NOTICE OF CORONAVIRUS-RELATED INABILITY TO PAY RENT
(CALIFORNIA EXECUTIVE ORDER N-37-20)
Instructions
The California Attorney General has approved this form for optional use by tenants affected by the
coronavirus pandemic to notify their landlords of their inability to pay rent. This form is intended for
use to preserve rights under the Governor’s statewide order. Local measures where you live may
provide greater protection; you should research the applicable local rules carefully.
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Fill all the blanks below and check the boxes that apply.
Deliver a copy to your landlord.
Keep a copy of this notice (or at least a cell phone picture).
Gather and keep documentation to prove your inability to pay rent, such as termination or layoff
notices, pay stubs, bank statements, medical bills, or a signed letter from an employer.

DATE:

(Put the date here)

TO:

FROM:
(Landlord or manager’s name)

(Tenant’s name)

TENANT’S HOME ADDRESS:
(Fill in the full address of the unit you are renting)
REASON:

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I am unable to pay the full amount of rent for the rental unit listed above, for the
following COVID-related reason(s) (Check all that apply):
A tenant (or tenants) in the household lost income due to the coronavirus, the state of
emergency, or the related government response (such as a layoff or reduction in hours).
A tenant (or tenants) in the household needed to miss work to care for a child whose school
was closed in response to the coronavirus.
A tenant (or tenants) in the household was unable to work because of sickness with confirmed
or suspected coronavirus.
A tenant (or tenants) in the household was unable to work because of a need to care for a
household or family member who was sick with confirmed or suspected coronavirus.
Other COVID-related reason (specify):

As a result, I need to delay some or all payment of the rent due, and am entitled to the protections of
Executive Order N-37-20. Thank you for your understanding and cooperation.
Sincerely,
(Sign here)