State*
Plaintiff Zip Code*
EVICTION PROPERTY INFORMATION
Property Street Line 1*
Property Street Line 2 (APT, Suite, Unit, etc)
Property City*
Property State*
Property Zip*
Property County*
Type of Property
What type of property is this?*

Single FamilyMulti-Family (Apartments/Condos)Mobile HomeGovernment Housing
Do you/landlord own the mobile home?*

YesNo. The tenant owns the mobile home
TENANT INFORMATION
How many tenants are on the lease? NOTE: This is how many are on the lease agreement itself. If there are individuals in the property who are not on the lease, they are Occupants, not tenants.*

1234
TENANT INFORMATION

Please provide as much contact information about your tenant as possible. If you don't know some of the information, leave it blank
Tenant 1 Name*
Tenant 1 Telephone Number
Tenant 1 Email
example@example.com
Is Tenant 1 an Individual or a Company?

IndividualCorporation
Tenant 2 Name*
Tenant 2 Telephone Number
Tenant 2 Email
example@example.com
Is Tenant 2 an Individual or a Company?

IndividualCorporation
Tenant 3 Name*
Tenant 3 Telephone Number
Tenant 3 Email
example@example.com
Is Tenant 3 an Individual or a Company?

IndividualCorporation
Tenant 4 Name*
Tenant 4 Telephone Number
Tenant 4 Email
example@example.com
Is Tenant 4 an Individual or a Company?

IndividualCorporation
TENANT ACTIVE DUTY STATUS
Are any of the tenants active duty, or Reserve or National Guard members currently on an Active Duty Status?

YesNoI don't know
Is the tenant currently deployed?*

YesNo
LEASE INFORMATION
Type Of Lease. NOTE: In North Carolina, a lease does not have to be in writing. It can be an oral agreement between you and the tenant. Additionally, even if the lease is expired, you still have a lease agreement. In North Carolina, an expired lease agreement becomes a month to month lease by default.*

OralWritten
Do you have a copy of the lease agreement?*

YesNo
Lease Agreement*

Cancelof
What type of housing and lease is this? Please only select one.*

ConventionalPublic HousingSection 8
Rate of Rent. If tenant is a section 8 tenant, please put the tenant's share. DO NOT INCLUDE THE AMOUNT PAID BY THE GOVERNMENT.*
Date Rent Due. NOTE: This is the previous due date. For example, if you are filling out the form on February 15th, then then due date would be February 1st.*

MonthDayYear
Date
Rent Collection. When is rent collected?*

MonthlyWeekly
BASIS FOR EVICTION AND DAMAGES
What is the reason you are seeking an eviction? NOTE: You can check more than one box.*

Non-Payment of Rent.Holdover.Breach of Lease. NOTE: This also includes non-payment of rent if it is a SPECIFICALLY ARTICULATED BREACH of the lease agreement.Criminal activity.
NON-PAYMENT OF RENT
How many months is the tenant behind on rent? You can count a partial month as a whole month.*
Have you sent, or given, the tenant a notice of non-payment of rent? Note: This includes both written and verbal notices*

YesNo
Do you have a copy of the notice available? NOTE: You can provide a copy to us later. You will receive an email with a link to upload documents. If you don't have the notice readily available, select "Yes. But I don't have it now" and provide it to us later*

Yes. I have a copy available for uploadYes. But I don't have it nowNo. I didn't keep a copy of the noticeNo. The notice was given verbally
Notice of Non-Payment. Please upload a copy of your notice.*

Cancelof
Do you have a rent ledger that you keep? Note: The rent ledger can include bank statements, Venmo, CashApp, or any other documentary evidence that supports the tenant stop making payments*

YesNo
Do you have a copy of the rent ledger available? NOTE: You can provide a copy to us later. You will receive an email with a link to upload documents. If you don't have the documents readily available, select "Yes. But I don't have it now" and provide it to us later*

Yes. I have a copy available for uploadYes. But I don't have it nowNo. I didn't keep a copy of the noticeNo. The notice was given verbally
Rent Ledger. Please upload a copy of your ledger.*

