Fillable EVICTION NOTICE Tenant Name Street Address City, State, (State of New Hampshire)

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EVICTION NOTICE Tenant Name Street Address City, State, (State of New Hampshire)

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NHJB-3041-D (11/01/2021) Page 1 of 3
EVICTION NOTICE
TO:
Tenant Name
Street Address
City, State, Zip Code
You currently rent property located at:
Street Address Apartment # Town/City
from your landlord:
of the City of , in New Hampshire. This notice is to inform you
of your landlord’s intent to evict you and to request that you vacate the premises, on or before
(known as the expiration date).
The reason for this eviction is:
(NOTE: All applicable reasons for eviction may be checked but the above listed expiration date must comply
with the notice requirements set forth in RSA 540:3 II; the time frame for eviction notices may vary depending
upon the reason for eviction.)
Your failure to pay the rent that was due and in arrears when you received the Demand for Rent
that was served on you on . You failed to pay rent due for the rent
period of . You now owe $ in back rent.
(7 day notice is required per RSA 540:3, II; BUT NOTE: if the reason for eviction is non-payment of
rent, the federal Coronavirus Aid, Relief and Economic Security (CARES) Act, Public Law 116-136,
may require additional notice to the tenant.)
YOU HAVE THE RIGHT TO AVOID EVICTION FOR FAILURE TO PAY RENT IF YOU ACT
QUICKLY. To avoid eviction, you must pay your landlord the following amounts before your hearing
in court:
All rent due or past due as of the day you make your payment;
$15 in liquidated damages;
Any other lawful charge(s) under your lease that you owe your landlord; and
If you pay after an eviction case (Landlord and Tenant Writ) is filed in court, you must also pay
the filing fee ($125) and any service costs, which are listed on the sheriff’s return of service.
You must act quickly to make the required payment because most hearings take place within
two to three weeks after an eviction notice is served on a tenant. You must make the payment
with cash, certified check, prepaid money order, electronic transfer, or other guaranteed or
immediately drawable funds. The delivery to your landlord of a written promise to pay the full amount
you owe from a state or local government, or an agency which administers federal funds, will also be
considered effective payment. You may only use this procedure to avoid eviction 3 times in any 12-
month period.
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.
Clear Form
EVICTION NOTICE:
(Tenant name)
NHJB-3041-D (11/01/2021) Page 2 of 3
Substantial damage done to the rental property as follows:
(RSA 540:2 II (b)) – (7 day notice is required)
Your failure to comply with a material term of the lease as follows:
(RSA 540:2 II (c)) – (30 day notice is required)
The following behavior by you or members of your family which adversely affects the health or
safety of the other tenants or the landlord:
(RSA 540:2 II (d)) – (7 day notice is required)
For the following other good cause:
(RSA 540:2 II (e), RSA 540:2 III, RSA 540:2 IV, or RSA 540:2 V) – (30 day notice is required)
For other statutorily authorized cause as follows:
(Identify specific reason and statutory authority – for example RSA 540:2, II(f) regarding lead exposure-hazard
abatements, or RSA 540:2 II(g) regarding preparing a unit for remediation of insects or rodents) – (30 day notice is
required.)
NOTE: This notice is not a court order requiring you to vacate the rental property. However, if you
remain on the premises after the expiration of this notice, your landlord may continue with New
Hampshire’s lawful eviction process: That process would result in you being served by a sheriff with
a summons called a Landlord and Tenant Writ. If served with a Landlord and Tenant Writ, you will
have the right to dispute the reason(s) for the eviction at a hearing before a judge. To do that, you
will have to file a document called an Appearance with the court where the eviction case is filed, no
later than the “return date” listed on the Writ.
Top of Page
EVICTION NOTICE:
(Tenant name)
NHJB-3041-D (11/01/2021) Page 3 of 3
Landlord Information and Certificate of Service
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
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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EVICTION NOTICE Tenant Name Street Address City, State, (State of New Hampshire)

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Completed 28 November 2021

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