Tenant’s Acknowledgement
On ______________ (date) at _____________ (time), tenant acknowledged receipt of
this notice.
____________________________________________________________________
Tenant Signature and Date
Certificate of Service
I certify that I personally served this notice on the following person:
_____________________________________________________________________
OR
I attempted to make personal service on the tenant(s) named above but no one
appeared. I believed tenant(s) to be absent, so I left the Notice at the rental unit in a
conspicuous place AND gave a copy to a “suitable” person at the unit (if available) AND
mailed a copy to the tenant.
OR
I attempted to make personal service on the tenant(s) named above but no one
appeared. I believed tenant(s) to be absent, so I left a copy of the notice with someone
of “suitable” age and discretion at the rental unit AND mailed a copy to the tenant.
Date: __________________________
Signature of person attempting service:
___________________________________________________________________
Printed Name:
___________________________________________________________________
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