Cancelof
Do you have late fees SPECIFICALLY WRITTEN into your lease agreement? Note: You cannot charge late fees unless they are specifically written in your lease.*

YesNo
Late Fees. Note: If your late fees, as written in your lease agreement, are greater than 5% of the rental amount, or $35.00 if you have a specific amount written as the penalty for late rent as opposed to a percentage, then input 0.00. Your late fee structure is illegal in North Carolina, and could subject you to a fine.
HOLDOVER TENANT
Date Lease Ended. NOTE: Only enter a lease expiration date if the current lease has expired, and proper notice has been given, meaning that the tenant was supposed to vacate the property on a certain date, and is still in the property at this time. This will usually apply to a holdover tenancy where proper notice has been given. THIS DOES NOT MEAN THE LEASE HAS ENDED BECAUSE IT EXPIRED, AND PROPER NOTICE HAS NOT BEEN GIVEN. *

MonthDayYear
Date
Have you sent, provided, a notice of termination or non-renewal to the tenant? Note: This notice can also be verbally given.*

YesNo
What date was the notice or non-renewal provided*

MonthDayYear
Date
What date was the tenant supposed to vacate the property?*

MonthDayYear
Date
Do you have a copy of the nonrenewal/termination notice available? NOTE: You can provide a copy to us later. You will receive an email with a link to upload documents. If you don't have the notice readily available, select "Yes. But I don't have it now" and provide it to us later*

Yes. I have a copy available for uploadYes. But I don't have it nowNo. I didn't keep a copy of the noticeNo. The notice was given verbally
Notice of Non-Renewal/Termination. Please upload a copy of your notice.*

Cancelof
Have you accepted ANY MONEY after you informed the tenant of the termination of the lease agreement?*

YesNo
Holdover Money Accepted. Please provide details of any money you accepted from the tenant, such as dates and amounts, after the notice of termination was provided.*
BREACH OF THE LEASE
Is one of the breaches of the lease agreement non-payment of rent? NOTE: Non-payment of rent must be specifically identified as a breach of the lease agreement in your lease. This does not mean that the lease simply states that rent is due on the 1st of the month.*

YesNoI don't know
Is there another breach of the lease OTHER THAN ,OR IN ADDITION TO, the non-payment of rent, criminal conduct, or holdover tenancy?*

YesNo
Have you sent a notice of the breach to the tenant? Note: This notice can also be verbally given.*

YesNo
Do you have a copy of the breach notice available? NOTE: You can provide a copy to us later. You will receive an email with a link to upload documents. If you don't have the notice readily available, select "Yes. But I don't have it now" and provide it to us later*

Yes. I have a copy available for uploadYes. But I don't have it nowNo. I didn't keep a copy of the noticeNo. The notice was given verbally
Notice of Breach. Please upload a copy of your notice.*

Cancelof
Have you accepted ANY MONEY after you informed the tenant of the breach of the lease agreement?*

YesNo
Breach Money Accepted. Please provide details of any money you accepted from the tenant, such as dates and amounts, after the notice of termination was provided.*
Breach of Lease. Please describe the nature of the breach in detail. Include dates as well as facts*
CRIMINAL CONDUCT
Did the criminal conduct occur on the property?*

YesNo
Has a police report been filed, or were the police called to the property?*

YesNo
Do you have a copy of the police report? NOTE: You can provide a copy to us later. You will receive an email with a link to upload documents. If you don't have the notice readily available, select "Yes. But I don't have it now" and provide it to us later*

Yes. I have a copy available for uploadYes. But I don't have it nowNo.
Police Report. Please upload a copy of the police report.*

Cancelof
Have you sent, provided a notice of the criminal conduct to the tenant? Note: This notice can also be verbally given.*

YesNo
Do you have a copy of the criminal conduct notice available? NOTE: You can provide a copy to us later. You will receive an email with a link to upload documents. If you don't have the notice readily available, select "Yes. But I don't have it now" and provide it to us later*

