Form Made Fillable by
To: ____________________________________________________________________________________________,
Tenant(s) in possession of the premises at _____________________________________________________________,
(Street address)
City of _________________________________________, County of __________________________ , California.
Please take notice that the rent on these premises occupied by you, in the amount of $ __________________, for rent due for the
following period from __________________________to ___________________________, is now due and payable.
YOU ARE HEREBY REQUIRED to pay this amount within THREE (3) DAYS from the date of service of this notice on you, or to
vacate and surrender possession of the premises. Your failure to do so will result in legal proceedings being initiated against you to
recover possession of the premises, declare the forfeiture of the rental agreement or lease under which you occupy the premises, and
recover rents, damages, and costs of suit.
the undersigned, or
the following person: ________________________________________________________________________
AT THE FOLLOWING ADDRESS: ___________________________________________________________________
_________________________________________, California, phone: _______________________________________
In person. Usual days and hours for rent collection are: ____________________________________________
by mail to the person and address indicated above _________________________________________________
by deposit to account _________________________ at ______________________________, a financial institution located
within 5 miles of your rental, at ___________________________________, California
by electronic funds transfer procedure previously established.
Date: ____________________________ ___________________________________________________ _______
State law permits former tenants to reclaim abandoned personal property left at the former address of the tenant, subject to certain
conditions. You may or may not be able to reclaim property without incurring additional costs, depending on the cost of storing the
property and the length of time before it is reclaimed. In general, these costs will be lower the sooner you contact your former landlord
after being notified that the property belonging to you was left behind after you moved out.
Proof of Service
I __________________________________________________, the undersigned, being at least 18 years of age, served this notice, of
which this is a true copy, on _____________________________________, one of the occupants listed above as follows:
___ On __________________, _____, I delivered the notice to the occupant personally.
___ On __________________, _____, I delivered the notice to a person of suitable age and discretion at the occupant’s
residence/business after being attempted personal service at the occupant’s residence, and business, if known. On
__________________, _____, I mailed a second copy to the occupant at his or her own residence.
___ On __________________, _____, I posted the notice in a conspicuous place on the property, after having attempted personal
service at the occupant’s residence, and business, if known, and after having been unable to find there a person of suitable age and
discretion. On __________________, _____, I mailed a second copy to the occupant at the property.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date: ____________________________ _______________________________________________