Land Lord Form
To: All Saints Interfaith Center of Concern
      1513 Noble Street
      Anniston, AL 36201
      256-236-7793 office  256-238-7776 fax
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Date *
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DD
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From:______________________________(Landlord/ Owner of Property) *
Re:__________________________________(Tenant/Lesse) *
Address of Property:________________________________ *
The Individual shown above has past due rent and other considerations as follows: Due for current month:$______________________ *
Due for past months as follows: Month:$_________________________, Month:$_________________________. *
Other Considerations:$____________________________. *
Comments/Explanations: *
Is eviction imminent if tenant in question does not pay by (date)_______________________, Yes or No? *
Will you waive the late fees if our charity agency gives assistance to your client? *
If you accept funds from All Saints Interfaith Center of Concern, will you extend the tenant's residency with you for 90 days from this date (while you work with the client to collect any unpaid rental charges)? *
Property Owner: *
Phone No.: *
Fax: *
Make Checks Payable To: *
Property Owner Mailing Address: *
Property Owner Signature *
Date *
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