NOTE: This form is used by Landlord/Agent when invasive repairs or fumigation work require the temporary move-
out of a Tenant(s), to notify the Tenant(s) of the conditions for the temporary displacement.
Date: ____________________, To Tenant(s): ___________________________________________________
Residing at: ______________________________________________________________________________
Items left blank or unchecked are not applicable.
By (Date) _________________, at (Time) ______:______ AM PM, you are kindly requested to
temporarily vacate the premises to allow for invasive repairs or fumigation of the premises.
The work to be performed is _________________________________________________________________
The work to be performed by________________________________________________________________.
The work is expected to be completed by (Date) ________________, at (Time) ______:______ AM PM
We kindly request that you cooperate with this temporary displacement by ____________________________
To compensate for the temporary displacement Landlord/Agent will provide Tenant(s)...
o Rent credit in the amount of $_________ per day, or
o Provide alternate accommodations at _____________________________________________ hotel/motel,
located at ______________________________________________________. In which case we will
handle the hotel/motel booking. We booked it under the name ___________________________________.
You may check in on (Date) ________________, at (Time) _______:_______.