Hirsch & Levy LLC - Fill Out Intake Form

BEGIN THE EVICTION PROCESS
Kindly fill out the Intake Form to start an eviction. Please provide us with all supportive documentation as soon as possible. Upon receipt, an attorney shall call you to follow up. Fields marked in RED are required.

LANDLORD INFORMATION

First Name

Last Name

Company

Street Address 1

Street Address 2

City

State

Zip Code

Phone

Fax

Email Address

Are you a current Hirsch, Levy & Fountain client?
No Yes

If you are not a current client, how were you referred to us?

PROPERTY INFORMATION

Record Title Owner (exactly as on deed to the eviction premises)

Street Address

City

State

Zip Code

Apartment/Floor

Number of Units

Does the State Marshal need to contact you to gain access to the subject premises?
No Yes

Mortgage Information - Is the property secured by Federal Financial Assistance?

TENANT INFORMATION
Adult occupants 18 years of age and older.

Tenant #1

add a second tenant

Tenant's Phone Number

Any prior Notices to Quit Possession OR any correspondence in writing sent to tenant?
No Yes

Reason For Eviction

List any Outstanding Housing/Health Code Violations

List Any Outstanding Tenant Required Repairs

Do any occupants have a criminal record, mental illness or exhibit violent behavior? If yes, please explain (Necessary information for Marshal).

LEASE INFORMATION

Lease Type?
Written Oral

Rent Due On

Total Monthly Rent $

Government Subsidy and/or Federal/State Rental Assistance

HUD/Section 8 Portion

Housing Authority/Agency (Specify name below)

Tenant Portion

Move In Date

Total Amount Owed

Does the State Marshal need to contact you to gain access to the subject premises?
No Yes

FILE ATTACHMENTS

Please include any files such as lease, notices you feel will help us evaluate your case

Disclaimer: This web site has been developed by the firm of Hirsch & Levy, LLC. Transmission and receipt of information from our website does not constitute an attorney-client relationship. Pursuant to the Rules of Professional Conduct which govern the practice of law in Connecticut and related laws of other jurisdictions, the material contained within this web site may be considered advertising. If you communicate with us by e-mail in connection with a matter for which we do not already represent you, your communication may not be treated as privileged or confidential. Also, we will not deem such a communication as establishing an attorney-client relationship between you and Hirsch & Levy, LLC. Such a relationship can only be established by Hirsch & Levy, LLC and upon proceeding through our conflicts of interest procedure. If and when you receive a retainer agreement from us to handle your legal matter, you will be our client and we may then exchange information. If you seek our advice, please contact us directly at (203) 336-3144. Communication by e-mail is not secure and you should avoid sending sensitive or confidential information by email unless it is adequately protected from interception and tampering. Personal information submitted to Hirsch & Levy, LLC is protected pursuant to Section 42-471 Connecticut General Statutes. Any intercepted or misdirected communication may lose the protection of attorney-client privilege.

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