Pennsylvania Ten Day Notice To Pay Rent Or Quit

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Name Yes / No and Name , AND TO ALL PERSONS IN POSSESSION

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 , Pennsylvania, 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 68 Pa.C.S. §250.501, within TEN (10) 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, to declare the lease agreement forfeited, and to recover rent.

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

You may make payments in the following ways:
Yes / No

1. Yes / No
1. Yes / No
1. Yes / No
1.

The TEN-DAY notice period expires at: Hour :Minute am / pm a.m. on Date .

THE LANDLORD RESERVES ALL RIGHTS AND REMEDIES PROVIDED UNDER THE LEASE AGREEMENT AND UNDER APPLICABLE LAWS OF PENNSYLVANIA, INCLUDING DAMAGES FOR UNPAID RENT, AND NOTHING IN THIS NOTICE MAY BE CONSTRUED AS A WAIVER OF THOSE RIGHTS AND REMEDIES.


________________________	_______________________________________
Date	Landlord Name
	Street address
	City , State , ZIP Code
	Phone

PAGE BREAK HERE

DECLARATION OF SERVICE OF 10-DAY NOTICE TO VACATE

I, ______________________________________________________ declare:
(Name of person serving notice)

1. I am now, and at all times mentioned in this declaration was, a citizen of the United States, a resident of the state of Pennsylvania, and over the age of 18 years. I make this declaration based on my personal knowledge. I am competent to testify to the matters in this declaration.

2. I served copies of the ten-day notice to pay rent or quit to the following tenant:


	_________________________________________________________ (Name of Tenant)

3. The ten-day notice to pay rent or quit was served at:


	_________________________________________________________ (Full Address)

4. I served the tenant by:

a. [ ] PERSONAL SERVICE. I personally handed a copy of the ten-day notice to pay rent or quit to the person listed in item 2

on _____________________________ at _______________ [ ] am [ ] pm
(Date) (Time)

b. [ ] POSTING & MAILING.
- (1) After attempting service, I affixed/posted a copy of the three-day notice to pay rent or quit in a conspicuous place at the address listed in item 3

on _____________________________ at _______________ [ ] am [ ] pm
(Date) (Time)

- (2) I thereafter mailed (by first-class, postage prepaid) a second copy of the ten-day notice to pay rent or quit to the person listed in item 2 to the address listed in item 3

				on _____________________________ at _______________ [ ] am [ ] pm (Date) (Time)

I declare under penalty of perjury of the laws of the state of Pennsylvania that the foregoing is true and correct.

DATED this ______________ day of _________________, 20__________, at ____________________, Pennsylvania.

___________________________________, Declarant

____________________________________
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