NOTICE TO QUIT FOR MATERIAL HEALTH / SAFETY VIOLATION(S)
To: ______________________________
(Tenant’s Name)
_____________________________
(Rental Unit Street Address)
_____________________________
(Rental Unit City/State/Zip)
You (tenant) have caused/allowed the following material health/safety violation(s):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
If you (tenant) do not correct the item(s) indicated above by _________________ (date)
at __________________ (time), your tenancy will be terminated and you will be
required to move out of the rental unit. In addition, a lawsuit may be filed to evict you.
If you correct the item(s) noted above prior to this date and time, you will not have to
move.
Today’s Date: ______________________________
Signature of party completing this notice:
__________________________________________________________________
Printed Name and Title (i.e. landlord, property manager, etc.):
___________________________________________________________________
Tenant’s Acknowledgement
On ______________ (date) at _____________ (time), tenant acknowledged receipt of
this notice.
____________________________________________________________________
Tenant Signature and Date
Certificate of Service
I certify that I personally served this notice on the following person:
_____________________________________________________________________
OR
I mailed the notice to the tenant via certified or registered mail.
Date: __________________________
Signature of person attempting service:
___________________________________________________________________
Printed Name:
___________________________________________________________________
click to sign
signature
click to edit