5-DAY NOTICE TO QUIT
To: _____________________________________________________________________
All residents (tenants and subtenants) in possession and all other in possession
The premises herein referred to is located in the City of __________________________,
County of __________________ State of ____________________, Zip Code __________
designated by the number and street as ________________________________________
Apt.______.
In accordance with your lease agreement signed on the _____ day of
____________________, 20_____ and the laws in the State of _____________________
WITHIN FIVE (5) DAYS after service on you of this notice, you are hereby required to
(Check Appropriate Box)
-----------------------------------------------------------------☐ - Pay to the undersigned or __________________________ an authorized agent, the
rent of the premises hereinafter described, of which you now hold possession amounting
to the sum of: ______________________________ Dollars ($______________________)
enumerated as follows:
$________________ Due from ______________, 20____ To ______________, 20____
or quit and deliver up the possession of the premises.
☐ - Remedy the violation described as
_________________________________________ as it is in non-compliance with your
lease agreement. You shall notify the landlord within the notice period that the violation
has been cured or quit and deliver the possession of the premises.
☐ - Quit and deliver possession of the premises due to an illegal act committed on the
premises. The illegal activity is described as ____________________________________
and therefore your tenancy has been terminated.
YOU ARE FURTHER NOTIFIED THAT, the owner/landlord does hereby elect to declare
that forfeiture of your lease or rental agreement under which you hold possession of the
above described premises and if you fail to perform or otherwise comply, will institute legal
proceedings to recover rent and possession of said premises which would result in a
judgment against you including costs and necessary disbursements together with possible
statutory damages as allowed by law for such unlawful detention.

Landlord/Agent Signature ___________________________

CERTIFICATE OF SERVICE
I certify that on the _____ day of ____________________, 20_____ I served this notice on
__________________________ by
☐ - delivering it personally to the person in possession.
☐ - delivering it on the premises to a member of his/her family or household or an
employee of suitable age and discretion with a request that it be delivered to the person in
possession.
☐ - first-class mail addressed to the person in possession.
Signature ___________________________