NHJB-3040-D (07/24/2018) Page 1 of 1
DEMAND FOR RENT
TO:
Tenant Name
Street Address
City, State, Zip Code
You have failed to make rent payments for the rent period of:
for property you currently occupy located at:
Street Address Apartment #
in New Hampshire.
Town/City
You now owe $ in back rent. As required by New Hampshire law (RSA 540), I
demand that you pay the full amount owed. Failure to make this payment may result in your eviction.
NOTICE: You may apply for rental assistance at your town/city welfare office if you are a qualified
residential tenant. However, all rental arrearages plus $15.00 must be paid in full by the expiration
date set forth on the Eviction Notice.
Landlord/Agent Name
Street Address
City, State, Zip Code
Date Signature
I certify that on , at am pm,
I gave in hand to left at the last and usual place of abode of
, above named, a true copy of
the above original notice.
Date Signature
