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________________________________ COUNTY OF_______________________________

AFFIDAVIT OF SERVICE - When served by a person not an officer____________________________, 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

                     (Seal)






Subscribed and sworn to before me this___day of_________,20____ 

_________________________________________________
               Notary Public
My Commission expires_____________20___.