Fill and Sign the Notice of Termination of Housing Benefit Form

Housing Benefit Termination Notice Page 1 of 2Basic form © James R. McDade (ver: 01-08-04) 209-667-2300 HOUSING BENEFIT TERMINATION NOTICE Note: Employers use this form to notify an employee and all occupants of the employer- provided housing that they must leave the premises. Check with legal counsel if you do not know the wage and hour rules. (Delete this note prior to use.)Date of Notice: ____________________To __________________________________________ and all other occupants of (employee’s name)_____________________________________, _____________________, California, 95_____:You are no longer eligible to live in the premises and permission for you to live in the premises is hereby revoked because the employee is no longer working for the company as of ________________, 20__. the employee has been out on leave since _________________, 20__, is not actively working for the company, and is not expected to return until _______________, 20___, at the earliest.the terms of the Housing Agreement were violated because _____________________ _____________________________________________________________ and the employee did not cure the breach.YOU ARE HEREBY NOTIFIED that you, and all those who are living in the house, must vacate the premises within [can be immediately if employment is terminated] [Option under CC§1946.1 if employment is not terminated and employee has lived in house for less than a year> 30 days], [Option if employment is not terminated and employee has been in house for over a year> 60 days, ] after the date of this notice is given to you. In other words, you must leave the house by _____________, 20___. If you fail to do so, legal proceedings will be commenced against you to recover possession of the premises and to recover damages for unlawful detainer, actual legal costs, and attorney’s fees pursuant to the Housing Agreement and as allowed by law.[Workers’ Compensation Leave Option: Please note that the Company must have a real business reason for having to end housing, such as the cost is too much for the employer to bare, or new workers won’t take the job without housing, or it is a undue burden on split shift workers to come back and forth from town to do their job.> Please note that the employee’s employment is not being terminated. We will evaluate the employee’s job situation if and when the employee can return to work. But in the mean time, the employee can no longer live in the house because the employee is not actively working and business necessity dictates that we give the house to another employee. We will inform the workers’ compensation insurance company that the housing benefit is being terminated. This should cause the employee to receive an increase in temporary workers’ compensation disability payments. Please contact the insurance company if there are any questions about the workers’ compensation benefits.Dated: _______________________ By: __________________________________ Owner, or Agent for Owner Acknowledgment of Receipt Housing Benefit Termination Notice Page 2 of 2Basic form © James R. McDade (ver: 01-08-04) 209-667-2300___________________________________ Date: _______________________Employee’s signature PROOF OF SERVICE Complete the appropriate statement, whether or nor the employee signed above: ____This notice was personally delivered to the employee on ________________, 20___ by ______________________.____ Employee was not home. This notice was left with ___________________________ (a responsible person) and then mailed to the occupants via first class U.S. mail, postage pre-paid on ___________________, 20___, by ________________________.____ Employee was not home and cannot be located. This notice was posted on the premises in a conspicuous place and mailed to the occupants via first class U.S. mail, postage pre-paid on ___________________, 20___, by _________________________.I hereby declare under penalty of perjury under the laws of the State of California that I am over the age of 18, and that the above statement is true and correct, and that I have signed this statement in ___________________, California, on ______________________, 20___.Signature of person delivering or posting this notice: ______________________________