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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 Yes / No Tenant Street Street address , Tenant City City , New York Tenant Zip ZIP Code , there is now due and unpaid rent in the total amount of $ Amount , representing rent due as follows: 1 / 2 / 3
| $ Amount owed from Date to Date . $ Amount owed from Date to Date . $ Amount owed from Date to Date . |
YOU ARE FURTHER NOTIFIED that in accordance with N.Y. RAPL § 711(2), 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, 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 NEW YORK LAW, INCLUDING DAMAGES FOR UNPAID RENT, AND NOTHING IN THIS NOTICE MAY BE CONSTRUED AS A WAIVER OF THOSE RIGHTS AND REMEDIES.
| ________________________ | _______________________________________ |
| Date | Landlord Name |
PAGE BREAK HERE
AFFIDAVIT OF SERVICE
| State of New York ) |
County of ______________________) |
| The undersigned being duly sworn, deposes and says: |
| (1) __________________________is not a party to the action, is over 18 years of age, and resides name of person serving notice |
| at ___________________________________________________________________. full address of person serving notice |
| (2) On________________________________, deponent served the 3-day notice to pay rent or quit on date of service |
| __________________________________________________ name of person served |
| at ____________________________________________________________________ complete address where other party/corporation served |
Select method of service:
[ ] PERSONAL SERVICE: by delivering a true copy of the 3-day notice to pay rent or quit personally; deponent knew said person/corporation so served to be the person/corporation described.
[ ] SERVICE BY MAIL: by depositing a true copy of the 3-day notice to pay rent or quit in a postage-prepaid, properly addressed envelope at a post office or official depository under the exclusive care and custody of the United States Postal Service.
| ____________________________________ Signature of person serving papers |
_______________________________ Printed name |
||
| Sworn to before me this ________________________ | |||
| day of ________________________________________ | |||
| _____________________________________________ Notary Public |