DISTRICT COURT OF MARYLAND FOR Located at Tenant(s) Address City, State, Zip Telephone Number Court Address City/County Case No. vs. Landlord(s)/Agent(s) Address City, State, Zip Telephone Number Serve By: Sheriff/Constable Certified Mail Private Process Server COMPLAINT FOR 1. I rent the property located at RENT ESCROW INJUNCTION City State Date Zip (Real Property � 8-211) Address 2. My rent is $ 3. The property has: Check all that apply. per month per week I last paid my rent on: no heat no running water inadequate sewage disposal facilities no hot water no electricity fire hazard rodent infestation in 2+ units structural defect which presents a serious and substantial threat to the physical safety of occupants health or fire hazard (describe) other serious and substantial threat to the life, safety or health of an occupant (describe) 4. The first time the Landlord was asked to fix these problems: 5. I notified the Landlord: Check all that apply. in person by phone text message in writing e-mail other written notice Date or Estimated Date regular mail certified mail inspection by an official other: 6. I am asking the court to: Check all that apply. order the Landlord to fix the problems allow me to pay my rent to the court until the problems are fixed reduce my rent to $ until the problems are fixed reduce my rent, paid or owed, starting from when my Landlord was first told about these problems, in the total amount of $ give me back the rent paid to the court, after all problems are fixed end my lease other: 7. Prior judgments: During the last 12 months, the Landlord has obtained judgments for possession of this property against me. Total # of judgments 8. Additional paperwork is attached to this petition: Yes No MILITARY SERVICE AFFIDAVIT I hereby affirm under the penalty of perjury that my Landlord is is not in the military service. That facts on I don't know whether my Landlord which I base this statement are: .OR, is in the military service. Date and signature as to the Complaint and the Affidavit: Date Signature of Tenant or Attorney TO THE LANDLORD: You are summoned to appear for trial on Court to Answer the Rent Escrow Complaint Date WRIT OF SUMMONS Date at Time in this Complaint for Injunction above. Signature of Clerk To request a foreign language interpreter or reasonable accommodation under the Americans with Disabilities Act, please contact the Court immediately. Possession and use of cell phones and other electronic devices may be limited or prohibited in designated areas of the court facility. DC-CV-083 (Rev. 04/2017) American LegalNet, Inc. www.FormsWorkFlow.com