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Rent Payment Ledger

TENANT: ____________________ MONTHLY RENT AMOUNT: _______________ DATE DUE: _______________

UNIT ADDRESS: ___________________________________________________________________________________

MONTH/YEAR DATE OF RENT AMOUNT AMOUNT NOT LATE FEES COMMENTS


(MM/YY) PAYMENT RECEIVED RECEIVED

TOTAL RENT $ TOTAL RENT $ TOTAL $


RECEIVED NOT RECEIVED LATE FEES
[ ] Check this box if you confirm that the tenant will occupy this unit for the next 3 months, if applicable to receive
payments for Future Rent.

NOTES: ___________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Owner/Landlord/Payee Signature: ____________________ Date Signed: _______________


Miami Dade County – Emergency Rental Assistance Program 2.4

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