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San Francisco Residential Rent Stabilization and Arbitration Board
519 Report of Alleged Wrongful Eviction 5/21/20
25 Van Ness Avenue #320 Page 2 of 4 Phone 415.252.4602
San Francisco, CA 94102-6033
REPORT OF ALLEGED WRONGFUL EVICTION
Please provide the following information for all parties who should receive notice of this report.
Owner Information
First Name Middle Initial Last Name
Mailing Address: Street Number Street Name Unit Number City State Zip Code
Primary Phone Number Email Address
Master Tenant Information (if applicable)
First Name Middle Initial Last Name
Mailing Address: Street Number Street Name Unit Number City State Zip Code
Primary Phone Number Email Address
Property Manager Information (if applicable)
First Name Middle Initial Last Name
Mailing Address: Street Number Street Name Unit Number City State Zip Code
Primary Phone Number Email Address
Other Landlord Representative Information (if applicable) Attorney Non-attorney Representative
First Name Middle Initial Last Name
Mailing Address: Street Number Street Name Unit Number City State Zip Code
Primary Phone Number Email Address
WARNING TO TENANTS: The filing of this report will not prevent the landlord from filing
an unlawful detainer (eviction) lawsuit against you in court. IF YOU RECEIVE COURT
PAPERS, YOU SHOULD SEEK LEGAL ASSISTANCE IMMEDIATELY.
San Francisco Residential Rent Stabilization and Arbitration Board
519 Report of Alleged Wrongful Eviction 5/21/20
25 Van Ness Avenue #320 Page 3 of 4 Phone 415.252.4602
San Francisco, CA 94102-6033
REPORT OF ALLEGED WRONGFUL EVICTION
I am filing this petition for the following reason(s):
1.
I received a written Notice to Quit or Vacate my rental unit (an eviction notice)
on from
(Date of Receipt of Notice) (First Name) (Last Name)
The eviction notice requires me to vacate my rental unit by:
(Date)
Yes, I have included a copy of the Notice to Quit or Vacate with this report.
2.
On ,
the landlord orally told me to vacate my rental unit and/or
(Date(s) of Receipt of Notice)
through conduct has tried to make me move out by: .
(Date)
Yes, I have included a true statement fully describing the basis for my claim on page 4.
Please complete the following:
My rent is due on the following date: My current rent is $
I offered to pay rent. Yes No If Yes, state amount $ and date of offer:
Did the landlord accept the rent? Yes No If No, please explain briefly:
I have vacated my rental unit. Yes No If Yes, state date of move-out:
An Unlawful Detainer (eviction) action has been filed in Superior Court: Yes No
If Yes, I understand that the Rent Board will not carry out an investigation on eviction cases filed in
Superior Court. I am responsible for filing my own response in Superior Court within 5 day of receiving
the unlawful detainer summons and complaint.
Do you live in the same unit with the owner? Yes No
If Yes, use t
he space provided on page 4 to describe the unit and state whether there are other
occupants in the unit.
Do you live in the same unit with a master tenant? Yes No
If Yes, did the master tenant give you written notice prior to commencement of your tenancy, that your
tenancy is not subject to the “just cause” eviction provisions of the Rent Ordinance? Yes No
(Please attach a copy of the notice.)
San Francisco Residential Rent Stabilization and Arbitration Board
519 Report of Alleged Wrongful Eviction 5/21/20
25 Van Ness Avenue #320 Page 4 of 4 Phone 415.252.4602
San Francisco, CA 94102-6033
REPORT OF ALLEGED WRONGFUL EVICTION
I believe this eviction is wrongful because:
I have been locked out of my
apartm
ent.
“Just cause” reason stated in
notice i
s not true.
Landlord has refused to accept rent
payment.
Utilities have been turned off.
No advice clause given on
eviction noti
ce.
Landlord has attempted to recover
posse
ssion of my unit through
harassment.
No “just cause” reason stated
on the evictio
n notice.
The landlord paid me incorrect
relo
cation amounts.
Other:
(Use additional sheets if necessary to provide a complete description of your claim of wrongful eviction.)
DECLARATION OF TENANT(S)
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THIS
INFORMATION AND EVERY ATTACHED DOCUMENT, STATEMENT AND FORM IS TRUE AND CORRECT.
NOTE: Every tenant of the rental unit who wishes to be included in this report must sign this declaration. Any tenant
who lives in a different rental unit must file a separate report.
(Print Name) (Signature of Tenant) (Date)
(Print Name) (Signature of Tenant ) (Date)
(Print Name) (Signature of Tenant) (Date)
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