LAKEWOOD MUNICIPAL COURT APPLICATION FOR RELEASE OF RENTAL ESCROW Sec. 5321.09(A)(1) N0. ________________________ TO: THE CLERK OF COURT The undersigned respectfully requests that the Clerk of the Lakewood Municipal Court release certain Rental Escrow payment(s) made to said Clerk by: ________________________________________ Tenant ________________________________________ Street No. ________________________________________ City, State, Zip This request is being made under the provisions of Section 5321.09 (A)(1) R.C. and the applicant says that the condition contained in the notice given pursuant to Division (A) of Section 5321.07 R.C. has been remedied and that the Tenant has given written notice to the Clerk that said condition has been remedied. __________________________________________________ Landlord or Agent __________________________________________________ Date ____________________________________________________________________________________________________________ AGREEMENT OF TENANT TO RELEASE ESCROW FUNDS I hereby agree to the release of Rental Escrow funds held by the Clerk of the Lakewood Municipal Court to __________________________________________________. Said funds having been paid into Court in lieu of payment of rent to my landlord. The condition(s) in the notice given pursuant to Section 5321.07 (A) R.C. having been remedied. ____________________________________ Tenant Street No. _________ Date __________________________________________________ __________________________________________________ City, State, Zip American LegalNet, Inc. www.FormsWorkFlow.com