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Lease Addendum Form

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VIOLENCE, DATING VIOLENCE

U.S. Department of Housing

OMB Approval No. 2502-0204

OR STALKING

and Urban Development

Exp. 6/30/2017

Office of Housing

LEASE ADDENDUM

2005

IOLENCE

GAINST

OMEN AND

USTICE

EPARTMENT

EAUTHORIZATION

CT OF

LANDLORD

UNIT NO. & ADDRESS

TENANT

This lease addendum adds the following paragraphs to the Lease between the above referenced

Tenant and Landlord.

Purpose of the Addendum

The lease for the above referenced unit is being amended to include the provisions of the

Violence Against Women and Justice Department Reauthorization Act of 2005 (VAWA).

Conflicts with Other Provisions of the Lease

In case of any conflict between the provisions of this Addendum and other sections of the Lease,

the provisions of this Addendum shall prevail.

Term of the Lease Addendum

The effective date of this Lease Addendum is ______________. This Lease Addendum shall

continue to be in effect until the Lease is terminated.

VAWA Protections

1. The Landlord may not consider incidents of domestic violence, dating violence or stalking as

serious or repeated violations of the lease or other “good cause” for termination of assistance,

tenancy or occupancy rights of the victim of abuse.

2. The Landlord may not consider criminal activity directly relating to abuse, engaged in by a

member of a tenant’s household or any guest or other person under the tenant’s control, cause

for termination of assistance, tenancy, or occupancy rights if the tenant or an immediate

member of the tenant’s family is the victim or threatened victim of that abuse.

3. The Landlord may request in writing that the victim, or a family member on the victim’s

behalf, certify that the individual is a victim of abuse and that the Certification of Domestic

Violence, Dating Violence or Stalking, Form HUD-91066, or other documentation as noted

on the certification form, be completed and submitted within 14 business days, or an agreed

upon extension date, to receive protection under the VAWA. Failure to provide the

certification or other supporting documentation within the specified timeframe may result in

eviction.

_________________________________________

__________________

Tenant

Date

_________________________________________

__________________

Landlord

Date

Form HUD-91067

(9/2008)

Lease Addendum Form

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