Family Life Center
Notice of Past Due Rent
DATE:
/
Month
/
Day
Year
Date
To (tenant)
First Name
Last Name
From (Landlord/Property Mgr.)
First Name
Last Name
Rent in the amount of:
$ Dollars
was due on the
first, last, etc.
day of
type month
For the period of
insert month
For the period of
-
Month
-
Day
Year
Date
to
-
Month
-
Day
Year
Date
To the month of
insert month
Please Bring your payment to the address below by:
-
Month
-
Day
Year
Date
To avoid a late fee of:
$ Dollars
Landlord / Property Manager Name
First Name
Last Name
Address
Phone Number
Landlord Email
example@example.com
Date
/
Month
/
Day
Year
Date
Signature
Please select the island where you reside, and where you are requesting assistance.
*
Maui
Kauai
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