NOTICE
To the above-listed tenants, under-tenants, assignees, and other persons in possession of the
premises, you owe rent for the following month(s):
$_________ for month of ____________, 20___ $_________ for month of ____________, 20___
$_________ for month of ____________, 20___ $_________ for month of ____________, 20___
$_________ for month of ____________, 20___ $_________ for month of ____________, 20___
$_________ for month of ____________, 20___ $_________ for month of ____________, 20___
The total rent now owed is $_______________.
You must either pay the total rent owed or move out of the premises within 14 days after you are
served with this notice, or the landlord will start an eviction case against you in court.
A copy of Notice to Tenant of Applicability or Inapplicability of the New York State Good Cause
Eviction Law is attached.
______________________________ ______________________________ _______________
Landlord or Agent Signature Print Landlord or Agent Name Date
_______________________________________________________________________________
Landlord or Agent Address
____________________ ______________________________
Landlord or Agent Phone Landlord or Agent Email
Written Demand for Past Due Rent and Good Cause Eviction Law Notice Page 2 of 7