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. Believing tenant(s) to be absent, I posted the Notice on the inside of the
rental unit’s main entry door.
OR
I attempted to make personal service on the tenant(s) named above but no one
appeared. Believing tenant(s) to be absent, I left a copy of the notice with someone over
the age of 16 at the rental unit.
OR
I mailed a copy of the notice to the tenant via certified, registered, or regular mail.
OR
Believing it unsafe to enter the rental unit, I posted the notice on the outside of the
main entry door in a sealed envelope.
Date: __________________________
Signature of person attempting service:
___________________________________________________________________
Printed Name:
___________________________________________________________________
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