Fillable Letter to Terminate Lease Due to Domestic Violence, (Civil Law Self-Help Center)

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Letter to Terminate Lease Due to Domestic Violence, (Civil Law Self-Help Center)

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Letter to Terminate Lease Due to Domestic Violence, Harassment, Stalking, or Sexual Assault
(Insert your name, address, and telephone number:)
(Date)
VIA CERTIFIED MAIL, RETURN RECEIPT REQUE
STED
(Insert name and address of landlord:)
RE: NOTICE OF TERMINATION OF RENTAL AGREEMENT DUE TO DOMESTIC VIOLENCE, HARASSMENT,
STALKING OR SEXUAL ASSAULT
Dear Sir or Madam:
I am a tenant or cotenant on the rental property located at
(insert property address) ____________________________________
___________________________________________________________________________________________________
This letter is to inform you that I am terminating my rental agreement pursuant to Nevada Revised Statute 118A.345. That
law allows a victim of domestic violence, harassment, stalking, or sexual assault to terminate a rental agreement by giving
the landlord written notice of termination. The termination becomes effective thirty days after the written notice or at the end
of the current rental period, whichever occurs sooner. The termination of my rental agreement will be effective on (insert
effective date) ____________________________________________.
A brief description of my reason for the termination of my rental agreement is as follows:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
_________________________________________. The actions, events, or circumstances described above, which resulted
in me (or a cotenant or household member) becoming a victim of domestic violence, harassment, stalking, or sexual assault
occurred within the last ninety days.
(Rev. 9/22/17)
© Civil Law Self-Help Center
NOTICE OF TERMINATION OF RENTAL AGREEMENT DUE TO DOMESTIC VIOLENCE, HARASSMENT, STALKING OR SEXUAL
ASSAULT
Page 2
(Rev. 9/22/17)
Nevada law requires that you not provide any information concerning my whereabouts to an "adverse party
1
," specifically
(insert name of adverse party) ______________________________________________________________________________.
I
(check one box)  am /  am not requiring that you install a new lock onto my dwelling. If I am requiring a new lock, I agree
to pay the cost of installation. If I am requiring a new lock, you are required under Nevada law to (a) refuse to provide a key
for the new lock to an adverse party, and (b) refuse to provide an adverse party access to my dwelling to reclaim property
unless a law enforcement officer is present.
Enclosed with this letter of termination is one of the following
(check one):



A copy of a protection order against domestic violence, harassment, stalking, or sexual assault that was issued to me (or
a cotenant or household member);
A copy of a written report from a law enforcement agency indicating that I (or a cotenant or household member) notified
the law enforcement agency of domestic violence, harassment, stalking, or sexual assault; or
A written affidavit signed by a qualified third party
2
in his or her official capacity, stating that I (or a cotenant or
household member) am a victim of domestic violence and identifying the adverse party.
Under Nevada law, I am liable for rent and any other outstanding obligations only through the date of termination stated
above. You may not withhold any security deposit for the early termination of my rental agreement. You also may not
disclose, describe, or characterize the termination of my rental agreement as an "early termination" to any prospective
landlord.
Sincerely,
(Sign you name)
(Print your name)
1
An "adverse party" is a person who is named in a protection order against domestic violence, a written report from a law enforcement agency, or a written statement from
a qualified third party and who is alleged to be the cause of the early termination of a rental agreement.
2
A "qualified third party" is (1) a physician licensed to practice in Nevada; (2) a psychiatrist licensed to practice medicine in Nevada and certified by the American Board of
Psychiatry and neurology, Inc., or the American Osteopathic Board of Neurology and Psychiatry of the American Osteopathic Association; (3) a psychologist licensed to
practice in Nevada; (4) a social worker licensed to practice in Nevada; (5) a registered nurse holding a master's degree in the field of psychiatric nursing and licensed to
practice professional nursing in Nevada; (6) a marriage and family therapist or clinical professional counselor licensed to practice in Nevada pursuant to chapter 641A of
NRS; (7) any person employed by an agency or service which advises persons regarding domestic violence or refers them to persons or agencies where their request and
needs can be met and who is licensed to provide health care pursuant to title 54 of NRS, or is a member of the board of directors or serves as the executive director of an
agency or service which advises persons regarding domestic violence or refers them to persons or agencies where their request and needs can be met; or (8) any member
of the clergy of a church or religious society or denomination that is tax exempt, who has been chosen, elected or appointed in conformity with the constitution, canons,
rites, regulations or discipline of the church or religious society or denomination.
© Civil Law Self-Help Center
(Rev.1, 9/22/17)
© Civil Law Self-Help Center
AFFIDAVIT OF QUALIFIED THIRD PARTY IN SUPPORT OF
NOTICE OF TERMINATION OF RENTAL AGREEMENT DUE TO DOMESTIC VIOLENCE
Name of qualified third party: ___________________________________________________________________________
Qualified third party's organization/affiliation, if any: _________________________________________________________
I, and/or
(insert name of cotenant or household member if applicable) ________________________________________________, am
a victim of domestic violence, meaning an act described in NRS 33.018.
The following is a brief description of the incident(s) constituting domestic violence:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
The incident(s) that I described above occurred on the following date(s) and time(s), and in the following locations:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
The incident(s) that I described above were committed by the following person(s):
___________________________________________________________________________________________________
I state under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct.
Dated this _____ day of _____________________, 20__, at (insert city) ___________________________, Nevada.
________________________________________________
(Signature of tenant, cotenant, or household member)
I verify that the person whose signature appears above was a victim of domestic violence and that the person informed me
of the name of the adverse party, meaning the person named in a protection order against domestic violence, a written
report from a law enforcement agency, or otherwise alleged to be the cause of the early termination of the rental agreement.
Dated this _____ day of _____________________, 20__, at (insert city) ___________________________, Nevada.
________________________________________________
(Signature of qualified third party)
SUBSCRIBED AND SWORN to before me this
____ day of ___________________________, 20____,
by _______________________________________________.
__________________________________________________
NOTARY PUBLIC in and for the County of _______________,
State of _______________.
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Letter to Terminate Lease Due to Domestic Violence, (Civil Law Self-Help Center)

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Completed 8 January 2021

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