NOTICE OF INTENT TO FILE A COMPLAINT FOR SUMMARY EJECTMENT (Failure to Pay Rent)
(Real Property Article § 8-401(c))
FROM:
TO
:
T
HIS IS NOT A NOTICE OF EVICTION
An action for repossession of the property may be initiated if the total amount listed below is not paid within 10 days
after the landlord provides this notice. You have a legal right to dispute the charges.
The past-due rent and late fee amounts claimed by the landlord to be due are:
$ rent for the ☐ months ☐ weeks to
$ *late fees for the ☐ months ☐ weeks to
*Due pursuant to the terms of your lease.
$ *TOTAL
*Does not include other charges related to utilities, services, other fees, fines, and court costs.
At your request, the landlord must promptly provide you an itemized accounting of debits and credits (rental ledger) showing
how
the landlord came up with the amount they claim you owe.
LANDLORD/AGENT CONTACT INFORMATION
(if different from above)
Phone Number: E-mail:
Address:
DATE AND METHOD OF PROVIDING NOTICE
This notice is being provided to the tenant by the landlord on by:
☐ First-class mail – mail service certificate of mailing ☐ Affixed to the door of the leased property
☐ Delivered electronically by: ☐ E-mail message ☐ Text message ☐ Electronic tenant portal
DC
-CV-115 (Rev. 07/01/2023)
RESOURCES FOR TENANTS AND LANDLORDS
• Tenants may qualify for a free lawyer through the Access to Counsel in Evictions program. Call 211 for a referral or
visit legalhelpmd.org for more information.
• Alternative Dispute Resolution (ADR) Office mdcourts.gov/district/adr/home
o Mediation is a conversation between the landlord and the tenant that is facilitated by a mediator.
Topics discussed in mediation may include: the amount of rent that is due and how and when it might
be paid; a move out date and conditions of moving out; modifying, extending or terminating the lease;
and/or, other topics important to the landlord and to the tenant. Mediation is available before a
nd
after a failure to pay rent case is filed in the District Court of Maryland. To request mediation, visit
mdcourts.gov/district/adr/landlordtenant.
• Rental assistance may be available to both Landlords and Tenants. Visit mdcourts.gov/legalhelp/housing.
• Speak with a lawyer for free at a Maryland Court Help Center. Get legal advice, help with forms, and referrals to rental
assistance programs. Visit mdcourts.gov/helpcenter or call 410-260-1392.
Date
Date
Signature of Landlord/Attorney/Agent
Attorney Number
Telephone
Landlord/Agent
Address
City, State, Zip
E-mail Address
Tenant (2)
Tenant (4)
Tenant (1)
Tenant (3)
Address
Telephone
City, State, Zip
E-mail Address(es)