Uninhabitable conditions at  __________________________________
                                                                        (address)

Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         
Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         
Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         
Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         
Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         
Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         
Item #_____
Where it is What is it When did it start How does it impact living
       
Told landlord Landlord response Repaired Cost Evidence
         

Notes: