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