To:
Tenant(s):___________________________________________

The Premises which are held and/or occupied by you are:

Address:___________________________________________________ Apartment or Suite Number:________
City:__________________________State:______ Zip:____________

Other notice address if different from the Premises above: _____________________________________________________________

This notice is to the above-named Tenant(s) and any other occupants of the above-referenced Premises.

WITHIN THREE DAYS from service of this Notice, you are required to:

Pay rent for the Premises in the following amount, which is past due, to:

Name: ________________________________ Phone Number: __________________
Address:___________________________________________________
City:________________________ State:______ Zip:_________
Between the hours of _______________ on the following days____________________