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| Name Yes / No and Name |
| Street address |
| City , State ZIP Code |
YOU ARE HEREBY NOTIFIED that there is now due the undersigned landlord the sum of $ Amount Yes / No plus $ Amount in late fees , being rent for the premises located in the city of City , and county of County , Illinois, and described as:
The late rental amounts are as follows:1 / 2 / 3
YOU ARE FURTHER NOTIFIED that payment of $ Amount is now DEMANDED of you, in accordance with 735 Ill. Comp. Stat. § 5/9-209, and that unless the entire payment is made within FIVE (5) days after service of this notice on you, your rental agreement will terminate immediately.
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.
The following forms of payment will be accepted [check all that apply]:
| _____ Cash | _____ Cashier's check | _____ Certified check |
| _____ Money order | _____ Personal check | _____ Electronic funds deposit |
You may make payments in the following ways: Yes / No
The FIVE-DAY notice period expires at: Hour :minute am / pm a.m. on Date .
THE LANDLORD RESERVES ALL RIGHTS AND REMEDIES PROVIDED UNDER THE LEASE AGREEMENT AND UNDER APPLICABLE LAWS OF ILLINOIS, INCLUDING DAMAGES FOR UNPAID RENT, AND NOTHING IN THIS NOTICE MAY BE CONSTRUED AS A WAIVER OF THOSE RIGHTS AND REMEDIES.
| ________________________ | _______________________________________ |
| Date | Landlord Name |
PAGE BREAK HERE
PROOF OF SERVICE
| ________________________________________________being duly sworn, on oath deposes and says: Name of person serving notice |
| 1. I served copies of the five-day notice to pay rent or quit. |
| 2. I served copies of the five-day notice to pay rent or quit to the following tenant: |
| _________________________________________________________ (Name) |
| 3. The five-day notice to pay rent or quit was served at: |
| _________________________________________________________ (Full Address) |
| 4. I served the tenant by: |
| on _____________________________ at _______________ am pm (Date) (Time) |
| (1) After attempting personal service, I left a copy of the five-day notice to pay rent or quit with or | ||||
| in the presence of a person above the age of thirteen years, residing on or in charge of the premises | ||||
| described in item 3: | ||||
____________________________________________________________________________ (Insert name of person you left the notice with who is at least 13 years old, or give description (age, sex, height, weight, etc.). if person refuses to give name) |
||||
| (2) on _____________________________ at _______________ am pm (Date) (Time) |
||||
| (1) After attempting service, I affixed/posted a copy of the five-day notice to pay rent or quit in a | ||||
| conspicuous place at the address listed in item 4, there being no one in actual possession of the | ||||
| residence | ||||
| on _____________________________ at _______________ am pm (Date) (Time) |
||||
| (2) I thereafter mailed (by first-class, postage prepaid) a second copy of the five-day notice to pay | ||||
| rent or quit to the person listed in item 3 to the address listed in item 4 | ||||
| on _____________________________ at _______________ am pm (Date) (Time) |
| (1) I mailed (by first-class, postage prepaid) a copy of the five -day notice to pay rent or quit to the | ||||
| person listed in item 3 to the address listed in item 4, with a returned receipt from the addressee | ||||
| on _____________________________ at _______________ am pm (Date) (Time) |
| Subscribed to and sworn before me this | ) | |
| ) | ||
| __________ day of _______________, 20_______ | ) | |
| ) | ||
| __________________________________________ Signature and Seal of Notary Public |
) | _______________________________________ Signature of person who served notice |