CDC Eviction Moratorium Declaration Form

This is a step by step interview to complete the required declaration form to stop an eviction under the CDC’s Eviction Moratorium. The moratorium is in place from September 4, 2020 to December 31, 2020.

If there is an eviction filed against you in court, you should file this form with the court where the eviction is filed. If your landlord has filed an eviction against you in court, you will have received a court document called a "Summons and Complaint." 

If you are behind on rent but have not had an eviction filed against you in court, you should give a copy of this form to your landlord. Do not file with the court if an eviction has not been filed against you.

The form assistant interview will give you the correct directions and version of the form based on your eviction status.

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After You Finish

Learn what to do when you have finished filling out this form.

If you have not had an eviction filed against you in court

 

Sign the form and make copies.

Carefully review, sign and date the form. Every adult that is on the lease must sign and date the form. Fill out the “Proof of Service” section with the information about when, how and where you will deliver the form to the landlord. Make at least two copies of the signed form.

Deliver a copy of the form to your landlord.

Mail, email or deliver by hand one of the copies of the form. Keep the original version of the form for your records.

If you have had an eviction filed against you in court

 

Sign the form and make copies.

Carefully review, sign and date the form. Every adult that is on the lease must sign and date the form. Fill out the “Proof of Service” section with the information about when, how and where you will deliver the form to the landlord. Make at least four copies of the signed form.

File the form at the court where your eviction was filed.

Go to the clerk’s office at the court where your eviction was filed. Give the clerk the original form and the copies. The clerk will timestamp the original and the copies, and give you back the copies that they do not need.

“Serve” the form.

Next, you need to "serve" one of the copies on your landlord or your landlord's attorney. If you have enough time before your hearing, you can "serve" the form by sending it in the mail. If you are filing on the day of your hearing, you can hand it to your landlord or their lawyer before the hearing starts. Keep at least one of the timestamped copies for your records.

Go to your eviction hearing.

At the hearing, make sure you bring your time-stamped copy of the form. Wait for your case to be called, then tell the judge that you filed your statement. You should be prepared to prove that you are eligible for the moratorium. Bring the following with you:

  • Copies of your applications for rent assistance
  • Pay stubs, bank statements or proof of receipt of a stimulus check
  • Documentation showing you lost your job, were laid off or had a cut in your hours
  • Proof, like receipts, of any rental payments you have made since your income was lost

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