Demand for Rent and Possession

DATE:	____________________

PREMISES:	__________________________________________________________________

TENANT:	__________________________________________________________________

LANDLORD:	____________________________________________________________

Landlord's Address: _______________________________________________________

You are hereby notified that you have breached your lease of the above-referenced premises by failing to pay rent (and late charges, if applicable and noted below) as follows:

Due Date	Monthly Rent	Rent Unpaid	Late Charge	Total
Totals

LANDLORD hereby demands that you immediately pay the total of the above-itemized rent (and late charges, if itemized above). You are further hereby notified that if you fail to immediately pay said total, LANDLORD will take legal action against you for recovery of possession of the above-
referenced PREMISES and collection of said rent (and late charges, if itemized above), together with rent (and late charges, if applicable) accruing after the date of this notice and through the date of judgment. Acceptance by LANDLORD of any partial payments you may make shall not waive LANDLORD's right to pursue legal action.

LANDLORD:

Signature of landlord or authorized representative

The undersigned certifies that a true copy of the foregoing Demand for Rent and Possession was delivered to TENANT on the ____ day of _____________, 20___.

Signature