Page 1 of 3 Revised June 2018 251 2018 Coconino County Law Library Person Filing : Street Address: City, State, Zip: P hone Number: Representing Self IN THE JUSTICE COURT PRECINCT, COCONINO COUNTY, ARIZONA Plaintiff(s): Case No. COMPLAINT Defendant: (Breach of Warranty of Habitability) For my/our complaint we make the following claims: 1. My/our name(s) and current address(es) is/are: Name: Address: Name: Address: 2. Defendant/Landlords name and address is: Name: Address: 3. I/we rent or rented the dwelling located a t from Defendant/Landlord beginning [ ] to the present OR [ ] until I/we moved out on Rent is/was in the amount of $ per month. 4. On numerous occasions, I/we requested that Defendant repair the following conditions on the premises (list conditions and date of first notification to landlord): 5. A.R.S. 33-1324 requires Defendant/Landlord to: A. Comply with the requirements of applicable building codes materially affecting health and safety. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Revised June 2018 251 2018 Coconino County Law Library B. Make all repairs and do whatever is necessary to put and keep the premises in a fit and habitable condition. C. Maintain in good, safe working order and condition all electrical, plumbing, sanitary, heating, ventilating, and other facilities and appliances supplied or required to be supplied by Defendant/Landlord. 6. Defendant/Landlord failed to repair the problems listed above as required by A.R.S. 33-1324 in spite of requests to repair. 7. I have suffered damages because of Defendant/Landlords inactions. THEREFORE, I/we request that this Court find the Defendant/Landlord in violation of A.R.S. 33-1324 and assess money damages pursuant to A.R.S. 33-1362(B) as follows: A. Damages (cannot exceed $10,000) in the total amount of $ including: [ ] Reduced value of the dwelling: $ monthly rent paid MINUS - $ value of dwelling with the problems EQUALS = $ monthly damages TIMES X number of months since first notice to landlord * $ TOTAL damages for reduce d value *(for example, 1.5 months, but no more than 12 months back from filing date) [ ] Property damage in the amount of $ . [ ] Alternate housing expenses (for example, motel) $ . [ ] Moving expenses (if problems forced tenant to move) $ . [ ] Other $ . In appropriate cases, this may include lost wages, emotional distress (see Thomas v. Goudreault, 163 Ariz. 159, 164-65, 786 P.2d 1010, 1015,1016 (1989)), and other damages that would not have occurred except for landlords failure to repair. B. Court costs and attorneys fees, if applicable. C. Other relief considered just by the Court. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Revised June 2018 251 2018 Coconino County Law Library VERIFICATION I have read this Complaint. It is true and complete to the best of my knowledge. ignature: State of Arizona Co unty of ) ) ) Subscribed and sworn or affirmed before me this date: by: . Seal: Notary Public: Notary Expiration Date: I have read this Complaint. It is true and complete to the best of my knowledge. ignature: State of Arizona County of ) ) ) Subscribed and sworn or affirmed before me this date: by: . Seal: Notary Public: Notary Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com