TEMPLATE LETTER:

Qualified Third Party Early Lease Termination Verification

As explained in Ending Your Lease Early Because of Abuse or a Crime, survivors, their household members, or their immediate family members may end their lease early. Survivors covered by this law include survivors of domestic violence, sexual assault, stalking, human trafficking, elder or dependent adult abuse, and survivors of crimes that caused injury or death, or involved a deadly weapon or involved the use or threat of force. The survivor, household member, or immediate family may break the lease without any penalty or fee, regardless of what the lease states.

Generally, to end a lease early, a tenant must provide their landlord written notice saying they are ending their lease early and a document verifying that they or their household member or their immediate family member is a survivor.

This resource includes a template letter a tenant can use to have a Qualified Third Party verify that they, their household member, or their immediate family member is a survivor. The following are Qualified Third Parties:

sexual assault counselors

domestic violence counselors

human trafficking caseworkers

victim of violent crime advocates

physicians and surgeons

osteopathic physicians and surgeons

registered nurses

psychiatrists

psychologists

licensed clinical social workers

licensed marriage and family therapists

licensed professional and clinical counselors

Part I of the template must be completed by the tenant. Part II of the template must be completed by the Qualified Third Party. If Part II is completed by a domestic violence counselor, sexual assault counselor, human trafficking caseworker or victim of violent crime advocate, then both Part I and Part II must be written on their organization’s letterhead. Letterhead is not required if Part II is completed by a California-licensed physician, surgeon, registered nurse, psychiatrist, psychologist, licensed clinical social worker, licensed marriage and family therapist, or licensed professional clinical counselor.

How do I get more assistance? Contact FVAP at info@fvaplaw.org or (510) 858-7358 for questions.

Tenant Statement and Qualified Third Party Statement under Civil Code Section 1946.7

Part I. Statement By Tenant

[If a sexual assault counselor, domestic violence counselor, human trafficking caseworker or victim of violent crime advocate completes Part II, then both Part I and Part II must be written on the advocate’s organization’s letterhead.]

I________________________________ [insert name of tenant], state as follows:

I, or a member of my household or immediate family, have been a victim of: ____________________________________________ [Insert one or more of the following: domestic violence, sexual assault, stalking, human trafficking, elder abuse, dependent adult abuse, or a crime that caused bodily injury or death, a crime that included the exhibition, drawing, brandishing, or use of a firearm or other deadly weapon or instrument, or a crime that included the use of force against the victim or a threat of force against the victim].

The most recent incident(s) happened on or about: __________________________. [Insert date or dates.]

The incident(s) was/were committed by the following person(s), with these physical description(s), if known and safe to provide: ________________________________________________________________________________________________________________________________________________________________. [If you know and it is safe to provide your abuser(s) name(s) and physical description(s), insert here]

____________________________________	__________________________

Signature of Tenant	Date

Part II. Qualified Third Party Statement

[If a sexual assault counselor, domestic violence counselor, human trafficking caseworker or victim of violent crime advocate completes Part II part, then both Part I and Part II of the letter must be written on the advocate’s organization’s letterhead.]

I, _______________________ [Insert Name of Qualified Third Party], state as follows:

My business address and phone number are: [insert business address and phone number] ______________________________

______________________________

______________________________

______________________________

[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 meet the definition of “victim of violent crime advocate” provided in Section 1947.6 of the Civil Code and I am employed, whether financially compensated or not, by a reputable agency or organization that has a documented record of providing services to victims of violent crime or provides those services under the auspices or supervision of a court or a law enforcement or prosecution agency.

____I am licensed by the State of California as a:: ___________________________ [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] and I am licensed by, and my license number is: ________________________________________. [Insert name of state licensing entity and license number.]

The person who signed the Statement By Tenant above stated to me that the person, or a member of the person’s household or immediate family, is a victim of: _________________________________. [insert one or more of the following: domestic violence, sexual assault, stalking, human trafficking, elder abuse, dependent adult abuse, or a crime that caused physical injury, emotional injury and the threat of physical injury, or death.]

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.

____________________________________	__________________________

Signature of Qualified Third Party	Date

California Civil Code § 1946.7.