[[City], [State], ]
Pursuant to the provisions of RSA 540:2, you are hereby given an eviction notice and notice to vacate, on or before , 20 , the premises and appurtenances owned by of the City of , in the County of , New Hampshire, which premises are now occupied by you.
The reason for this eviction notice is:
Your failure to pay rent due and in arrears when demanded pursuant to RSA 540:2 II (a). A demand to pay rent was served upon you on, 20 and you have refused and neglected to pay rent due for the period, 20, to , 20 .
You are hereby notified of your right to avoid this eviction by payment, prior to the expiration of this notice of all the arrearages plus fifteen dollars ($15.00) as liquidated damages, in accordance with RSA 540:9, provided however that you may not defeat an eviction for non-payment of rent by paying the arrearages plus $15.00 after an Eviction Notice is given more than three (3) times in a twelvemonth period.
Substantial damage done to the premises pursuant to RSA 540:2 II (b) as follows:
Your failure to comply with a material term of the lease pursuant to RSA 540:2 II (c) as follows:
Behavior by you or members of your family which adversely affects the health or safety of the other tenants or the landlord pursuant to RSA 540:2 II (d), or your failure to accept suitable temporary relocation due to lead-based paint hazard abatement, as set forth in RSA 130-A:8-a, I, as follows:
For other good cause pursuant to RSA 540:2 II (e), RSA 540:2 III, RSA 540:2 IV, or RSA 540:2 V as follows:
Dated: , 20
(City, State, Zip Code)
I hereby certify that on the day of , 20, at am/pm I gave in hand to/left at the abode of , above named, a true copy of the above original notice.
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