Notice of Relocation Payment

Notice of Relocation Payment

Mandatory renter relocation assistance applies to properties within Portland city limits. Landlords are required to notify PHB within 30 days of making a payment.

More about this requirement

Note: The reporting requirement does not constitute as proof of payment made to a tenant.

Have questions or need help completing this form?

RentalServices@portlandoregon.gov

503-823-1303

Submit a separate form for each unit where relocation payment was paid.

Rental Dwelling Unit Information

Street Address*

e.g. 1120 SW 5TH

Apartment or Unit #

City*

State*

Zipcode*

Bedroom Count*

Select or enter value

Payer Contact Information

Name*

Who made the payment? They will be the main contact for this notification.

Street Address*

e.g. 1120 SW 5TH

Apartment or Unit #

City*

State*

Zipcode*

Phone*

Phone

E-mail*

Mailing Address different from above?

Mailing Address*

e.g. 1900 SW 4th Ave

Unit #

City*

State*

Zipcode*

Ownership Information

Ownership structure of the Dwelling Unit for which relocation payment was made:*

Natural Person

Business Entity

Trust or Estate

Type and Name of Business Entity*

Payment Trigger

Relocation assistance payment was made for the following reason (select one)*

No-Cause Termination Notice

Qualified Landlord Reason

Rent Increase of 10% or More

Decline to Renew or Replace an Expiring Rental Agreement on Substantially the Same Terms

Qualified Landlord Reason:*

Demolish the Dwelling Unit or Convert to Nonresidential Use

Undertake Repairs or Renovations and Premises Are/Will Be Unsafe or Unfit for Occupancy

Immediate Family to Occupy as Primary Residence

Sale of Dwelling Unit to Purchaser Who Intends to Occupy as a Primary Residence

Form Certification

I hereby certify that the above information, to the best of my knowledge is true and complete. I understand that I must inform the Portland Housing Bureau immediately and in writing of any changes. I understand that a Landlord that fails to comply with any of the requirements set forth in PCC 30.01.085 shall be liable to the Tenant for an amount up to 3 times the monthly Rent as well as actual damages, Relocation Assistance, reasonable attorney fees and costs.

Electronic Signature*

Date*

Send me a copy of my responses

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