HAWAII 5-DAY NOTICE TO PAY RENT OR QUIT THE PREMISES
TO (Tenant’s Name): FROM (Landlord’s Name):
Address: Address:
City, State, Zip: City, State, Zip:
Telephone: Telephone:
NOTICE IS HEREBY GIVEN that you are in default in payment of rent for the above-described premises. You are
required to pay to the landlord or agent all rent now due and delinquent OR surrender the premises at or
before the 5
th
day following service of this notice. FAILURE TO PAY OR QUIT may result in an eviction order
directing the constable to remove you from the premises.
Date tenancy commenced:
Date rent became DELINQUENT:
Amount of rent DUE and DELINQUENT:
THIS FORM HAS BEEN WRITTEN PURSUANT TO §521-68
_______________________________________________________________________________________________
DECLARATION OF SERVICE
On ______________________________, 20____, at ______________ (time) I served a copy of this Notice on
the above-named tenant(s) pursuant to §521-68 in the following manner:
☐ by delivering a copy to the tenant(s) personally, in the presence of a witness;
☐ by leaving a
copy with __________________________________________, a person of suitable age and discretion at
tenant(s)’s place of residence or place of business, and mailing a copy to the tenant(s) and obtaining proof of mailing.
☐ by posting a copy in a conspicuous place on the door of the leased property and mailing a copy to the tenant(s)
at the place where the leased property is situated and obtaining a proof of mailing.
PURSUANT TO §521-68, I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
HAWAII T
HAT THE NOTICE WAS PROVIDED ON THE DATE AND IN THE MANNER LISTED ABOVE.
Date: ___________________________
_________________________________ _____________________________
Signature of Witness Signature of Tenant
________________________________
Printed Name of Witness
________________________________
Signat
ure of Server
________________________________
Printed Name of Server
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