16
DISCLOSURE OF INFORMATION ON DEATH IN A RENTAL UNIT
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORD’S DISCLOSURE:
At the time of this lease agreement, Landlord certifies the following information
pertaining to the history of death in the rental property:
____ No death reported
____ Death by natural causes
____ Death by violent crime: ________________________________________________________
____ Death by communicable disease: ______________________________________________
Tenant has a right to have questions answered pertaining to death in the rental unit
to the best of the Landlord’s knowledge upon request.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date