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Real Estate Documents and Forms - Notice to Repair
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DATE OF NOTICE: $day day of $month, $year

LANDLORD NAME: _____________________

PREMISES ADDRESS: ________________________________________


  1. Pursuant to a written lease dated  $month $day, $year, I am the Tenant for the premises described as: ________________________________________ (the "Premises"), of which I now hold possession.
  2. The Premises require certain repairs that are the Landlord's responsibility; namely: ______________________________________________________________________________
  3. You are required to perform these repairs within a reasonable time after receipt of this Notice. If you do not perform the said repairs within a reasonable time period after receipt of this Notice, I may terminate my Lease as the said repairs materially affect my health or safety.
  4. This Notice of Repair is given pursuant to the Lease and the applicable laws of  the State of $state and in no way impairs or limits any of the other remedies or rights that I may have under the Lease or under the said laws.

Tenant's Name:_____________________

Contact Phone Number

Landlord's Name:_____________________

Contact Address


I, the undersigned, AFFIRM AND DECLARE under penalty of perjury that:

  1. I am at least 18 years of age.
  2. I served a true copy of this Notice to Repair, on _____________________ (the Landlord") as follows:

[   ] On _______________ ____, 20___  I personally handed this Notice to Repair to _____________________, the Landlord.

[   ] On _______________ ____, 20___  I personally handed this Notice to Repair to ___________________, one of the Landlord's agents.

[   ] On _______________ ____, 20___  I sent by   [    ] first class   [   ] certified   [   ] registered  mail a true copy of this Notice to Repair to the landlord address for service provided in the Lease.  Certified/Registered item # _________________________.

[   ] On___________________________________________________________________________________


SWORN BEFORE ME at the city of ________________,  in the State of ____________________ this $day day of $month, $year


A Notary Public for
The State of ____________________
My Commission Expires __________.

Signature :  _______________________________

Print Name: _______________________________

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