Fill and Sign the Pennsylvania Failure Form

      [Date]       [Landlord’s Name]                   [Landlord’s Address] Re: Notice to Landlord: Failure of Landlord to return all prepaid but unearned rent, and security deposit recoverable by Tenant. Dear       : [Landlord’s Name] I am your tenant at the following premises:       [Address of premises] This letter is to provide you with legal notice of your failure to-date to return all of the prepaid but unearned rent I paid to you for the month of _______________ , 20 ___ , and my security deposit- all of which is recoverable by me. The circumstances of my departure from the leased premises, as you know, were as follows [describe] :       Because my departure resulted from your breach of our Lease Agreement and/or other wrongful conduct by you contrary to applicable landlord-tenant law, I am due a refund of all prepaid but unearned rent in the amount of $ __________ . Furthermore, my security deposit must be returned in good faith by you, including sufficient documentation (including receipts for repairs) of any amount not returned. I have not heard from you on this matter. If you fail to return the amounts owed, I will take all possible action against you under applicable law, including seeking substantial punitive damages against you for your knowing and intentional failure to comply with the law. Sincerely, Tenant: ______________________________________ Date: _________________ [signature] Proof of Delivery This Notice delivered to Landlord or Landlord’s authorized agent: [ ] by personal delivery [ ] certified/registered mail, return receipt requested [ ] other form of notice pursuant to Lease Agreement:       Signed: ______________________________________ Date: __________________________