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| Please discard this page before providing the notice to your tenant. |
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| WISCONSIN 5 -DAY NOTICE TO PAY RENT OR QUIT |
| 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 , Wisconsin, ZIP code , One year or less / Year-to-year / More than one year 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 Wis. Stat. Ann. §704.17(1), within FIVE (5) 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, the rental agreement will terminate and Name will institute legal proceedings against you to recover possession of the premises, rent, and damages.
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 |
The FIVE (5) -DAY NOTICE PERIOD expires at: Hour Hour :Minute am / pm a.m. on Date .
You may make payments in the following ways: Yes / No
THE LANDLORD RESERVES ALL RIGHTS AND REMEDIES PROVIDED UNDER THE LEASE AGREEMENT AND UNDER APPLICABLE WISCONSIN LAW, INCLUDING DAMAGES FOR UNPAID RENT, AND NOTHING IN THIS NOTICE MAY BE CONSTRUED AS A WAIVER OF THOSE RIGHTS AND REMEDIES.
| _______________________________________________ Landlord or Landlord's Agent Signature |
| _______________________________________________ Date |
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PROOF OF SERVICE
(choose all that apply)
[ ] a. Tenant acknowledges receipt of the 5 -day notice to pay rent or quit:
| _______________________________________ Date |
_______________________________________ Signature |
[ ] b. The 5 -day notice to pay rent or quit was personally served on
| __________________________________ Name |
by the undersigned on | ________________________________. Date |
[ ] c. The 5 -day notice to pay rent or quit was provided to ________________________, someone apparently in charge of, or living in, the premises, and was mailed by first class, registered or certified mail to the Tenant's last known address by the undersigned on ___________________________.
[ ] d. After attempting to serve the notice in the manner set forth in a and b above, the 5 -day notice to pay rent or quit was provided to _________________________, someone apparently in charge of, or living in, the premises, and was mailed by first class, registered or certified mail to the Tenant's last known address by the undersigned on __________________________.
[ ] e. Tenant was served by first-class registered or certified mail at Tenant's last known address.
| _______________________________________ Date |
_______________________________________ Signature |