Attachments
To help verify the 14-day notice to quit for domestic violence, the tenant must attach one of these documents to the notice[1]:
- A copy of a restraining order (or other type of protective order).
- A copy of an official written report by law enforcement confirming a report of domestic violence, sexual assault, stalking, human trafficking, or elder abuse was filed by the tenant.
- Documentation from a qualifying third party (health practitioner or counselor) indicating the tenant has sought assistance for physical or mental injuries sustained from any of the above-mentioned acts of violence.
Sample
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CALIFORNIA 14-DAY NOTICE TO TERMINATE LEASE (DOMESTIC VIOLENCE)
Date: [MM/DD/YYYY]
To: [LANDLORD NAME]
[LANDLORD ADDRESS]
I, [TENANT NAME], am a tenant at [RENTAL ADDRESS]. I am, or a family member who lives in my home is, a victim of domestic violence, sexual assault, stalking, human trafficking, elder abuse, or dependent adult abuse. Pursuant to California Civil Code § 1946.7, this letter serves as my 14-day notice that I will end my rental agreement on [MM/DD/YYYY].
For documentation of the abuse, I have enclosed (one of the following):
- A copy of a temporary restraining order/emergency protective order/protective order issued within the last 180 days on behalf of myself or a family member who lives in my home.
- A copy of a police report, issued within the last 180 days, showing that I, or a family member living in my home, was the victim of an act of domestic violence, sexual assault, stalking, human trafficking, elder abuse, or dependent adult abuse.
- Documentation from a qualified third party (such as a doctor, psychologist, licensed clinical social worker, or domestic violence or sexual assault counselor) verifying that I am, or a family member in my home is, a victim of domestic violence, sexual assault, stalking, human trafficking, elder abuse, or dependent adult abuse.
Tenant Signature: _____________________________
Printed Name: _____________________________
STATEMENT BY TENANT
I, [TENANT NAME], state as follows: I, or a member of my household or immediate family, have been a victim of [DESCRIBE INCIDENTS].
The most recent incident happened on or about [MM/DD/YYYY].
The incidents were committed by the following person(s), who have the following physical description(s): [NAME + DESCRIBE ABUSER(S)].
Tenant Signature: _____________________________
Printed Name: _____________________________
Date: ______________
QUALIFIED THIRD-PARTY STATEMENT
Third Party Name: [THIRD PARTY NAME]
Third Party Address: [THIRD PARTY ADDRESS]
Third Party Number: [THIRD PARTY PHONE NUMBER]
Check and complete one of the following:
☐ – I meet the requirements for a sexual assault counselor.
☐ – I meet the requirements for a domestic violence counselor.
☐ – I meet the requirements for a human trafficking caseworker.
☐ – I am licensed by the State of California as a [TYPE OF MEDICAL/COUNSELOR LICENSE], and I am licensed by [STATE LICENSING ENTITY] and my license number is [LICENSE NUMBER].
The person who signed the Statement By Tenant above stated to me that he or she, or a member of his or her household or immediate family, is a victim of [DESCRIBE INCIDENTS]. The person further stated to me the incident(s) occurred on or about the date(s) stated above. I understand that the person who made the Statement By Tenant may use this document as a basis for terminating a lease with the person’s landlord.
Third Party Signature: _____________________________
Printed Name: _____________________________
Date: ______________