State of __________ Rev.

2021787

POST-PANDEMIC TENANT RENTAL REVISAL REQUEST

This Post-Pandemic “Tenant” Rental Revisal Request Notice (this “Notice”) is sent on __________,
20___ by :

Tenant(s): _________________________________________________________ (“Tenant”). Residing

at address (location) _________________________________, APT/SUITE:_____________ City of
_______________, State of _______________, _______________ .

To Landlord: _______________________ (“Landlord”) Reference Phone: ( ) __________________.

This “Notice” has been established to notify the “Landlord”_________________________ of the Post-
Pandemic “Tenant” request for a rent modification or revisal. This agreement will reestablish the rental
relationship with “Tenant” and “Landlord” as it relates to the repayment agreement set forth from this date
forward.

Moratorium Time Period: “Tenant” _______________________________ has not paid rent to

“Landlord” due to the national pandemic rent moratorium from the date of ____________ 20____ to
____________20____. “Tenant” (Pre-Pandemic) rent was $_______________ per month. The total
amount delinquent in this balance to date is $_______________.

Post Pandemic Rental Revisal Request: “Tenant” requests “Landlord” to forgive $____________ or
_________% of delinquent unpaid rent during the Pandemic Moratorium. The tenant is requesting to pay
$______________ amount in full and establish a new Post-Pandemic Rental Agreement with a monthly
rental increase of $____________ added per month to satisfy the rental revisal request.

Pre-Pandemic Rental Deposit: “Tenant” understands all deposits given to “Landlord” (Pre-Pandemic)
will be forfeited as of the date of this notice.

Post Pandemic Rental Notice: In the event of a future Pandemic and/or Moratorium of tenant’s rent (for
national reasons only), tenant agrees to pay a reduced rate of ________ % with a the total monthly
amount of $___________ to maintain cost of tenancy. With this contingency, the cost of rent will remain
the same both present and post pandemic/world event.

☐I “Landlord” agree to above terms and will revise a Post-Pandemic Rental Agreement to reflect these
changes. ____________ (initials).

☐I “Landlord” do not agree to above terms and will revise a Post-Pandemic Rental Agreement and will
submit a rebuttal statement with changes. ____________ (initials).

Landlord Rebuttal: The “Landlord” has a right to rebuttal this Post-Pandemic Tenant Rental Revisal
Request as it relates to: rental price, percentage of repayment and due-date of New Post-Pandemic
Tenant Rental Agreement.

The “Tenant understand that the “Landlord” has all rights to deny this request without question. The intent
for this request is to ONLY come to favorable terms as it relates to the continued partnership and rental

Post-Pandemic Tenant Rental Revisal Request Rev. 2021787

(previously) established between the “Tenant” and “Landlord.” This request is sent in good faith and will
be considered a legal and biding contract on behalf of the “Tenant” and “Landlord” as both parties agree.

I “Tenant” _________________________________________________ who resides on the premises of

_____________________________________________________________________ agree to this
document sent on __________________ 20_______. I will abide by this agreement with the repayment
arrangement set forth in this contract. I will complete this form and New Post-Pandemic Rental Agreement
and will send a signed/notarized copy to the “Landlord” with payment on or before the date ending
______________________ 20______.

Landlord’s Acknowledgment (initial)

(a) ________ Landlord has received copies of all information listed above.

(b) ________ Landlord agrees to the Tenant Post-Pandemic Tenant’s Rental Revisal Request.

(c) ________ Landlord does not agrees to this Post-Pandemic Tenant’s Rental Revisal Request and will
submit a rebuttal statement.

Tenant’s Acknowledgment (initial)

(d) ________ Tenant understand this contract is legal and binding as long as the Landlord is in
agreement. This request acts as a formal letter between tenant and landlord as a request for rental
revisal.

Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that
the information they have provided is true and accurate.

Witness
_______________________________________ Date _______________________________

Witness
_______________________________________ Date _______________________________

Post-Pandemic Tenant Rental Revisal Request Rev. 2021787