_____________________________________________________________________________________________________________________ (name address of former tenant)

When the premises was vacated at __________________________________________

the following items remained on the premises: _________________________________

_______________________________________________________________________

_______________________________________________________________________

_____________________________________________________________________.

The location where the property can be claimed is: _____________________________ ________________________________________________________________.

Pursuant to _______________________ (applicable statute) _____________________ (former tenant) must claim the property no later than ________________________, 199 ______, at the above address, and pay all storage costs/fees. If the property is not reclaimed it will be ______________________________________________________

______________________________________________________________________

________________________________ (sold, destroyed, auctioned, etc)

___________________________________ (Landlord’s signature)

____________________ Date

______________________________________________________________________________________