Use this letter if you are a tenant who must break your lease to due

California Tenants – Use this letter if you are a tenant who must break your lease to due

domestic violence, sexual assault, stalking, human trafficking, elder abuse or dependent

adult abuse

Instructions:

1. Click here to open a Microsoft Word version of this sample letter 

2. The Microsoft Word-version will have the same blank spaces as this version, but

will not have the comments in the margin. Fill out the blanks in the Microsoft

Word-version using the comments on the margins of this version as a guide. 

3. Use this sample letter if you are a tenant who must break your lease due to

domestic violence, sexual assault, stalking, human trafficking, elder abuse or

dependent adult abuse

4. Please note that you should tailor this letter to the facts in your case. This

template is not a substitute for legal advice. If you need help finding a tenant

attorney, please see the Tenants Together Directory. 

5. Once filled out with your information and sent to your landlord, keep a copy for

your records. 

Sent via Certified Mail- Return Receipt Requested

(___________)

(______________)

Dear (___________________) ,

I (__________________) am a tenant at (___________________). 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 (___________________).

Commented [MC1]: Date

Commented [MC2]: Full name of landlord and/or property

manager

Commented [MC3]: Address of landlord and/or property

manager

Commented [MC4]: Full name of landlord and/or property

manager

Commented [MC5]: Your/tenant’s name(s)

Commented [MC6]: Address, City, State, Zip

Commented [MC7]: Date at least 14 days from the date of this

letter (though it can be later if you want)

California Civil Code § 1946.7 allows victims of abuse that have a restraining order, a

police report, or documentation from qualified third-parties to break their lease without

owing additional rent. Tenants must provide at least 14-days’ notice of intent to

terminate the tenancy, and after those 14 calendar days, the tenant is no longer

responsible for rent. California Civil Code § 1946.7(d). If the tenant vacates the

apartment before the 14-days’ notice period ends, and the landlord re-rents the unit for

that period, the landlord must refund the prior tenant rent for the those days in which

the new tenant occupied the unit. California Civil Code § 1946.7(d).

For documentation of the abuse, I have enclosed:

 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 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

Sincerely,

(__________________)

* * *

Providing Proof of Violence – Qualified Third Party Statement

This is a template for a qualified third party statement, which can be used to show that

a tenant, or family member living with the tenant, is a victim of domestic violence,

sexual assault, stalking, human trafficking, elder abuse, or dependent adult abuse, for

the purposes of breaking a lease. The tenant completes and signs Part I. Part II is

completed and signed by certain professionals, such as sexual assault counselors,

domestic violence counselors, human trafficking caseworkers, doctors, registered

nurses, or psychologists. If the professional making the statement is a sexual assault

counselor, domestic violence counselor, or human trafficking caseworker, the law

requires that the professional provide this statement on his or her organization’s

letterhead.

Commented [MC8]: You must provide your landlord with

documentation about abuse (including restraining order, police

report or note from doctor/social worker). You only need to provide

one piece of documentation. Include the bullet point of the document

that you have and delete the other two

Commented [MC9]: If you do not have a restraining order or

police report, you can get a doctor, psychologist, social worker or

domestic violence/sexual assault counselor to write a note for you.

The template for the note is below.

Commented [MC10]: Your signature

Commented [MC11]: Your full name

Commented [MC12]: This can be used if you do not have a

restraining order or police report. You will fill out Part I and a

qualified third-party (doctor, social worker, psychologist) must fill

out Part II. You do not need to complete this if you have a

restraining order or police report documenting the abuse.

Tenant Statement and Qualified Third Party Statement under Civil Code Section

1946.7

Part I. Statement By Tenant

I, (__________________), state as follows:

I, or a member of my household, have been a victim of (_________________).

The most recent incident(s) happened on or about (__________________).

The incident(s) was/were committed by the following person(s), with these physical

description(s) (_________________).

(__________________)

(___________)

Part II. Qualified Third Party Statement

I, (__________________), state as follows:

My business address and phone number are: (___________________).

Check and complete one of the following:

____I meet the requirements for a sexual assault counselor provided in Section 1035.2

of the Evidence Code and I am either engaged in an office, hospital, institution, or center

commonly known as a rape crisis center described in that section or employed by an

organization providing the programs specified in Section 13835.2 of the Penal Code.

____I meet the requirements for a domestic violence counselor provided in Section

1037.1 of the Evidence Code and I am employed, whether financially compensated or

not, by a domestic violence victim service organization, as defined in that section.

____I meet the requirements for a human trafficking caseworker provided in Section

1038.2 of the Evidence Code and I am employed, whether financially compensated or

not, by an organization that provides programs specified in Section 18294 of the

Welfare and Institutions Code or in Section 13835.2 of the Penal Code.

____I am licensed by the State of California as a: (_______________________) and I am

licensed by, and my license number is: (_______________________)

Commented [MC13]: Your full name

Commented [MC14]: Insert one or more of the following:

domestic violence, sexual assault, stalking, human trafficking, elder

abuse or dependent adult abuse.

Commented [MC15]: Date of last incident of abuse if you

remember and feel comfortable stating it

Commented [MC16]: Names and physical description of the

perpetrator if you know/remember it and feel comfortable stating it

Commented [MC17]: Your signature

Commented [MC18]: Your full name

Commented [MC19]: Date

Commented [MC20]: Qualified third party name

Commented [MC21]: Address, City, State, Zip, Phone Number

Commented [MC22]: Insert one of the following: physician and

surgeon, osteopathic physician and surgeon, registered nurse,

psychiatrist, psychologist, licensed clinical social worker, licensed

marriage and family therapist, or licensed professional clinical

counselor.

Commented [MC23]: Insert one of the following: physician and

surgeon, osteopathic physician and surgeon, registered nurse,

psychiatrist, psychologist, licensed clinical social worker, licensed

marriage and family therapist, or licensed professional clinical

counselor.

Commented [MC24]: Insert name of state licensing entity and

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, is a victim of: (_________________).

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.

(__________________)

(___________)

Commented [MC25]: Insert one or more of the following:

domestic violence, sexual assault, stalking, human trafficking, elder

abuse or dependent adult abuse.

Commented [MC26]: Signature of qualified third party

Commented [MC27]: Full name of qualified third party

Commented [MC28]: Date