STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT FIVE DAY DEMAND NOTICE FOR NON-PAYMENT OF RENT (G.L. 1956 § 34-18-35) Date of Mailing: Name: Address: City: State: Zip Code: You are now more than fifteen (15) days in arrears for some or all of the rent owed under your rental agreement. State law requires that you be sent this notice of arrearage. Unless you make payment of all rent in arrears within five (5) days of the date this notice was mailed to you, an eviction action may be instituted in court against you. You can prevent the eviction by paying all the rent owing within five (5) days of the mailing of this notice. If you believe you have legal reason for not paying this rent, you will be able to present that defense at the eviction hearing. The rent in arrears as of the above date is $_______________________. ________________________________________________ Signature Landlord/Owner ________________________________________________ Print Name Landlord/Owner ________________________________________________ Address Landlord/Owner I hereby certify that I placed in regular U.S. Mail, First Class postage prepaid, a copy of this notice addressed to the tenant on the ___________ day of ______________________________, 20_____. ________________________________________________ Signature Landlord/Owner DC-55 (revised November 2014) American LegalNet, Inc. www.FormsWorkFlow.com