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Proof of Temporary Relocation Payment Form (For: Landlords, Property Managers, and Authorized Agents)

  1. Purpose

  2. This form should be submitted after EACH Temporary Relocation Payment portion is disbursed to the Tenant.

  3. Temporary Relocation Payment

    A Temporary Relocation Payment shall be provided by any Landlord who takes action to terminate tenancy for temporary vacation in Order to Undertake Substantial Repairs (RMC Section 11.102.030(a)).

  4. A Landlord shall provide the Relocation Payment in the amount required by Resolution No. 115-16 to each Eligible Tenant through direct payment to the Tenant. In lieu of direct payment to the Tenant, a Landlord may choose to distribute the Relocation Payment through an escrow account; however all costs of an escrow opened pursuant to the provisions of RMC Section 11.102.070 shall be borne by the Landlord. The Landlord shall pay one-half (1/2) of the applicable Relocation Payment when the Tenant has informed the Landlord in writing of the date when the Tenant will vacate the Rental Unit and the other half upon certification that the Tenant has vacated the Rental Unit on the date provided in the notice (RMC Section 11.102.070(a)-(b)).

  5. Instructions

  6. 1. Complete the following online form.

  7. 2. Upload a PDF copy of the Cashier's Check provided to the Tenant(s).

  8. Rental Unit Information

  9. Tenant Information

  10. Current Mailing Address

  11. Additional Information

  12. Additional Tenant Information

    Please list the name(s) of any other individuals on the lease or rental agreement.

  13. Pet Accomodations

  14. Landlord Information

  15. Landlord Mailing Address

  16. Termination of Tenancy Information

  17. Attach a copy of the cashier's check or personal check addressed to the Tenant.

  18. Please note: Any records included with this form and submitted to the City of Richmond, Rent Board, or Rent Program may be subject to disclosure pursuant to the California Public Records Act.

  19. Certification of Correctness of Information

  20. Certification of Correctness of Information*

    Under penalty of perjury under the laws of the state of California, I hereby certify that the foregoing information and that contained in any attached sheets is true and correct to the best of my knowledge and belief.

  21. Signature

  22. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

  23. Signature Verification*

  24. Form Resubmission?

  25. Leave This Blank:

  26. This field is not part of the form submission.