Acknowledgment of Receipt of Statement of Tenant Rights and Responsibilities – Virginia Court

The “Acknowledgment of Receipt of Statement of Tenant Rights and Responsibilities” form serves as a formal acknowledgment that the tenant has received a summary of their rights and responsibilities under the Virginia Residential Landlord and Tenant Act (VRLTA). As of July 1, 2024, the form ensures that tenants are informed of key provisions and protections afforded to them by Virginia law. This form is critical for ensuring that tenants are aware of their legal rights and obligations, promoting transparency and accountability in landlord-tenant relationships. For more information, tenants are encouraged to visit the Virginia Department of Housing and Community Development’s website or contact their local legal aid program.

Filling out the “Acknowledgment of Receipt of Statement of Tenant Rights and Responsibilities” form is straightforward. Follow these steps to ensure all necessary information is provided accurately:

Review the Statement

1. • Before filling out the acknowledgment form, thoroughly read the “Statement of Tenant Rights and Responsibilities” provided by the landlord. This statement outlines your rights and responsibilities under the Virginia Residential Landlord and Tenant Act.

Fill in the Property Address

1. • Locate the section labeled “For property address.”
   • Write the full address of the rental property where you are the tenant.

Tenant Acknowledgment

1. • Check the Appropriate Box
     • If you have received the statement of tenant rights and responsibilities, check the box next to “Signed this acknowledgment of receipt of the statement of tenants’ rights and responsibilities.”
     • If you have not received the statement, check the box next to “Did not sign this acknowledgment of receipt of the statement of tenant’s rights and responsibilities.”

Signatures

1. • Landlord Signature
     • The landlord should sign on the line labeled “Landlord Signature.”
     • Print the landlord’s name on the line labeled “Printed Name.”
     • Enter the date the form is signed next to the landlord’s signature.
   • Landlord Agent (if applicable)
     • If there is a landlord agent, they should sign on the line labeled “Landlord Agent (if applicable).”
     • Print the agent’s name on the line labeled “Printed Name.”
     • Enter the date the form is signed next to the agent’s signature.
   • Tenant Signatures
     • Each tenant should sign on the lines labeled “Tenant Signature.”
     • Print each tenant’s name on the lines labeled “Printed Name” next to their respective signatures.
     • Enter the date the form is signed next to each tenant’s signature.

Multiple Tenants

1. • If there are multiple tenants, each tenant must provide their signature, printed name, and date of signing.

Make sure all parties have read and understood the statement of rights and responsibilities before signing the form. Retain a copy of the completed form for your records.