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| Name Yes / No and Name |
| Street address |
| City , State ZIP Code |
YOU ARE HEREBY NOTIFIED that under the lease agreement dated Date under which you hold possession of the premises located at Street address , City , VT, ZIP Code , there is now due and unpaid rent in the total amount of $ Amount , representing rent due as follows: 1 / 2 / 3
YOU ARE FURTHER NOTIFIED that in accordance with 9 V.S.A § 4467(a), within FOURTEEN (14) days after service of this notice on you, you must pay the above-listed amount in full or leave the premises described above. If you do neither of these, Name will institute legal proceedings against you to recover possession of the premises, to declare the lease agreement forfeited, and to recover rent and damages (which may include treble damages as allowed by law).
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 FOURTEEN-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 VERMONT 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
1. At the time of service, I, the undersigned, was at least 18 years of age.
2. I served copies of the fourteen-day notice to pay rent or quit.
3. I served copies of the fourteen-day notice to pay rent or quit to the following tenant:
| _________________________________________________ (Name) |
4. The fourteen-day notice to pay rent or quit was served at:
| __________________________________________________________________ (Full Address) |
5. I served the tenant by:
| in item 3 on _____________________________ at _______________ am pm (Date) (Time) |
| (1) After attempting personal service, I left a copy of the fourteen-day notice to pay rent or quit | |||||||
| with or in the presence of a person of suitable age and discretion: | |||||||
_________________________________________________________________________ (Insert name of person you left the notice with who is at least 18 years old, or give description (age, sex, height, weight, etc.) if person refuses to give name) |
|||||||
| (2) on _____________________________ at _______________ am pm (Date) (Time) |
|||||||
| (3) I thereafter mailed (by first-class, postage prepaid) a second copy of the fourteen-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) After attempting service, I affixed/posted a copy of the fourteen-day notice to pay rent or | |||||||
| quit in a conspicuous place at the address listed in item 4 | |||||||
| on _____________________________ at _______________ am pm (Date) (Time) |
|||||||
| (2) I thereafter mailed (by first-class, postage prepaid) a second copy of the fourteen-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) |
| I declare under penalty of perjury that the foregoing is true and correct. | |
| Signed on ______________________________________, at __________________________, Vermont (Date) (Location) |
|
| _________________________________________ ______________________________________ Print name of person who served notice Signature of person who served notice |