APPEAL OF THE RENT AMOUNT
REPORTED TO THE CITY BY THE LANDLORD
 
A tenant of a rental unit may appeal the rent amount reported to the City by the landlord through the Annual Rental Unit Registration process within fifteen (15) days of the date of the mailing of the Notice of Rent Amount Reported by Your Landlord.  A tenant may dispute the rent amount reported for the unit if the amount is incorrect.  A tenant may not dispute the rent amount based upon additional contractual housing services provided to a unit. 
 
I appeal the amount of rent reported by landlord for my rental unit $ (state the rent amount reported by your landlord).  I declare that the amount of rent paid on the date reported by the landlord was $ and request an administrative hearing on my appeal. 

I am attaching supporting documents (Required)

Tenant Information
First Name:
Last Name:
Unit Address:
City:
State:
Zip:
Move In Date:
Date of Last Increase:
Amount of Last Increase:
Daytime Phone Number:
Email:

Property Information (If Known)
Landlord First Name
Landlord Last Name
Property Manager/Company Name:
Landlord daytime phone number:
Landlord Mailing Address:
City:
State:
Zip:

Supporting Documentation
 I declare under penalty of perjury that the information provided by me on the above form is true and correct to the best of my knowledge and belief. I also understand that if I have provided any information that has been falsified, I am in violation of the Municipal Code and will be subject to an administrative fine or enforcement action.
 
Signature: Date: