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Form #5APD : PORTLAND NOTICE OF TERMINATION

QUALIFYING LANDLORD REASON

Please Note: This version of the "Portland Notice of Termination Qualifying Landlord Reason" form is for use with Rental Properties within the City of Portland, Oregon ONLY.
To switch to the standard Oregon State version of this form click the button below.

 

Required entries are indicated by blue icons or *

et al (and all others)




 
Owner/Agent hereby serves you 90 days' notice of the termination of your tenancy for a Qualifying Landlord Reason:
 
 
 
 
 
Your tenancy is being terminated and you must vacate the Rental Unit you now occupy no later than 11:59 p.m. (end of day) on
 
 
The facts which support this notice are:
 
 
RELOCATION FEE - If the Owner of the Dwelling Unit has an ownership interest in more than four residential Rental Units subject to ORS Chapter 90, a Relocation Fee of one month’s Periodic Rent is required to be paid to the Tenant(s) at the time this notice is delivered. Termination of tenancy for a Qualifying Landlord Reason for rental properties located within the Portland city limits may also require a City of Portland Relocation Fee, unless exempt. If required the Fee varies based on the number of bedrooms, and is required to be paid within 45 days of service of the Notice of Termination. Both Fees must be paid at the time prescribed by law; however, the required Portland Fee may be reduced by the amount of the state Fee previously paid. Visit: https://www.portland.gov/phb/rental-services/renter-relocation-assistance to learn more.
 
 

If your Termination Date is not at the end of your Rental Period, and you have not paid a Last Month’s Rent Deposit, you will owe Rent for a partial month.

Your prorated Rent from
 
 through
 
 is
 

If you did pay a Last Month’s Rent Deposit that exceeds the Date of Termination, the Landlord is required to account for those funds separately at the time of Security Deposit Reconciliation within 31 days of surrender of possession of the Dwelling Unit.

 

Please Note: Signature field must be filled in and signed after printing.

Owner/Agent Signature:   Date:
 

The following forms are required to be included with this form by the City of Portland, OR

 
Portland Housing Bureau Letterhead


Rental History Form Required Under Portland City Code Title 30.01.087.F

Within the City of Portland, a landlord is required to provide this completed form to a Tenant within 5 business days of receiving a request from a tenant, receiving notice from the Tenant of intent to terminate the tenancy, or when a Landlord gives notice of intent to terminate a tenancy. This form may be transmitted in digital or paper form.

Tenant Information

Tenant Name:
 
 

Landlord Information

Landlord Name:
 
Contact Information:
 

Residency Information

Address:
 
Move-in Date:
 
Move-out Date (if known):
 
 

Please Note: Signature field must be filled in and signed after printing.

 
Landlord Signature   Date

Rental History Form
Form 30.01.087.F (Valid through 12/31/2022)
Page 1 of 3

Equal Housing Opportunity
 

Previous Two-Year Rent Payment History (A payment ledger detailing the same information may be used to meet the requirements of this form)

COVID-19 Guidance: A lanlord may choose to indicate 'Deferred' on months where rent payment has been deferred under local, state or federal eviction moratoria

 

Note: Entering or changing the month, year and paid Rent information for the first entry will automatically populate the remaining entries.
The remaining entries
can then be adjusted as needed.
The first entry
should be the oldest, but no more than two years back.

Month:
 
Year:
 
Paid ?
 

Month:
 
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Paid?
 

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Paid?
 

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Paid?

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Paid?
 

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Paid?
 

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Month:
 
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Paid?
 

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Paid?
 

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Paid?

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Paid?

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Paid?

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Paid?
 

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Paid?
 

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Paid?
 

Month:
 
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Paid?
 

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Paid?
 

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Paid?
 

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Paid?
 

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Paid?
 

Month:
 
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Paid?
 

Rental History Form
Form 30.01.087.F (Valid through 12/31/2022)
Page 2 of 3

 
Equal Housing Opportunity
 

If you believe you have been harassed or discriminated against because of your race, color,
national origin, religion, gender, familial status, disability, marital status, source of income,
sexual orientation including gender identity, domestic violence, type of occupation,
or age over 18 seek legal guidance regarding your rights under Fair Housing law.

 

For translation or interpretation, please call 503-823-1303
TTY at 503-823-6868 or Oregon Relay Service at 711

 

503-823-1303: Traducción e interpretación | Chuyển Ngữ hoặc Phiên Dịch | 翻译或传译
Письменныйили устный перевод | 翻訳または通訳| Traducere sau Interpretare
번역 및 통역 | Письмовий або усний переклад | Turjumida ama Fasiraadda
ةيوفشلاو ةيريرحتلا ةمجتر لا | ການແປພາສາ ຫຼື ການອະທິ ບາຍ

 

This requirement is in addition to any other rights and responsibilities set forth in the Oregon
Residential Landlord and Tenant Act under Oregon Revised Statute Chapter 90, and Portland
Landlord-Tenant Law under Portland City Code Title 30.

 

The information in this form is for educational purposes only. You should review appropriate
state statute, city code, and administrative rule as necessary. If you need legal guidance, or are
considering taking legal action, you should contact an attorney.

Rental History Form
Form 30.01.087.F (Valid through 12/31/2022)
Page 3 of 3


Portland Notice of Additional Protections

 
et al (and all others)

 

30.01.085 Portland Renter Additional Protections.
(Added by Ordinance No. 187380; amended by Ordinance Nos. 188219, 188519, 188558, 188628, 188849, 189421 and 189726, effective November 1, 2019.)

 
 

Portland Notice of Security Deposit Rights

 
et al (and all others)

 

30.01.087 Security Deposits; Pre-paid Rent. (Added by Ordinance No. 189581; amended by Ordinance Nos. 189715 and 190064, effective August 21, 2020.) In addition to the protections set forth in the Oregon Residential Landlord and Tenant Act (“Act”) and in Sections 30.01.085 and 30.01.086, the following additional Tenant protections regarding Security Deposits apply to Rental Agreements for a Dwelling Unit covered by the Act. For purposes of this Section, unless otherwise defined in this Section or elsewhere in Chapter 30, capitalized terms have the meaning set forth in the Act.


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