Date: ___________________

To: __________________________

From: _________________________

Under a lease dated ____________________, you are the tenant and occupant of premises located at ____________________________________________________________.

In the above-mentioned lease, you agreed to make monthly rental payments in the amount of _________________________ dollars ($___________). You are now behind in your rental payments in the amount of _________________________ dollars ($______ )and have failed and refused to pay your rent since ______________________, in accordance with the terms of the above-mentioned lease.

Accordingly, within three (3) days after you receive this notice, you are required to pay the above sum or surrender possession of the premises in a broom-clean condition to the Landlord. Should you not comply, the Landlord will commence eviction proceedings under the applicable statute to recover possession of the premises.

___________________________

Landlord’s Signature