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 a copy with someone of “suitable”
age and discretion at the rental unit 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 posted a copy of the Notice at the
rental unit in a conspicuous place AND mailed copy to the tenant AND left a copy with
someone of “suitable” age and discretion at the rental unit (if available).
Date: __________________________
Signature of person attempting service:
___________________________________________________________________
Printed Name:
___________________________________________________________________
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