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 of the notice with someone
over the age of 12 residing at the rental unit.
OR
I attempted to make personal service on the tenant(s) named above but the tenant
did not appear. I believed tenant(s) to be absent, so I posted the in a conspicuous place
at the rental unit.
OR
I attempted to make personal service on the tenant(s) named above but the tenant
did not appear. I believed tenant(s) to be absent, so I mailed the notice to the tenant.
Date: __________________________
Signature of person attempting service:
___________________________________________________________________
Printed Name:
___________________________________________________________________
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