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Create a Non-payment Notice
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Property Name
What is your tenant's full name?
What is the address of the leased premise that your tenant is living?
State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
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Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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New Hampshire
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New Mexico
New York
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Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What is the name of the landlord the lease agreement is with?
What is the mailing address of the landlord?
State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What is your tenant's mailing address?
(if different than leased premises)
State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
How much rent (in $$$) does your tenant owe?
(exclusive or late fees or other costs )
What months does the delinquent rent represent?
(i.e. January, February, etc.)
How much (in $$$) does the tenant owe in late charges?
(subject to the terms of your lease agreement)
What months do the late charges represent?
(i.e. January, February, etc.)
How much (in $$$) does the tenant owe for other charges?
( i.e. Carport, Lock-out, Damages, etc. )
What are these other charges?
(i.e. Carport, Lock-out, Damages, etc. )
Payment will be accepted by? Please check the appropriate boxes:
Cash
Money Order
Certified or Cashiers Check
Personal Check
If the tenant has questions, who should they contact?
(if different than landlord)
What is the telephone number of the contact person above?
(if different than landlord)
A copy of this notice was delivered to Tenant:
By personal service
By registered/certified mail
By first class mail
By posting on the front door of the above leased premises
Notice delivered/posted on the
Notice delivered/posted/mailed in his/her capacity as:
Landlord/Lessor
Agent for Landlord