MUTUAL AGREEMENT TO EXTEND NOTICE OF INTENT TO VACATE
Office Use Only: ATTN:
Original Notice of Intent To Vacate (NIV) submitted to HACC on: _____________________________________
Mutual agreements to extend NIV’s must be submitted to the HACC no later than seven (7) days before
original requested vacate date.
Granting an extension of the NIV will not change the voucher date form original issue date.
Only one (1) Mutual Agreement to Extend NIV, up to a maximum of thirty days (30), will be granted per
assisted unit. If the tenant does not move by the approved extended date, a new valid Notice of Intent to
Vacate (NIV) must be submitted to the HACC.
Extensions will not be granted on additional Notice of Intent to Vacate received from the same unit.
______________________________________________________ Client #_____________________
Lease/rental agreement between Property Owner/Manager and tenant was scheduled to terminate on
_____________________________, due to the following requested action:
(Please Check One)
_________ 30 Day Notice of Intent to Vacate from Tenant
_________ 30 Day Notice to Vacate with cause from Property Owner/Manager
_________ 60 Day Notice to Vacate with cause from Property Owner/Manager
_________ 90 Day Notice to Vacate from Property Owner/Manager
Property Owner/Manager and tenant mutually agree to rescind notice described above, and extend lease/rental
agreement. Tenant is scheduled to vacate the assisted unit on __________________________.
By signing below, Property Owner/Manager and tenant understand that after the above stated vacate date, housing
assistance payments will cease and tenant will be responsible for the full contract rent.