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ATTENTION HOUSING PROVIDERS!

HB 4401 allows for service of notice for non-payment of current moneys owing, but only under very specific circumstances. This form is provided for your convenience only.

YOU ARE STRONGLY ADVISED TO SEEK PROFESSIONAL LEGAL COUNSEL BEFORE TAKING ANY ACTION AGAINST YOUR RESIDENTS AT THIS TIME!!!

Form #4A : 10-DAY NOTICE TO PAY OR VACATE FOR NON-PAYMENT OF RENT

Required entries are indicated by blue icons or *

Tenant(s)* (required)

Tenant(s)

et al (and all others)

Property Address* (required)

Unit #

City (Oregon ONLY)

OREGON Zip Code

This is to inform you that your rent is now at least seven (7) days past due. This is your 10-day written notice to pay your past due rent or your rental agreement will be terminated as provided by Oregon Landlord/Tenant Law.

To Satisfy This Notice, You Must Pay At Least Your Past Due Rent Amount of:

0.00

This notice has been served personally to each individual named above.

This notice has been served by posting on the main entrance door of the dwelling unit and mailed First Class Mail:

This notice has been served by First Class Mail and the effective date is extended by four days, including date mailed:

Housing Choice/Section 8 Voucher Recipients: Notice is served by one of the methods above AND a copy mailed, emailed or faxed to the Public Housing Authority the same day.

If you are on a fixed-term lease, be advised your landlord has the option to terminate your tenancy at the end of your lease if you have received three or more notices for noncompliance (including non-payment of rent) within a 12-month period preceding the end of the fixed term. Owner/Agent may terminate the tenancy by issuing a 90-day notice prior to the lease end date, or 90 days prior to the date designated in the notice, whichever is later. Correcting the third or subsequent violation is not a defense to the termination.

This is your

1st, 2nd, 3rd

violation in the last 12 months.

Please Note: Signature field must be filled in and signed after printing.


Owner/Agent Signature:				Date:

MAKE PAYMENTS TO:

Owner/Agent

Address

City

State

Zip

Telephone

For Informational Purposes Only:

Late Fee per Written Rental/Lease Agreement:

Late Fee

Actual Damages (costs) incurred by Owner/Agent for permission and service of this notice:

Damages

Other Amounts Owed:

Other Owed

Total Amount Due (not including rent amount above):

Total Due

There may be additional charges due under your rental agreement for which you remain responsible. To avoid termination of your tenancy for non-payment of rent, you need only pay the Past Due Rent Amount listed above.

If you are a veteran of the armed forces, assistance may be available from a county veterans' service officer or community action agency. Call the 2-1-1 information service to learn about resources in your area.

Form #4A : 10-DAY NOTICE TO PAY OR VACATE FOR NON-PAYMENT OF RENT

Rev.1/21

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