Landlord Estoppel Certificate Form

Landlord Estoppel Certificate Form
Provide the property, lease, rent, deposit, and contact details needed to prepare a landlord estoppel certificate.
Property and Lease Identification
Property address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Unit or suite number
Lease commencement date
MonthDayYear
Date
Lease expiration date
MonthDayYear
Date
Lease/account reference number
Parties and Rent Status
Landlord / Legal Owner Name
First NameMiddle NameLast Name
Tenant Name(s) or Entity Name
Current Monthly Base Rent Amount
Current Security Deposit Amount
Lease Status Confirmation
Certificate Request and Delivery
Requested Certificate Date
MonthDayYear
Date
Contact Person for Questions
Contact Email
example@example.com
Preferred Delivery Method
Additional Notes or Special Instructions
Should be Empty: