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| Name Yes / No and Name | |
| Street address | |
| City , State ZIP Code |
YOU ARE HEREBY NOTIFIED that you are indebted to me in the sum of $ Amount for the rent and use of the premises at Street address , City , County County, Florida, ZIP Code , now occupied by you. I hereby demand payment of the rent or possession of the premises within THREE (3) days (excluding Saturday, Sunday, and legal holidays) from the date of delivery of this notice, to wit: on or before Date at my address listed below.
If you vacate the premises or are evicted, I will retake possession of the premises under Fla. Stat. § 83.595. In addition to unpaid rent, late fees, and damages to the premises, you will be liable for the future rent and late fees until your lease expires, less any rent I receive from rerenting the premises. If a lawsuit is filed, you may be liable for my attorney's fees and costs.
| ________________________ Date |
_______________________________________ Name |
| Street address | |
| City , State , ZIP Code | |
| Phone | |
I HEREBY CERTIFY that a true copy of this notice was furnished by:
| ( ) U.S. mail | |
| ( ) Personal delivery to resident(s) | |
| ( ) Posting in a conspicuous place on the premises in the absence of the resident(s) | |
Delivered by: _______________________________ Date: _______________ Time: ____________