| This written statement shall be provided at the time of the initial interview unless a rental application is required by the licensee, in which case this written statement shall be provided at the time the rental application is taken. |
| Consumer Notice For Tenants |
| THIS IS NOT A CONTRACT |
| (Not to be used when licensee is subagent for landlord, agent for tenant or transaction licensee.) |
________________________(Licensee) hereby states that with respect to this property (describe property) |
| __________________________, I am acting in the following capacity: (check one) |
| (_) Owner/Landlord of the property; |
| (_) A direct employee of the Owner/Landlord; OR |
| (_) An agent of the Owner/Landlord pursuant to a property management or exclusive leasing agreement |
| I acknowledge I have recieved this Notice:______(Consumer)______ ______(date)______ |
| ______(Consumer)______ ______(date)______ |
| I certify that I have provided this Notice:______(Licensee)_______ ______(date)______ |