DISTRICT COURT OF MARYLAND FOR City/County Located at Case No. Court Address vs. Plaintiff (Tenant) Defendant (Landlord) Address Address City State Serve By: Sheriff/Constable PETITION Zip City State Certified Mail IN ACTION OF RENT ESCROW Zip Private Process FOR INJUNCTION The Tenant respectfully states that: he/she rents the property at 1. for the sum of $ per month week there exists conditions and defects on the leased premises shown above, which constitute, or if not promptly corrected will 2. constitute, a fire hazard or serious threat to the life, health, and safety of occupants thereof, including but not limited to: 3. 4. lack of heat, lack of light, lack of electricity, lack of hot or cold running water, (except if the property is a one-family dwelling, or a multi-family dwelling, where the Tenant is responsible for payment of the water charge and where the lack of such water is the direct result of the Tenant's failure to pay the water charge) lack of adequate sewage disposal rodent infestation (except if the property is a one-family dwelling) existence of flaking, loose or peeling lead paint, or lead paint which is accessible to child structural defect(s) presenting a serious and substantial threat to the physical safety of the occupants other health or fire hazard and that the Landlord was notified by Tenant of the existence of the defects or conditions by certified mail or by actual notice of the defects or conditions or by written violation notice from an appropriate state, county, municipal agency on . The Landlord has not made the necessary repairs or corrected the condition complained of in the notice to the Landlord found by the Court to exist on , , Case No. Year WHEREFORE, the Tenant requests the Court to order that the Landlord repair the defects or correct the conditions alleged above by the Tenant that the amount of the rent be abated and reduced to $ per and a rent escrow account be established by this court until the above conditions are corrected by the Landlord and approved as required that damages be awarded for breach of the covenant of quiet enjoyment or warranty of habitability in the amount of $ that the Landlord's action for non-payment of rent distress for rent, Case No. be dismissed or that judgment be entered for the Tenant. At least one Defendant is in the military service. No Defendant is in the military service and the facts supporting this statement are: Specific facts must be given for the Court to conclude that each Defendant who is a natural person is not in the military. I am unable to determine whether or not any Defendant is in military service. I solemnly affirm under the penalties of perjury and upon personal knowledge that the contents of the above Complaint are true and I am competent to testify to these matters. Date Tenant's/Attorney's Signature/Attorney I.D. Telephone Number WRIT OF SUMMONS TO THE DEFENDANT (LANDLORD): YOU ARE HEREWITH SUMMONED TO APPEAR FOR TRIAL ON at Date Time an Action of Rent Escrow a Petition for Injunction at the suit of the Tenant in the above case. Date in this Court to Answer Signature To request a foreign language interpreter or reasonable accommodation under the Americans with Disabilities Act, please contact the Court immediately. DC/CV 83 (Rev. 9/2009) American LegalNet, Inc. www.FormsWorkFlow.com