Date: __________

To: __________ and all other occupants of __________.

You are hereby notified that rent is past due in the amount of $__________ for the period of __________.

You are required to pay the full amount within __________ days after service of this notice, or vacate and surrender possession of the premises.

If you fail to do either, the Landlord will initiate legal proceedings to recover possession, unpaid rent, and costs as permitted under the laws of __________.