To ___________________________, tenant in possession:

You are hereby required to pay the rent on the premises herein described, of which you now hold possession, pursuant to a written lease, amounting to _____________ (amount) being the rent now due to me by you for the period from _____________ to __________ or you are hereby required to deliver up possession of the premises, within _________ (no. of days) days after service on you of this notice, to the undersigned or the undersigned will institute legal proceedings against you, to declare a forfeiture of the lease under which you occupy said premises and to recover possession thereof, with treble rents and damages.

The premises referred to are commonly known as ___________________________________________________ (Address, apartment no.)

___________________________________________________ (City, state, zip code)

Dated: _______________

_____________________

(Lessor)