TENANT QUESTIONNAIRE

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LANDLORD / TENANT DISPUTES

TENANT QUESTIONNAIRE

1. What is the address of the apartment, condominium, hotel or
house which you are complaining about?

_______________________________________________

Apartment / Unit Number ______ House? ______

______________________________ ________________
City Zip Code

2. How many apartments are in the building you are
complaining about? _________

3. Did the landlord live in the building you are complaining
about? Yes ___ No ___

4. What is your address now?

_______________________________________________

Apartment / Unit Number ______ House? ______

______________________________ _________________
City Zip Code

5. What is your home phone number? (_____) - _____ - ________

6. What is your work phone number? (_____) - _____ - _________

7. Are you over the age of 18 years old? Yes ______ No ______

8. Did you have any co-tenants at the address which is the
subject of this complaint? Yes ___ No ___

9. If you had any co-tenants, what were their names?

_____________________________________________________________

10. How much was your security deposit? - $_______________

11. If you paid your security deposit by check, do you have the
check? Yes ___ No ___

12. If you paid your rent by check, do you have the checks?
Yes ___ No ___

13. When did you pay the security deposit to the Landlord?

At the time I moved in. ____ After I moved in. ____

Before I moved in. ____ Date paid? __________________, ______

14. Did you receive a separate receipt for the security
deposit? Yes ___ No ___

15. If you received a receipt, do you have it? Yes ___ No ___

16. Did you ever receive interest on your security deposit from
your landlord? - Yes ____ - No ____

17. When did your landlord pay the interest to you or credit
you with the interest off of your rent?

Yearly ____ Never ____

18. Was your lease written or oral? Written ______ Oral _____

19. Do you have a copy of your lease? Yes ___ No___

20. When did your lease begin? _____________, _____

21. When did your lease end? _____________, _____

22. Did your Landlord return any part of your security deposit
to you? Yes ___ No ___ If so, how much? $__________._____

23. If your Landlord returned any part of your security
deposit to you, when did this happen? Give the date to the
best of your memory? ________________________, __________

24. If your landlord did not return the entire security deposit
to you, did the landlord send you a written letter
explaining the deductions? Yes ___ No ___

25. If there were any deductions from your security deposit did
the landlord provide you with receipts for the deductions?
Yes ___ No ___ Do you have the copies? Yes ___ No ___

26. Did your Landlord promise to do any repairs to your
apartment before or after you moved in? Yes ___ No ___

27. If the Landlord promised to do any repairs before you moved
in did the Landlord ever do the repairs? Yes ___ No ___

28. What repairs which were promised by the Landlord were not
completed?

__________________________________________________________

29. Were there problems with your apartment? Yes ___ No ___

30. What were the problems? ___________________________________

_________________________________________________________________

31. Did you notify the Landlord in writing of the problems?
Yes ___ No ___

32. If in writing, do you have a copy? Yes ___ No ___

33. If you did notify the Landlord, when did you do this?

Before your moved in ____ After you moved in ____

34. Did you pay all of the rent including the last month?
Yes ___ No ___

35. Did you tell the Landlord when you were going to move out?
Yes ____ No ____ In writing? Yes ___ No ___

36. Was an inspection conducted by the Landlord before you
moved out? Yes ____ No ____

37. Did you photograph the apartment before you moved out?
Yes ___ No ___

38. Did you do any damage to the apartment while you lived
there or while you were moving out? Yes ____ No ____

39. Describe any damage you caused? _________________________

_________________________________________________________________

40. Did you have any pets in the apartment? Yes ___ No ___

41. How much was your monthly rent? $_________.____

42. Did you leave the apartment because your lease was over?
Yes ___ No ___

43. If you left for other reasons, what were they? ___________

______________________________________________________________

44. Did the Landlord take you to court to evict you or throw
you out?

I was evicted by a court order ______

I was thrown out without a court order ______

I do not know if there was a court order or not ______

45. If you were evicted, did you go to court? Yes ____ No ____

46. If you were evicted, what was the court date? ______, 199__

47. Were the appliances which came with the apartment in
working order? Yes ____ No ____

48. What appliances, if any, were not working?
Stove top _____ Refrigerator _____ Oven ____

Other(s) ________________________________________________________

49. Where do you work? Unemployed ______

Employer's name _______________________________________________

Employer's address ____________________________________________

50. How long have you worked there? __________________________

51. What do you do at your job? ________________________________

52. Was a short form copy of the City of Chicago Landlord -
Tenant ordinance printed on or attached to your lease?
Yes ___ No ___

53. Did your Landlord notify you of any building violations
from the City of Chicago before you moved in?
Yes ____ No ____

54. Do you know if there were any building code violation
notices served on the Landlord while you were living in the
apartment? Yes ____ No ____

55. Did the Landlord keep up the condition of the building?
Yes ____ No ____

56. If not, describe the problems with the building? ________

_____________________________________________________________

_____________________________________________________________.

57. Did the Landlord keep the electric, gas and water utilities
in working condition? Yes ___ No ___

58. Did your landlord ever come into your apartment without
notifying you about it in advance? Yes ___ No ___

59. If your landlord entered your apartment without permission,
when did this happen? __________________________________________

60. If there was a late payment charge in your lease, how much
was it? $__________.___

61. Did the landlord ever lock you out of your apartment?
Yes ___ No ___

62. What was the name of your landlord?

_________________________________________________________________

Address ________________________________________________________

63. Was the landlord represented by an agent? Yes ___ No ___

64. If yes, what is the name of the agent? ______________________

Address ________________________________________________________

65. Was the property sold during your tenancy? Yes ___ No ___

66. If it was sold, were you notified that your security
deposit was transferred to the new landlord?
Yes ___ No ___

67. Do you have a copy of the notice? Yes ___ No ___

68. Have you ever given anyone any statements about this
complaint? Yes ___ No ___

69. Do you know of any witnesses to your complaints?
Yes ___ No ___

70. If there are any witnesses, who are they? ________________

_______________________________________________________________

71. Will the witnesses testify for you? Yes ___ No ___

72. For the purpose of determining your ability to be impeached
as a witness in litigation, I need to know if you ever been
arrested as an adult? Yes ___ No ___

73. Have you ever been convicted of a crime as an adult?
Yes ___ No ___

74. In order to prevent any problems with the immigration
service, I need to know if you are a U. S. citizen?
Yes ___ No ___

75. If you are not a citizen, what is your immigration status?

______________________________________________________________

76. Have you ever consulted another attorney about this
problem? Yes ___ No ___

77. If so, what is the name of the attorney? ___________________

78. If so, why do you want to change attorneys? ______________

________________________________________________________________

______________________________ ____________________________
Your Signature Print your name

Date of Signature ______________, 200__

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