NOTICE TO QUIT FOR MATERIAL HEALTH/SAFETY VIOLATION
To: ______________________________
(Tenant’s Name)
_____________________________
(Rental Unit Street Address)
_____________________________
(Rental Unit City/State/Zip)
You (tenant) have committed 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 items noted above prior to the above 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 attempted to make personal service on the tenant(s) named above but no one
appeared. I believed tenant(s) to be absent, so I left the Notice at the rental unit in a
conspicuous place.
OR
Tenants were served by registered or certified mail.
Date: __________________________
Signature of person attempting service:
___________________________________________________________________
Printed Name:
___________________________________________________________________
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