Date form is filed

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(Date form is filed)


Re: Premises: (Tenant’s Address)

(No. of rooms) Rooms floor (floor No.) side (Apt. No.) apartment

at (Tenant’s address)

used for □ Business □ Dwelling purposes.


Tenant and, Undertenant

(Tenant’s Name & Address) (If applicable) John/Jane Doe

___________________________ _____________________________________

___________________________ _____________________________________

First name of Tenant and/or Undertenant being

fictitious and unknown to petitioner, person intended

being in possession of the premises herein described
or assigns, and every person in possession of the premises.
You are hereby notified that the Landlord elects to terminate your tenancy of the above described premises now held by you under monthly hiring. Unless you remove from the said premises on (* See explanation for date term expires), the day on which your term expires, the Landlord will commence summary proceedings under the Statute to remove you from said premises for the holding over after the expiration of your term and will demand the value of your use and occupancy of the premises during such holding over. (List the reason(s) for tenancy to be terminated).
If the following applies to your case, write what applies.

  1. These premises are not subject to Rent Control.

  2. These premises are not subject to Rent Stabilization.

  3. Tenant has no lease.

  4. Tenant has not paid use and occupancy (rent).

You may accept rent until the tenancy termination date. You may not accept rent after the tenancy termination date.

At least 30 days must elapse between completed service of this paper and the tenancy termination date. Tenancy termination must be the end of a rental period and at least 30 days from date of completed service.
Example: Tenant’s rent is due on 1st of each month and today is March 5, 1995 and appears will be completely served by March 7, 1995. the termination date would be April 30, 1995 (which is the last day of the rental period).
Tenant’s rent is due on the 1st of each month and today is January 23, 1995 and papers will be completely served on January 24, 1995. the termination date would be February 28, 1995 (which is the last day of the rental period).

Dated: (Date of notice)

(Owner’s Signature)


Print Owner’s Name

(Owner’s Address)



3 or 5 Day Notice for Non-Payment (check your lease)


Aviso al Inquilo
(Date notice is filled out)

To: Date:_______________

(Tenant’s Name & Address)

___________________________ The sum of la suma de $ (amount owed) ___________________________ for rent from para rent de (Date tenant began owing to

present). List sequentially amounts owed for each month.

Monthly Rent: $___________

Tenant of the above premises:
TAKE NOTICE That you are justly indebted to the Landlord of the above described premises as set forth above, which you are required to pay on or before the expiration of three days from the day of the service of this Notice, or surrender up the possession of said premises to the Landlord, in default of which the Landlord will commence summary proceedings under the State to recover the possession thereof.
TOME AVISO: Que usted adeuda al casero de la propiedad arriba mencionada segun lo arriba expuesto que usted ebe pagar en o antes del termino de tres dias a partir del dia que usted receiba este aviso o entregar posesion de dicho local al casero. En caso de incomplimiento el casero comensara un juicio sumario de acuerdo a la ley para recobrar su propiedad.
__________________________Landlord, Casero

Print Owners Name

­­__________________________Agent, Agente

Print Agent’s Name

Immediately if you are currently receiving Inmediatantente, si esta recibiendo asistencia publica al

bring this three-day notice for rent to the presente, traiga este aviso para pagar renta dentro de tres

worker who handles your case. Your dias al trabajador que maneja su caso. Su tranajador

worker will consider this notice on an considerara este aviso con character de emergncia posible,

emergency basis and may be able to mente podra proveerle fondos para evitar que usted pierda

provide funds to avoid the possible loss su apartamento.

of your apartment. Si no recibe asistencia publlica al presente y necesita ayuda

If you are not currently receiving public financiera, usted debe solicitarla inmediatamente en su

assistance and require financial help, centro local de mantenimiento de ingreso. Si nuestra este

you should apply immediately at your aviso a la receptionista usted posiblemente podra tener.

local Income Maintenance Center. If

you show this notice to the receptionist,

you may also be entitled to assistance

on an emergency basis.

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