Notice of Intent to Vacate

Tenant to Complete

Name(Required)

First Last

I am submitting a thirty day Notice of Intent to Vacate my current unit located at :(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

It is my intention to vacate completely, no later than(Required)

Consent(Required)

I understand that to be eligible to have my subsidy transferred to a new unit, the following conditions must be met:
1. I must leave my current unit owing no monies for unpaid rent, utilities and/or damages.
2. Subsidy will not begin at my new unit until it has been confirmed that all my belongings have been removed from old unit.
3. Items I am not moving with me, including all trash, have been properly disposed of.
4. The unit is in its original condition minus normal wear and tear.
5. The keys have been returned to the landlord.
6. If you are responsible for the Water Bill, please attach a copy when submitting this form.
7. I understand it will be my responsibility to pay for any days I remain in the old unit after taking possession of a new unit.

Tenant Phone Number(Required)

Landlord to Complete

I ACKNOWLEDGE THAT THE ABOVE TENANT IS VACATING MY UNIT ON THE DATE SPECIFIED. AS OF THIS DATE, THE FOLLOWING APPLIES:

Tenant rent is current:(Required)

Yes

If no, indicate the amount owed(Required)

Tenant water bill is current:(Required)

Yes

If no, indicate the amount owed(Required)

Damages to unit(Required)

Are expected.

Are not expected.

If expected, estimated repairs are(Required)

Landlord Phone Number(Required)