Fill and Sign the Supplied or Required to Be Supplied by You Form

[Date] [Landlord’s Name] [Landlord’s Address] Re: Notice to Landlord: Failure to comply with applicable building codes. 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 comply with the requirem ents of the applicable building and housing codes at the above address, resulting in the unsatisfactory condition of the leased premises. Specifically, you have failed to: [check all that apply] [ ] Repair and maintain window and doors in good repair and working condition. [ ] Maintain the roof in good repair and watertight condition. [ ] Maintain in good and safe working order and condition all electrical, plumbing, sanitary, heating, venti lating, air -conditioning and other facilities and appliances, including elevators, supplied or required to be supplied by you. [ ] Make all repairs and do whatever is necessary to put and keep the premises in a clean, fit and habitable condition. [ ] O ther: You are hereby notified to take immediate action to remedy the problems I have listed. In the event you fail to correct the above conditions, I shall take advantage of all remedies under the law. Should you have any questions please let me know. Due to the severity of these problems, your attention is appreciated. 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: _ _________________________