CITY OF OAKLAND
RENT ADJUSTMENT PROGRAM
250 Frank H. Ogawa Plaza, Suite 5313
Oakland, CA 94612-0243
TEL (510) 238-3721
FAX (510) 238-6181
TDD (510) 238-3254
Owner Pre-Move Out Negotiation Filing (rev. 4/17/18)
Owners Pre-Move Out Disclosure Certification Form
The owner must provide this form to the Rent Adjustment Program prior to
commencing Move Out Negotiations.
Owner’s Name
Telephone
Owner’s Mailing Address
E-mail
(a) The owner intends to enter into Move Out Negotiations to recover possession of the
rental unit located at:
Oakland, CA
Street Number
Unit Number
Zip Code
(b) A list of all dates on which the Owner initiated other Move Out Negotiations
with any current or prior Tenants at the property and the Rental Units
occupied by each Tenant, completed to the best of the Owner's recollection
and knowledge.
Date of Move Out Negotiation
Unit Number
I certify that I have provided each Tenant with the disclosure form required by the
Tenant Move Out Agreement Ordinance.
Owner’s Name And Owner’s
Representative, if Applicable
Date the owner provided tenant with the
disclosure form
Owner’s or Representative’s Signature