Repair and Withholding Letter to Landlord

Use this form letter to tell your landlord you have defects in your rental unit that materially affect health and safety. You can fill in the PDF, below, or print it out and fill it in by hand. Or you can use the text below. Learn more about rental repair problems.


(write your name)

(write your address)


(write your landlord's name)

(write your landlord’s address)


(write today’s date)

Dear (write your landlord’s name):

I rent a home from you. The home is located at (write your home address). There are defects at the home I rent from you that materially affect health and safety. 9 V.S.A. 4458. I would like you to fix these problems. The problems at my home are:







Please contact me in the next seven (7) days to let me know when you can fix these problems. If you do not repair within 30 days of this letter, I will withhold my rent until these problems are fixed. Because the date of this letter is (write today’s date), I will begin withholding on (write the first rent due date that is 30 days after date of letter).

Please contact me at (write your mailing address, phone number or both).




(sign your name)

(print your name)


Our PDF file does not fully comply with all applicable guidelines for accessible digital documents. For the most accessible experience, use the text above.

Updated: Nov 24, 2020