Eviction Prevention Mediation Request

Eviction Prevention Mediation Request

All fields required.
STOP If you are a TENANT, please read below before proceeding any further:

Please be advised of tenant eligibility to request a mediation ONLY if a violation has occurred in at least one of the following areas below and written notice, via certified mail, has been given to the landlord/property manager within specified time frames according to the Uniform Residential Landlord Tenant Act

https://yourlegalaid.org/resources
https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=3572
- Lease violation(s)
  https://yourlegalaid.org/resources
- Building Code violations
  https://louisvilleky.gov/government/codes-regulations
  https://louisvilleky.gov/government/codes-regulations/property-maintenance-code-enforcement
- Violations of the Uniform Residential Landlord Tenant Act (URLTA)
  https://apps.legislature.ky.gov/law/statutes/chapter.aspx?id=39159
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=35729
- Conflict in interpretations of URLTA and/or the Kentucky Landlord Tenant Law and/or lease agreement and/or building code violations
  https://apps.legislature.ky.gov/law/statutes/chapter.aspx?id=39159
TENANTS please be advised of the below forms and/or documentation required within five business days of a scheduled mediation:
- Pre-Mediation Assessment Form
- Copy of written notice specifying violation
- Certified mail receipt confirming written notice
- Total amount of “back-rent” due
- Maintenance receipts
- Photos and/or recordings of violations
- Accurate monthly rental rate
- Current/signed lease agreement
STOP If you are a LANDLORD/PROPERTY MANAGER, please read below before proceeding any further:

Please be advised that landlords who have an active eviction filed against a tenant are ineligible for Eviction Prevention Mediation.

LANDLORDS please be advised of the below forms and/or documentation required within five business days of a scheduled mediation:
- Pre-Mediation Assessment Form
- Copy of written notice specifying lease agreement and/or URLTA and/or Kentucky Landlord Tenant Laws violation(s)
- Certified mail receipt confirming written notice
- At least a 90-day ledger documenting deficiency in rental payments
- Total amount of “back-rent” due
- Photos and/or recordings of violations
- Accurate monthly rental rate
- Current/signed lease agreement
Full Name*

First NameLast Name
Primary Contact Number*
Primary Email Address*
Please Select One

Property ManagerLandlordTenant
Property Management Company
Name of Landlord
Name of Property Manager
FLEXIBLE Scheduling Offered
Mondays – Thursdays: 9am-6pm
Fridays: 9am-1pm
Saturdays: 9am-1pm
Mediations are scheduled in two-hour time blocks
(i.e. 9am-11am, 11am-1pm, and 4pm-6pm, etc.).

Please be advised that resolve: Restorative Practices LLC strives to schedule mediations according to “desired appointment dates”; however, due to demand, it is not always possible.
1st desired appointment date:*

MonthDayYear
Date
Hour MinutesAM/PM Option
2nd desired appointment date, if the above selection is not available.*

MonthDayYear
Date
Hour MinutesAM/PM Option
Required Tenant Contact Information
Full Name*

First NameLast Name
Primary Email Address*
Address

Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact Number
Required Landlord or Property Manager Contact Information
Full Name*

First NameLast Name
Employer*
Position Title*
Primary Contact Number*
Business Email Address*
Business Address

Address Line 2

CityState / Province

Postal / Zip Code
Initial contact will be made by resolve: Restorative Practices LLC within three business days per receipt of the Request for an Eviction Prevention Mediation.
Should be Empty: