Required entries are indicated
	by blue icons or *
	
		
			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.
		
	 
	 
	
 
 
 
	
		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 Nonpayment 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.
 
 
 
Please Note: Form must be
	signed and dated after printing.
	
		
			
				
					|  | 
				
					| Owner/Agent Signature: |  |  | Date: |  | 
			
		 
	 
 
	
		For Informational Purposes Only:
	 
	
	
	
	
	
	
	
	
	
		 There may be additional charges due under your Rental Agreement for which you remain
			responsible. To avoid Termination of your Tenancy for Nonpayment 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.
	 
 
 
The following Notice is required to be
	included with this form by the State of Oregon.
	NOTICE RE: EVICTION FOR NONPAYMENT OF RENT
	
	THIS IS AN IMPORTANT NOTICE OF WHERE TO GET HELP IF
YOU
		ARE FACING POTENTIAL EVICTION FOR NONPAYMENT
	
		
			- (Spanish) Este formulario está disponible en español en:
- (Russian) Бланк этого документа можно получить на русском языке в:
- (Vietnamese) Đơn này có bằng tiếng Việt tại:
- (Traditional Chinese) 本表格的繁体中文版在:
- (Korean) 한국어로 번역된 양식은 다음 웹 싸이트에서 찾을 수 있습니다:
 
    
	You must comply with deadlines identified in a notice of nonpayment or you risk losing your housing
	Rental assistance and support services may be available. Dial 2-1-1 or go to www.211info.org.
		Find a local service provider at https://www.oregon.gov/ohcs/housing-assistance/pages/emergency-rental-assistance.aspx
	
    If you have a child under 1 year old living with you and you have been approved for rent assistance through Medicaid, you may be able to delay the eviction. See
         https://www.courts.oregon.gov/forms/Pages/landlord-tenant.aspx for more information.
    
	Low-income tenants may be able to receive free or low-cost legal advice by contacting a legal aid organization.
		Go to https://oregonlawhelp.org/association-legal-aid-programs-oregon to find an office near you. The Oregon
		State Bar provides information about legal assistance programs at www.osbar.org/public