3),24+,$$$$$$$$»$$$$$$$$$,5"6)27,86)9:9;*0,5"6&2
$$$$$$$$¼$$$$$$$<,=49"
Application by Tenant to Deposit Rent with the Clerk
5*.+,>"?,$$$$$$$½$$$$$$$$
>*'+,*)-,@--&+..,"/,!+)*)2 >*'+,*)-,@--&+..,"/,A*)-0"&-,"&,@B+)2
$$$$$$$$$$$$$¾$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$¿$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
!+0+;4")+,>"#,$$$$$$$À$$$$$$$$$ !+0+;4")+,>"?,$$$$$$$$$$Á$$$$$$$$$$
C7,/9009)B,"62,249.,/"&'<,3,*',*;;079)B,2",-+;".92,*00,&+)2,24*2,9.,:6&&+)207,-6+,*)-,D+:"'+.,-6+,2",'7
0*)-0"&-<,E924,24+,50+&F,"/,24+,:*;29")+-,5"6&2?,(=?G?5?,HIJII?KL,"&,HMINK?LJ(C1(K11?
O*2+ $$$$$$$$Â$$$$$$$$$$$$ P9B)+-#$$$$$$$$$$$$Ã$$$$$$$$$$$$$$$
Affidavit(Information) in Support of Application
!4+,/"00"E9)B,/*:2.,*&+,2&6+,2",24+,D+.2,"/,'7,F)"E0+-B+,(7"6,'6.2,:4+:F,")+,"/,24+,2E",";29").
;&"Q9-+-,9),RN1#
K? 87,0*)-0"&-,-9-,)"2,.6;;07,'+,E924,)"29:+,9),E&929)B,24*2,4+S.4+,E*.,*,;*&27,2",*)7,&+)2*0
*B&++'+)2,E49:4,:"Q+&+-,24&++,"&,/+E+&,-E+009)B,6)92.,(P+:29"),MINK?LJ(511?
N? $$$$$ 3,B*Q+,E&922+),)"29:+,2",'7,A*)-0"&-,"/,49.S4+&,/*906&+,2",/60/900,49.S4+&,"D09B*29").,*.
&+T69&+-,D7,P+:29"),=?G?5?,MINK?LJ(@1,(:";7,"/,249.,>"29:+,9.,*22*:4+-,4+&+2"1
=G
$$$$$ >",)"29:+,E*.,B9Q+),2",'7,0*)-0"&-,D+:*6.+,4+S.4+,-9-,)"2,B9Q+,'+<,9),E&929)B<,24+
)*'+,*)-,*--&+..,"/,24+,"E)+&,"&,"E)+&U.,*B+)2,*.,&+T69&+-,D7,=?G?5?,P+:29")
MINK?KV(@1?
I? W*7'+)2,"/,'7,&+)2,-6+,6)-+&,24+,&+)2*0,*B&++'+)2,9),24+,*'"6)2,"/,X,$$$$$Ä$$$$$$,;+&
'")24,*)-,-6+,"),$$$$$$»»$$$$$,9.,5YGGZ>!,(3,4*Q+,'*-+,*00,;*7'+)2.,2",-*2+1?
PE"&),2",'+,*)-,.9B)+-,9),'7,;&+.+):+,249.,$$$$»¼$$$,-*7,"/,$$$$»½$$$<,NL$»¾$$?
P9B)+-#
$$$$$$$$$$$»¿$$$$$$$$$$$$$$ $$$$$$$$$$$$»À$$$$$$$$$$$$$$
, ,(!+)*)21 ,(O+;627,50+&F1
Notice to Landlord or Agent
W0+*.+,D+,*-Q9.+-,24*2,24+,*D"Q+,2+)*)2,4*.,-+;".92+-,E924,24+,50+&F,&+)2,-6+,/"&,24+,;&+'9.+.
'+)29")+-,*D"Q+?,,!49.,9.,*,:";7,"/,49.S4+&,*;;09:*29")?