APPLICATION BY TENANT TO DEPOSIT RENT WITH THE CLERK Bowling Green Municipal Court, Bowling Green, Ohio TO THE CLERK OF COURT: No. ___________________ NAME AND ADDRESS OF TENANT: NAME AND ADDRESS OF LANDLORD: ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ In accordance with Section 5321.07(B)(1) of the Ohio Revised Code, I hereby make application to deposit all rent that is due and hereafter becomes due the landlord, with the clerk of the captioned court. _____/_____/_____ Signature ________________________________________ INFORMATION IN SUPPORT OF APPLICATION: The undersigned says the following facts are true to the best of his/her knowledge: 1) Notice was given in writing to landlord as prescribed in Section 5321.07(A) [copy of this notice attached]. 2) Service was made on landlord as follows: _______________________________________________________ 3) That payment of my rent due under the rental agreement is current and that my rent is due _______________ in the amount of $_______________. 4) Landlord did did not supply me with a notice in writing that the landlord was a party to any rental agreement which covered three or fewer dwelling units (Section 5321.07(C)). APPLICANT STATES UNDER THE PENALTIES OF PERJURY AND FALSIFICATION THAT THE ABOVE INFORMATION AND APPLICATION HAS BEEN READ AND IS BELIEVED TO BE TRUE. _____/_____/_____ Signature _________________________________________ NOTICE TO LANDORD OR AGENT Please be advised that the above applicant has this date deposited a rental payment with this Court under the provisions of Section 5321.07 of the Ohio Revised Code. Said deposit has been placed in the Rent Escrow Account of the Civil Division and may be released to you upon your application and satisfaction of the provisions of Section 5321.09 of the Ohio Revised Code. _____/_____/_____ ___________________________________________ Mary A. Cowell, Clerk of Court American LegalNet, Inc. www.USCourtForms.com