Appendix F:  Sample Repayment Plan (before a court case is filed)
REPAYMENT PLAN

Tenant Name:											
Rental Unit Address:										
												
Landlord/Owner Name:										
Landlord/Owner Address:										
													
	The above-named Tenant and Landlord/Owner enter into the following agreement to permit the Tenant to repay past due rent. The Tenant and Landlord/Owner agree that the past due amount to be repaid consists of:  
□ 	rent: $			, 
□	late fees: $			,
□	other penalties: $			, and  
	Please provide description of other penalties: ____________________
□	other: $			 
Please provide description: _______________________________

for a grand total of $________________. 

	Tenant agrees to pay $			 each MONTH / WEEK or BI-WEEKLY (circle one) beginning on ______				, 20__, until the above total is repaid in full. Tenant further agrees to keep current on rent due pursuant to the lease terms. In addition, Landlord/Owner agrees not to file a claim for possession for possession of Tenant’s rental property based on the past due amount above unless: (1) Tenant defaults on the Repayment Plan, and (2) Landlord/Owner has provided Tenant with a ten (10) day notice to bring payments current under the Repayment Plan. 
	Tenant may tender payments under this Repayment Plan in the following way(s): 
																																							
If there is a failure to comply, parties may file an action before the court.
Tenant and Landlord/Owner enter into this agreement freely and voluntarily, under his/her/their own will and volition. 

Tenant							Landlord/Owner

													
Printed Name						Printed Name

Date							Date