5-Day Notice of Past Due Rent Page 1 of 1
Landlord:
_________________________________________________________________
Tenants:
_________________________________________________________________
Property Description
• Property address: ___________________________________________________________
• Apartment number: _____
• Number of rooms: _____
• On what floor(s): _____
• On what side [check all that apply]: left right front back middle
This property is used as a [check one]: business residence
List the names of every tenant, under-tenant, assignee, and person in possession of the premises:
1. ____________________________________ 7. ___________________________________
2. ____________________________________ 8. ___________________________________
3. ____________________________________ 9. ___________________________________
4. ____________________________________ 10.___________________________________
5. ____________________________________ 11.___________________________________
6. ____________________________________ 12.___________________________________
[If you need more space to list tenants, please attach an extra sheet to this form.]
NOTICE
To the above-listed tenants, under-tenants, assignees, and other persons in possession of the
premises:
• In your lease, you agreed to pay your rent on or before the _____ day of each month.
• You have not paid the rent for the month of ____________, 20___ and it is more than five
days past the due date.
• The total rent owed is $_______________.
• You must either pay the total rent owed, or an eviction case will be filed against you in court.