Rental or Lease - Notice to Pay

[Street Address] [City/State/Zip]

Date: ________________________

To: __________________________
[Street Address]
[City/State/Zip]

RE: Unit # _______

You are notified that you owe the amount of $______ calculated as follows:

Rent............................... $___________
Late Fee........................... $___________
Other(s):

  • ____________________........... $___________
  • ____________________........... $___________
  • ____________________........... $___________
  • ____________________........... $___________
  • ____________________........... $___________
  • ____________________........... $___________

Total Owed......................... $___________

You must pay this amount in cash, money order or certified check. A personal check will not be accepted.

If you fail to pay within 3 DAYS of when you receive this notice, your tenancy is terminated and you must move. If you do not move, a lawsuit will be filed to evict you. If you pay within 3 days, you may stay.

________________________________
[Fict./dba/Owner Name]
[Rent Address]
[City/State/Zip]
[Phone #]


The undersigned received this notice on the ________ day of _____________, 20__ at __________am/pm.


___________________________
(Tenant)


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