Date of Notice: ______________________________

Name of Resident: ___________________________

Apartment: _________________________________ Telephone: _______________________

I, the undersigned, hereby serve notice that I intend to vacate the above mentioned apartment on the _________________ day of ________________________ 20_____

(Note to Tenant: If you have fulfilled all the terms of your lease you may anticipate a deposit refund. However, in order to receive a complete refund, you must comply with the following items. Keep in mind that your liability is not limited to the amount of your security deposit.)

1. I am responsible for any and all costs incurred by any other party due to my failure to vacate the premises on or before the date indicated above.
2. I may not rescind this notice nor may I change the date of vacating except by written consent of the property owner/manager.
3. I am responsible for all incurred utility bills through the date of actual vacating. (Where Applicable)
4. I am responsible for the full last month's rent. My Security Deposit may NOT be applied toward payment of any rent due.
5. My failure to return all key's (apartment, mail box, laundry room, storage, etc.) issued for my apartment will result in a $25 to $50 charge for each key. I also understand that the apartment will not be considered vacated and I will be responsible for rent until ALL key's are returned.
6. I understand that submitting this notice does not relieve me of any liability that I may have under my present Lease Agreement.

COMMENTS:_______________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

I intend to move to:
_____________________________________ _________________________________
Street address City

_____________________________________ _________________________________
State Zip Code

Reason for vacating: __________________________________________________________

Resident's Signature ______________________________Date Vacating ___________ 20___

Received By: _________________________________________

Date Received:________________________________________