NHJB-3040-D (07/24/2018) Page 1 of 1 DEMAND FOR RENT TO: Tenant Name Street Address City, State, Zip Code You have failed to make rent payments for the rent period of: for property you currently occupy located at: Street Address Apartment # in New Hampshire. Town/City You now owe $ in back rent. As required by New Hampshire law (RSA 540), I demand that you pay the full amount owed. Failure to make this payment may result in your eviction. NOTICE: You may apply for rental assistance at your town/city welfare office if you are a qualified residential tenant. However, all rental arrearages plus $15.00 must be paid in full by the expiration date set forth on the Eviction Notice. Landlord/Agent Name Street Address City, State, Zip Code Date Signature I certify that on , at am pm, I gave in hand to left at the last and usual place of abode of , above named, a true copy of the above original notice. Date Signature American LegalNet, Inc. www.FormsWorkFlow.com