Fillable DEMAND FOR RENT Tenant Name Street Address City, (State of New Hampshire)

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DEMAND FOR RENT Tenant Name Street Address City, (State of New Hampshire)

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NHJB-3040-D (11/01/2021) Page 1 of 2
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. Additionally, tenants and landlords impacted by COVID-19 may be eligible for
financial assistance with rent and utility costs. Learn more and apply at CAPNH.org or call 2-1-1.
However, all rent due, plus fees, must be paid in full prior to any hearing on the merits in court about
this eviction.
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
Clear Form
Top of Page
NHJB-3040-D (11/01/2021) Page 2 of 2
FREE MEDIATION IS AVAILABLE FOR RESIDENTIAL LANDLORD AND TENANTS
Mediation is free: Landlord and tenant mediation is provided at no cost to the parties.
Mediation gives the parties control: A trained, neutral mediator helps the parties discuss their
issues and explore options to resolve their dispute. The parties can decide whether to participate in
mediation and whether to settle their case or not. They do not give up any rights by participating in
mediation.
Mediation is confidential: Anything that is discussed in mediation is confidential and cannot be
revealed outside of mediation, including in any eviction case that may be filed.
Mediation is convenient: Mediation takes place remotely, by video or telephone, at a time agreed to
by all the parties.
Mediation must be started before a case is filed, for most cases: For most court locations,
mediation is only available before a case is filed in court (i.e. before a Landlord and Tenant Writ is
issued). Post-filing mediation is only available in a few locations. If an eviction notice has been
served, parties must request mediation immediately.
To request mediation:
Call: 603-271-6418
Email: evictiondiversion@courts.state.nh.us
Important Notice: A request for mediation does not automatically pause a landlord and tenant
case. If you are served with a Landlord and Tenant Writ, you must file an Appearance with the court
which issued the Writ no later than the “return date” listed on the Writ. If you do not, the court may
evict you and/or order you to pay money to the landlord without hearing from you.
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DEMAND FOR RENT Tenant Name Street Address City, (State of New Hampshire)

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Completed 28 November 2021

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