DOMESTIC VIOLENCE EARLY LEASE TERMINATION
PURSUANT TO ARIZONA REVISED STATUTES SECTION 33-1318 (UPDATED 12-10-09)
NOTICE: IF YOU FALSELY CLAIM TO BE A VICTIM OF DOMESTIC VIOLENCE IN ORDER TO OBTAIN AN EARLY
LEASE TERMINATION YOU MAY BE CHARGED AND CONVICTED OF A CRIMINAL OFFENSE AND BE LIABLE TO
YOUR LANDLORD FOR TREBLE DAMAGES.IN ORDER TO HAVE YOUR LEASE PREMATURELY TERMINATED
AND TO BE RELEASED FROM FUTURE OBLIGATIONS UNDER YOUR RENTAL AGREEMENT, YOU MUST
COMPLY WITH ALL OF THE REQUIREMENTS OF THE LAW AND PROVIDE THE INFORMATION REQUESTED ON
I, _________________________, have a legally valid lease or rental agreement for the premises located
at:___________________________, unit #________. The lease or rental agreement is scheduled to expire
on:_______________. I declare, under penalty of perjury, that I am a victim of domestic violence as
defined by Arizona Revised Statutes 13-3601, and that to the best of my knowledge; the information
provided by me in this written notice is truthful and accurate.
I am requesting an early termination and release from my lease, effective __________,20__, a date mutually
agreed to by my landlord (and which is not later than 30 days from the date of this
notice)._____________(landlord initials indicate agreement). As evidence that I am a victim of domestic
violence, I avow that I am a victim of domestic violence pursuant to one of the requirements listed in ARS
13-3601(A) and agree to provide evidence of such to my landlord:
□ Marriage or former marriage or that he/she resides or has resided with me in the same household.
□ We have a child in common.
□ I am or the defendant is pregnant by the other party.
□ I am related to the defendant or the defendant's spouse by blood or court order as a parent, grandparent,
child, grandchild, brother, sister, or by marriage as a parent-in-law, grandparent-in-law, stepparent, step-
grandparent, stepchild, step-grandchild, brother-in-law or sister-in-law.
□ I am a child who resides or has resided in the same household as the Defendant and am related by blood to
a former spouse of the Defendant or to a person who resides or who has resided in the same household
as the Defendant.
□ The relationship between the me and the defendant is currently or was previously a romantic or sexual
relationship. (The following factors may be considered in determining whether the relationship between
the tenant and the defendant is currently or was previously a romantic or sexual relationship: type of
relationship, length of relationship, frequency of interaction between the parties, if relationship has
terminated, the length of time since the termination)
**REMINDER: YOU MUST PROVIDE EVIDENCE OF THE ABOVE TO YOUR LANDLORD AS
PART OF THIS REQUEST TO EARLY TERMINATE YOUR LEASE. FAILURE TO DO SO MAY
RESULT IN THE REJECTION OF YOUR REQUEST**
As evidence that I am a victim of domestic violence, I am providing the following at least one of the
following documents, along with this written notice:
□ A copy of a protective order issued pursuant to section 13-3602 to a tenant who is a victim of domestic
violence, with me listed as the plaintiff.
□ A copy of a written departmental report from a law enforcement agency that states that I notified the law
enforcement agency that I was a victim of domestic violence.
□ Per my landlord’s request, I am providing a copy of a receipt or signed statement that the order of
protection has been submitted to an authorized officer of a court for service.
The action, events or circumstances that resulted in my being a victim of domestic violence as defined in
Section 13-361 occurred on___________________, (Must be within the thirty day period immediately
preceding this written notice of termination to the landlord, unless waived by the landlord).
________________(Landlord initials indicating waiver of thirty day requirement)
THE PERSON NAMED IN THE ORDER OF PROTECTION OR A DEPARTMENTAL REPORT AS INDICATED ABOVE
HAS PROVOKED THIS EARLY LEASE TERMINATION, AND IS DEEMED TO HAVE INTERFERED WITH THE
RESIDENTIAL RENTAL AGREEMENT BETWEEN THE LANDLORD AND TENANT REGARDLESS OF WHETHER
THIS PERSON IS A PARTY TO THE RENTAL AGREEMENT. THIS PERSON MAY BE LIABLE FOR ALL ECONOMIC
LOSSES INCURRED BY A LANDLORD FOR THE DOMESTIC VIOLENCE EARLY LEASE TERMINATION. THIS
CIVIL LIABILITY INCLUDES UNPAID RENT, EARLY LEASE TERMINATION FEES, COSTS TO REPAIR DAMAGE TO
THE PREMISES AND ANY REDUCTIONS OR WAIVERS OF RENT PREVIOUSLY GRANTED TO THE TENANT WHO
WAS THE VICTIM OF DOMESTIC VIOLENCE.
YOU MUST PROVIDE THE FOLLOWING INFORMATION OR YOUR REQUEST MAY BE DENIED.
□The name and all known addresses to me of the person who provoked this early lease.
termination are contained in the copy of the order of protection or a departmental report provided to the
landlord with this written notice:____________________________________________________________
Per my landlord’s request, in addition to the name and address contained in the copy of the order of
protection or a departmental report provided to the landlord with this written notice, I know the person also
uses the following name and/or address(es).
Additional Names:_______________________ Date of Birth:_____________ Soc Sec #_______________
Additional Addresses/Phone #: _____________________________________________________________
On or before the termination and release date indicated above, I will submit to the landlord the sum of
$______________, representing rent owed through the date of the lease termination plus any pervious
obligations outstanding. I understand that if I have pre-paid rent for the month in which the lease is
terminated, the landlord may retain the prepaid rent and no refund is due to me. If I have paid a security
deposit pursuant to Section 33-1321, the security deposit shall not be withheld for the early termination of
the lease if I meet the requirements prescribed by Section 33-1318 Subsection A, but may be withheld for
payment of damages which the landlord has suffered by reason of my noncompliance with Section 33-1341.
I understand that if there are multiple tenants who are parties to the rental agreement that is being terminated
herein, the tenancy for those tenants also terminates. The tenants who are not the victims of domestic
violence, excluding the person named in an order of protection or a departmental report pursuant to by
Section 33-1318 Subsection A, that caused the termination of this lease, may, at the landlord’s sole
discretion, be released from any financial obligations due under the previously existing rental agreement and
the remaining tenants may be permitted to enter into a new lease with the landlord if the tenants meet all
current application requirements.
Tenant Signature_________________________ DATE___________
Delivered to the Landlord or their agent:______________________(name of person receiving notice)
_____By hand this date:______By certified mail this date:______ (certified receipt number :__________)