LANDLORD'S FIVE DAY NOTICE

To_________________________________

You are hereby notified that there is now due to the undersigned landlord the sum of____________

dollars being rent for the premises located in__________________, County of____________________,

and State of___________, described as follows:__________________________________________________

_______________________________________________________________________________________________.

And you are further notified that payment of said sum so due has been and is hereby demanded of

you, and that unless payment thereof is made on or before the expiration of five (5) days after

service of this notice, your lease of said premises will be terminated.

Only FULL PAYMENT of the rent demanded in this notice will waive the landlord's right to

terminate the lease under this notice, unless the landlord agrees, in writing, to continue the

lease in exchange for receiving partial payment.

Dated this___day of__________,20_____.

___________________________________ __________________________________________________

Landlord/Managing Agent Address

_____________________ __________________________________________________

Telephone

_________________________________________________________________________________________________

STATE OF________________________________ AFFIDAVIT OF SERVICE - When served by a

person not an officer

COUNTY OF_______________________________

____________________________, being duly sworn, on oath deposes and says that on the______day of

____________,20___he/she served the within notice on the tenant named as follows:*

____ (1) by delivering a copy thereof to the within named tenant,_______________________________.

____ (2) by delivering a copy thereof to___________________________________,person above the

age of ten years, residing in or in charge of the within described premises.

____ (3) by sending a copy thereof to said tenant by** registered/certified mail, return receipt

requested.

____ (4) by posting a copy thereof on the main door of the within described premises, no one

being in actual possession thereof.

*Check off all applicable paragraphs. ________________________________________________

** Strike out word not applicable. Signature of Notice Server

Subscribed and sworn to before me this___day of_________,____

(Seal)

_________________________________________________

Notary Public