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The City of Portland, Oregon

Portland Housing Bureau

Solving the unmet housing needs of the people of Portland.

Phone: 503-823-2375

fax: 503-823-2387

421 SW 6th Avenue, Suite 500, Portland, OR 97204

More Contact Info

 


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Notice of Relocation Payment Form

1. Rental Dwelling Unit Information
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e.g. 1120 SW 5TH or 5TH AND MAIN
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2. Applicant Information (will be point of contact)
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e.g. 1120 SW 5TH or 5TH AND MAIN
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3. Ownership Information

Please provide information on the ownership structure of the Dwelling Unit for which you paid a Relocation Assistance Payment.

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4. Payment Trigger

Please provide the basis on which you made the Relocation Assistance Payment.

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5. Unit Size

Please provide the bedroom count of the unit.

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Form Certification

I hereby certify that the above information, to the best of my knowledge is true and complete. I understand that I must inform the Portland Housing Bureau immediately and in writing of any changes. I understand that a Landlord that fails to comply with any of the requirements set forth in PCC 30.01.085 shall be liable to the Tenant for an amount up to 3 times the monthly Rent as well as actual damages, Relocation Assistance, reasonable attorney fees and costs.

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