EVICTION LEGAL SERVICES - Eviction -Flat Fee

KENNETH 
VERCAMMEN & ASSOCIATES, PC

ATTORNEY AT LAW

www.njlaws.com

Landlord tenant eviction questionnaire -
CLIENT INFORMATION SHEET

Please fill out completely

(Please
Print)

NAME
__________________________________________________________

      

ADDRESS _______________________________________________________

CITY _____________________________ STATE
_______ ZIP _____________

CELL-PHONE
___________________________________ (Area
Code Needed)

      

PHONE-DAY __________________________ NIGHT
______________________

E-MAIL ADDRESS
_________________________________________________

TYPE OF MATTER:
________________________________________________

REFERRED BY:
___________________________________________________

If referred by a person, is this a client or
attorney?  If you heard about the law
office on the internet, which search engine? 
What search terms did you use?

TODAY’S DATE:
__________________________________________________

DESCRIPTION OF MATTER:

______________________________________

______________________________________

______________________________________

­­­­­­

QUESTIONS TO ASK ATTORNEY:
______________________________________

________________________________________________________________

Eviction
Details

1. Name
of Plaintiff(s)/Landlord(s): ___________________

Name
of all Defendant(s)/Tenant(s): ____________________ 

____________________

____________________

___________________

2. Address
of Rental Premises: ____________________

Tenant’s
Phone No.: ____________________

3. The
tenant(s) now reside(s) in and has (have) been in possession of these premises
since

____________________________

(mm/dd/yyyy)

under
(check one)  _______ written or  _______ oral agreement

 4.  __ Check here if the tenancy is subsidized
pursuant to either a federal or state program or the apartment is public
housing.

5. Amount due.  The (check one) (x) monthly or ( ) weekly
amount that must be paid by the tenants(s) for these premises is $___________

 
payable on the _______ day of each (__) month or ( __) week in advance.

COMPLETE PARAGRAPHS 6A, 6B AND 6C IF
COMPLAINT IS FOR NON-PAYMENT OF RENT

6A. 
There is due, unpaid and owing from tenant(s) to landlord   for
rent as follows:

$______  base
rent  for ___________ month

$___ 
late charges, under paragraph ____, Line ___________ of written                              lease   [no late fees unless set forth in written
lease]

$______  base
rent  for ___________ month

$______  base
rent  for ___________ month

$ _________ attorney's fees, as specifically
provided for in the lease under paragraph ____, Line ___________  [no attorney 
fees unless set forth in written lease]

       ________
other (specify ___________), if permitted by federal law, local law and the
lease.

         $______ 
court costs (fees for filing and serving the complaint)

Total
due as of this notice is $______________________

Amount
due after first day of the next month $___________________

IF THE COMPLAINT IS FOR OTHER THAN OR IN ADDITION TO
NON-PAYMENT OF RENT.  ATTACH ALL NOTICES TO CEASE AND NOTICES TO
QUIT/DEMANDS FOR POSSESSION.

Landlord seeks a judgment for possession for the additional
or alternative reason(s) stated in the notices 

attached
to this complaint.  STATE REASONS 
under the Lease or Violations of NJ Eviction Law

________________________________________________________________