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Landlord Demand for Unpaid Rent

Click here for completed sample. Bolded items are examples of completed fields from this form.
Tenant:
(Name of tenant who is delinquent.)
Tenant's Street Address:
Apt No.:
(Apartment number or letter, if applicable)
City:
State/Province:
(Select a U.S. state or Canadian province.)
Zip/Postal Code:
Country:
Select U.S.A. or Canada
Your Name:
Your Street Address:
City:
State/Province:
(Select a U.S. state or Canadian province.)
Zip/Postal Code:
Country:
Select U.S.A. or Canada
Lease Signed:
(Indicate the date the lease was signed)
Landlord on Lease:
(Indicate name of landlord on the lease, if different than your name.)
Amount of Time Late:
(Indicate how late the tenant's rent is - e.g., 30 days)
Amount of Rent: for
Violation:
(Indicate in clear language how the tenant has violated the lease. Press <ENTER> to start a new line.)
Remedy:
(Indicate in clear language what the tenant can do to remedy the breach. Press <ENTER > to start a new line.)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.