Eviction Defense Questionaire

Eviction Defense Questionaire

LET US DELAY YOUR EVICTION
We need this information to delay your eviction. Typical evictions are delayed ~14-90 days

Please fill out fully.Upload a picture of your court document to skip a lot of questions
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
How did you hear about us?

Other
Do you have current eviction case?
Reason for eviction?

Other
What County is the eviction filed?
Eviction Case number
Eviction JP Precinct
Eviction JP Place
Eviction JP Court number
Take Photo of Court Documents
JP County Court Date

MonthDayYear
Date
JP County Court Time

Hour Minutes

AM/PM Option
Upload Court Summons (recommended)

Cancelof
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you applied for Rental Relief or Help?

Other
Have you been approved for rent relief or still pending?
How did you receive your Eviction Notice?

Other
Signed date

MonthDayYear
Date
Additional Question 1
Additional Question 2
Have you missed your court date?
When was your court date?

MonthDayYear
Date
What was your reason for missing?
New Question
Do you intend to remain in your current residence or seek alternative housing?
Would you be interested in receiving professional assistance in finding a place through Second Chance Housing Partners?
Do you give permission to share your phone number or contact information?
Signature
Should be Empty: