NOTICE TO LANDLORD OF RENT ESCROW
Name of tenant:
Name of landlord:
Name and address of escrow:
Date of deposit of rent into escrow:
Amount of rent deposited into escrow:
The following condition has been certified by a local building official to substantially endanger, impair, or affect the health or safety of a tenant:
That written notice of the conditions needing repair was provided to the landlord on ..., and ... days have elapsed and the repairs have not been made.
......................
(Sworn Signature)
RCW 59.18.115