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| Name Yes / No and Name |
| Street address |
| City , State ZIP Code |
YOU ARE HEREBY NOTIFIED that under the lease agreement dated Date under which you hold possession of the premises located at Street address , City , Arkansas, ZIP Code , there is now due and unpaid rent in the total amount of $ Amount , representing rent due as follows: 1 / 2 / 3
YOU ARE FURTHER NOTIFIED that Ark. Code Ann. §18-60-304, within THREE (3) days after service of this notice on you, you must pay the above-listed amount in full or leave the premises described above. If you do neither of these, the rental agreement will terminate and Name will institute legal proceedings against you to recover possession of the premises, rent, and damages.
The following forms of payment will be accepted [check all that apply]:
| _____ Cash | _____ Cashier's check | _____ Certified check |
| _____ Money order | _____ Personal check | _____ Electronic funds deposit |
The THREE-DAY NOTICE PERIOD expires at: Hour :Minute am / pm a.m. on Date .
You may make payments in the following ways: Yes / No
THE LANDLORD RESERVES ALL RIGHTS AND REMEDIES PROVIDED UNDER THE LEASE AGREEMENT AND UNDER APPLICABLE ARKANSAS LAW, INCLUDING DAMAGES FOR UNPAID RENT, AND NOTHING IN THIS NOTICE MAY BE CONSTRUED AS A WAIVER OF THOSE RIGHTS AND REMEDIES.
| _______________________________________________ Landlord or Landlord's Agent Signature |
| _______________________________________________ Date |
PAGE BREAK HERE
| PROOF OF SERVICE |
| (choose all that apply) |
[ ] Tenant acknowledges receipt of the 3-day notice to pay rent or quit:
| _______________________________________ Date |
_______________________________________ Signature |
[ ] The 3-day notice to pay rent or quit was personally served on
| __________________________________ Name |
by the undersigned on | ________________________________. Date |
[ ] Tenant was served by registered or certified mail.
| _______________________________________ Date |
_______________________________________ Signature |