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66A 1005 66A 1005 Z:\F3\FORM\FORMULA\RDL 066\66A (Québec)

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Conciliation offerte Conciliation acceptée
N° de la demande
Code du recours
ADDRESS OF DWELLING IN QUESTION
Municipality
Postal code
Apt.StreetN°
(Press hard when writing)
Municipalité Code du préposé
1863 RA1863 DD
1863 PD
Régie
du logement
Application relating to abandonment
Apt.Street
First name
Municipality
Postal code
N°
Work telephone no.Home telephone no.
Application numberDate
The lessee has abandoned the dwelling without right on or around
did not take possession of the dwelling
was evicted following a decision rendered on
OBJECT OF THE APPLICATION
N.B. : To modify this demand, an amendment must be filed and served before the hearing.
An
amendment will not be permitted at the hearing unless the other party is present and the tribunal
authorises it.
$
$
$
$
$
$
$
$
$
$
$
Total
other
damage and deterioration :
bank charges
tracing charges
energy costs
advertising costs
equivalent of lost rent due for the months of
The lessor has suffered the following damages :
has not been rented.The dwelling has been rented as of the ;
Upon the lessee's departure rent was unpaid for the following months
Damages :
Recovery of rent due at the time of the lessee's departure :
JourMoisAnTypeSéquenceBur.
DateN°
Application signed on
(Write in capital letters)
Date Signature
Rôle
Date de production
GROUNDS IN SUPPORT OF THE APPLICATION
Family name (1)
PlaintiffLessorPlaintiffLessee
(Complete address, if different than that of the dwelling in question)
DESCRIPTION OF PARTIES
RDL-066A-E (10-05)Régie du logement
information regarding the object or grounds of the application
Annex attached to add;
parties to the application
Apt.Street
First name
Municipality Postal code
N°
Work telephone no.Home telephone no.
Family name (1)
Apt.
First name
Municipality Postal code
N°
Work telephone no.Home telephone no.
Family name (2)
Apt.Street
First name
Municipality Postal code
N°
Work telephone no.Home telephone no.
Family name (2)
Street
$
DayMonthYear DayMonthYear
Beginning
of
lease
End
of
lease
Monthly
rent
To condemn jointly and severally
Costs
Interest and additional indemnity pursuant to
the Civil Code
Date
0.00
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66A 1005 66A 1005 Z:F3FORMFORMULARDL 06666A (Qubec)

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Completed 16 July 2020

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