Pest Infestation Disclosure

Property Address:

Landlord/Property Manager Name:

Tenant Name(s):

Disclosure:

I hereby disclose that to the best of my knowledge, the property has had a pest infestation or treatment within the past 12 months.

To my knowledge, the property has not had a pest infestation or treatment within the past 12 months.

If infestation or treatment occurred, please describe pest(s) and date(s):

Additional Comments:

Landlord/Manager Signature: Date:

Tenant Signature: Date: