Town of Fairfield - Fair Rent Commission Complaint Form

Town of Fairfield - Fair Rent Commission Complaint Form

Instructions to complainant/tenant: Please answer all questions applicable to your complaint.
General Information
Complainant - Tenant Name (s):*

First NameLast Name
Address, including unit # if applicable*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail Address*
Length of time in this rental unit (please list years & months below):*
Oral, month-to-month leaseWritten, one year lease?
What is your current monthly rent? (include $ amount below):*
What was your monthly rent last year? (include $ amount below):*
What was your monthly rent two years ago? (include $ amount below):*
Amount of monthly rent being proposed by the landlord (include $ amount below):*
Date new lease is scheduled to begin:*

MonthDayYear
Date
Description of Rental Unit: # of Rooms*
Description of Rental Unit: # of Bedrooms*
Description of Rental Unit: # of Bathrooms*
YesNo
YesNo
YesNo
Are there any other fees required? Please explain below:*
Landlord Information
Property Owner*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-Mail Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Property Manager (if applicable)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Nature of Complaint
A tenant may file a complaint with the Fair Rent Commission (FRC) if:

1) The tenant has been notified of a substantial increase in rent which would cause the rent to be higher that what other tenants in the community are paying for similar apartments;

2) A major service which the landlord has previously supplied has been decreased to an extent that affects the rental value of the apartment; or

3) It appears that the landlord has requested the rent increase in retaliation for the tenant's having made a request for repairs; a health, safety, or housing code inquiry or complaint to the Town; or taking some other action which the landlord perceived as adverse.
In the space provided below, please explain why you believe the increase in rent is excessive; why your landlord's response to your property maintenance, health and/or concerns described is inadequate; or what other complaint you wish to make that is within the Fair Rent Commission's jurisdiction:*
I affirm under the penatlties provided by law that the information I have provided is true to the best of my knowledge.
Signature of Complaint Tenant*
Date*

MonthDayYear
Date
Should be Empty:

Town of Fairfield - Fair Rent Commission Complaint Form

General Information

Landlord Information

Nature of Complaint