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Accommodation Request

Below is a sample request for an accommodation for a disability. To use this sample, take out the information between brackets and replace it with information specific to your situation. Use the link below the notice to download a sample form.

Request for Accommodation

To: [Larry Landlord
123 Landlord Lane
Lincoln, NE 68508]

Date: [4/29/2015]

RE: Request for Accommodation

Dear [Ms. Landlord],

I am writing you to request an accommodation for a disability under the Fair Housing Act at the following property: [123 Tenant Trail, Lincoln, NE 68508]. Specifically, the following accommodation is necessary for our use and enjoyment of the property: [Reserved parking space next to enterance of the building.] This accommodation addresses the needs of my/our disability in the following ways: [These changes allow full use of the property despite Theresa's mobility limitations]. Please keep all information regardiong my/our disability strictly confidential.

Thank you for your consideration on this matter.

(42 U.S.C. §§ 3601 – 3619)

[Terry Tenant]                                             [Theresa Tenant]


Certificate of Service

The undersigned hereby certifies that a true and accurate copy of the above and foregoing was [ X ]mailed first class postage prepaid _____ hand delivered on: [4/29/2015]

to: [Larry Landlord
123 Landlord Lane
Lincoln, NE 68508]                                   [Theresa Tenant]

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