Kentucky Court of Justice, AOC-216

Comes the Plaintiff and for his/her complaint states that:
1. On the _________ day of __________________, _______, Defendant(s) contracted to lease __________________
____________________________________________________________________________________________
located at ____________________________________________________________________________________
under a  written OR  oral lease with Plaintiff as lessor;
2. Under the lease terms, Defendant(s) agreed to pay $____________ per  day  week  month, payable on the
_____________ day of each  week  month  year as rent;
3. Defendant(s) has/have breached the lease because of the following: (check all that apply)
 Failure to pay rent for the  day  week  month  year of _______________________________________
in the amount(s) of $_______________ and has/have not paid late fee for the  day  week  month  year
of _______________________________________ in the amounts of $_____________________.
As of _________________________, _____ the total amount of back rent and late fee(s) owed to the Plaintiff
date
from the Defendant(s) is: ___________________.
 Failure to vacate following expiration of lease.
 Other violation of lease: ______________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
4. Plaintiff gave Defendant(s) written notice to vacate on __________________, _____. Defendant(s) has/have not vacated.