__________________

[Date]

_____________________________________
[Landlord’s Name]

_____________________________________
_____________________________________
_____________________________________
[Landlord’s Address]

Re: Notice to Landlord: self-help repossession of premises prohibited by law

Leased Premises Address:

_______________________________
_______________________________
_______________________________

Dear [Landlord] ________________________________:

This notice is provided to you in accordance with the provisions of the Uniform Residential
Landlord Tenant Act and other applicable Federal and State housing laws.

The law generally provides that as Landlord you may regain possession of the leased premises in
accordance with the terms of the lease by my surrendering possession, or by appropriate court
action, or based on my abandonment of the property.

Your attempt to retake possession on the ____ day of _________________, 20____, was a
violation of the lease and the law and constitutes unlawful self-help. I have not surrendered the
property nor have I abandoned same. I demand that you follow the law in pursuing eviction
remedies. I hereby reserve all my legal rights and remedies in this matter.

Sincerely,

Tenant: ______________________________________ Date: _________________

[signature]
Proof of Delivery

This Notice delivered to Landlord or Landlord’s authorized agent:

[ ] by personal delivery
[ ] certified/registered mail, return receipt requested
[ ] other form of notice pursuant to Lease Agreement: ________________________________
____________________________________________________________________________

Signed: ______________________________________ Date: __________________________