Yes. I have a copy available for uploadYes. But I don't have it nowNo. I didn't keep a copy of the noticeNo. The notice was given verbally
Notice of Criminal Conduct. Please upload a copy of your notice.*

Cancelof
Have you accepted ANY MONEY after you informed the tenant of the criminal conduct, or after you became aware of the criminal conduct?*

YesNo
Criminal Conduct Money Accepted. Please provide details of any money you accepted from the tenant, such as dates and amounts, after the notice of termination was provided.*
Criminal Conduct. Please describe the nature of the breach in detail. Include dates as well as facts*
ADDITIONAL MONEY DUE
Are there any utility payments due? Add up anything that is not rent or late fees, and is itemized on your ledger as utilities.*

YesNo
Are there any additional monetary damages other than what has already been covered?*

YesNo
Additional Damages Amount*
Please describe the nature of the Additional Damages, along with a breakdown of the amount.*
STATUS OF COURT FILING
Have you already filed the eviction?*

YesNo
Do you have the case file number for the eviction? NOTE: The file number will be on the paperwork you received back from the courthouse*

YesYes. I have it, but don't have it readily available.No
What is the Case File Number?*
Do you know the court date and time? NOTE: If this is an appeal, this is not the magistrate court date. The date and time is in reference to the district court date. If you know the district court date select "Yes." If you are still waiting on the district court date, select "No."*

YesYes, but I don't have it availableNo
Court Date*

MonthDayYear
Date
Court Time. NOTE: Please write as 8:00, 8:30, 1:30, etc. You do not need to write am or pm.*
ADMINISTRATION SECTION
Rent in Arrears as of Date. NOTE: Rent should be prorated as of the date of submission. Divide the number of days in the month by the monthly rental amount. FOR EXAMPLE: If the rent rate is $500 a month, and the tenant is behind this month's, but it is only the 15th of the month of a 30 day month, the Rent in Arrears is $250, not $500.00. Similarly, if the tenant is behind last month's rent in addition to this month's rent, the amount owed would be $750, not $1000.00*
NONPAYMENT BREACH*
Non-payment of rent
Court Filing Fee*
Sheriff Service Fee*
Appearance Fees
Attorney Fees
Total Monetary Damages*
Amount of Damages
Amount Of Rent Past Due*
Total Amount Due
Date

MonthDayYear
Date
Eviction Cost
SCRA AFFIDAVIT
1.As of the current date: (check one of the following)*

a.I have personal knowledge that the defendant named above is in military service.b.I have personal knowledge that the defendant named above is not in military service.c.I am unable to determine whether the defendant named above is in military service.
2. Have you received military orders?*

I have received military ordersI have NOT received military orders
3. Did you use the SCRA website?*

I used the SCRA websiteI did not use the SRCA website
Will the SCRA website results be attached?*

SCRA website results are attachedSCRA website results are NOT attached
If you did not use the SCRA website, how do you know the defendant is not in military service?
1. The undersigned has received information from the owner of the property that the defendant is not a member of the Armed Forces. 2. Additionally, the undersigned counsel has inquired into the military status of defendant by way of providing notice to the tenant, and tenant has failed to respond. If and when defendant provides notice to the undersigned, the undersigned shall inform the court of defendant's status as a member of the Armed Forces for which the Servicemembers Civil Relief Act would apply.
Should be Empty:

Summary Ejectment Questionnaire

PLAINTIFF INFORMATION

PROPERTY MANAGER CONTACT INFORMATION

Plaintiff Information

EVICTION PROPERTY INFORMATION

Type of Property

TENANT INFORMATION

TENANT INFORMATION

TENANT ACTIVE DUTY STATUS

LEASE INFORMATION

BASIS FOR EVICTION AND DAMAGES

NON-PAYMENT OF RENT

HOLDOVER TENANT

BREACH OF THE LEASE

CRIMINAL CONDUCT

ADDITIONAL MONEY DUE

STATUS OF COURT FILING

ADMINISTRATION SECTION

SCRA AFFIDAVIT