Your First Name/Last Name

Address

Postal Code/ CITY

[Name and Surname]

Address

Postal Code/ City 

Done at [your city], on [specify the date].

Subject : Departure notice

Dear Sir or Madam,

I inform you of my decision to leave my current dwelling located at [address of the dwelling]

My departure from the dwelling will take place from today within a period provided by law (3 months from the receipt of this letter).

Please accept, Madam, Sir, my best regards.

[Your signature]