OFFICE OF
Gary Simpson
614 DIVISION ST. MS-37
•
PORT ORCHARD, WASHINGTON 98366
•
(360) 337-7104
•
FAX (360) 337-5736
TENANT INFORMATION SHEET (This form is not to be modified in any manner)
**ALL FIELDS MUST BE COMPLETED**
Law Firm / Company Information:
Name, Phone, Mail Address
Property Information:
Type of Dwelling:___________________________
Outbuildings:
Is this a Secured Apt Building:
_
_
Landlord / Property Manager Information:
Name, Phone, Mail Address
If a Mobile Home,
Who owns the Mobile Home:
Who owns the Real Property:
VIN # or Plate Number:
Landlord Intent at Time of the Eviction:
(Check one)
Change locks and store property
Remove all property from the dwelling
Eviction Information:
Local Contact Name & Phone Number:
Reason for the Eviction:
Tenant Information:
Tenant Names & Dates of Birth
Others Occupying the Property / Children
Names & Dates of Birth
Length of Time in Residence:
Pets:
Known Weapons:
Based on a Foreclosure? (check one)
Yes No
Do the tenants have any disabilities that will
require accommodations (Please include any local,
state or federal assistance and case-worker
names)?
What problems have there been:
(check what applies)
Assaults Alcohol Abuse Drug Abuse
Mental Health Problems
Others:
Other Information:
