Notice is hereby given that you are required, within thirty (30) days, to move from and deliver up possession of the above-referenced premises.
             This notice is intended for the purpose of terminating the Lease/Rental Agreement by which you now hold possession of the above-described premises, and should you fail to comply, legal proceedings will be instituted against you to recover possession, to declare said Rental Agreement forfeited, and to recover rents and damages for the period of unlawful detention.
             Please be advised that rent on said premises is due and payable up to and including the date of termination of your tenancy under this notice.
             } S.S. AFFIDAVIT OF SERVICE - When served by a
             ______________________________, being duly sworn, on oath deposes and says that on the _________day of (mo.) __________, (yr.) _________ he/she served the within notice on the tenant named therein, as follows:*
             ___ (1) by delivering a copy thereof to the within named tenant, ______________________.
             ___ (2) by delivering a copy thereof to ________________________, a person above the
             age of ten years, residing in or in charge of the within described premises.
             ___ (3) by sending a copy thereof to said tenant by** (certified, registered) mail, return
             ___ (4) by posting a copy thereof on the main door of the within described premises, no one
             being in actual possession thereof.
             * Check off all applicable paragraphs. ______________________________
             ** Strike out word not applicable. Signature of Notice Server
             Subscribed and sworn to before me this ______ day of (mo.) _______________, (yr.) ______
             ______________________________
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