Subject: Confidential Notification and Request Regarding Lease Agreement at [Rental Address]

Dear [Landlord’s Name],

I am writing to inform you that I, or one of my roommates on my lease, have been a victim of [domestic
violence/sexual assault/stalking/etc.] as defined under California Civil Code §1946.7.

In accordance with this statute, I am requesting [ex. “early termination of my lease agreement, effective
[Desired Termination Date]” or “a change of locks to my rental unit for safety purposes”].

Enclosed are the necessary documents to substantiate this request, including [ex. “a copy of a restraining
order” or “a police report dated within the last 180 days”].

I appreciate your understanding and prompt attention to this sensitive matter. Please confirm receipt of
this notice and the implementation of the requested action.

Sincerely,
[Your Name]
[Contact Information]